(Updated October 2016)
Flu vaccine information is everywhere you turn these days, from the supermarket to the news. Every year around this time, questions about flu vaccination start popping up in cancer clinics. Many people with cancer (and survivors) may be wondering how they can best prevent getting sick, and if they should be vaccinated against the flu. Here are the facts…
According to Neil Fishman, MD, associate professor of Infectious Diseases and director of Healthcare Epidemiology and Infection Control at The University of Pennsylvania, all immunosuppressed individuals should receive influenza vaccination (a single shot includes 3 or 4 strains, depending on the manufacturer). People currently undergoing treatment for cancer and those who are in remission should be vaccinated, as both of these groups are at higher risk for developing complications from influenza infection. These patients should receive only the injected vaccine, since the inhaled form** contains live viruses. It would be best to receive the vaccine when they are the least immunosuppressed in order to guarantee a maximal response. This means that they should not receive the vaccine during their nadir (the time when blood counts are at their lowest, typically 7-14 days after treatment). Talk with your healthcare team about the best time for you to get vaccinated.
In addition, the people you live with should also be vaccinated to lower their risk of getting the flu – and therefore the risk of them exposing you. In some cases they can receive the nasal (live) vaccine**, though if you are receiving active treatment, the shot is safest to decrease your risk of exposure.
Dr. Fishman also advises that people with cancer (particularly those on therapy or post-transplant) also get a pneumovax vaccine. This vaccine helps to prevent a common strain of bacteria that can cause pneumonia as well as other serious infections. The CDC recommends pneumovax for adults over 65, for smokers and for “people with certain health problems” – this includes health problems or treatments that weaken the immune system. People with cancer may require a second dose of pneumovax, given 5 years after the first. Patients should discuss their need for re-vaccination with their healthcare team.
Remember, while receiving cancer treatment, you are at an increased risk of getting infections, including colds and the flu, particularly when your blood counts are low. What precautions should you take as a patient receiving cancer therapy? Most importantly, wash your hands often- it is the easiest, most effective way to prevent the spread of infection. Keep hand sanitizer in your bag, desk, car or anywhere you may not be able to access a sink for handwashing. Avoid touching your eyes, nose and mouth- that is how germs get in. It is perfectly acceptable not to shake hands or to ask people who are sick (or have sick people in their household) not to visit you. Ask any visitors to wash their hands upon arrival and, whenever possible, avoid places with crowds of people, particularly when your blood counts are at their lowest. Have other members of your household get vaccinated as well; you don’t want them bringing these infections into your house where it will be harder to avoid.
Still, even the best handwashers get sick sometimes, so don’t blame yourself if you do. Get plenty of rest, drink plenty of fluids, and help to prevent the spread of the flu to others by staying home when you are sick.
You can learn a lot more about cancer and the flu through the CDC webpage on this topic.
Now roll up your sleeve – this won’t hurt a bit!
Also see Ask the Experts: Exposure to People After Vaccines.
**For the 2016-17 flu season, the nasal spray vaccine (Flumist) is NOT available.
Thank you, Carolyn, for discussing my question about the novel H1N1 2009 flu out loud, and providing effective and timely communication once again between those at Oncolink and cancer patients.
One more question… Where might the pneumonia vaccination fit into the picture for cancer patients this year?
I spoke with Dr. Fishman, who said it is important for people with cancer (particularly those on therapy or post transplant) to get pneumovax. For those who don’t know, pneumovax prevents the most common strains of bacteria that cause pneumonia. Dr. Fishman does advise that you not get all 3 shots at once (seasonal flu, H1N1 and pneumovax). Since H1N1 has not reached providers yet, you could start with the other two.
The CDC reccommends pneumovax for adults over 65, smokers and “people with certain health problems” – this includes health problems or treatments that weaken the immune system. People with cancer may require a second dose of pneumovax, given 5 years after the first. Patients should discuss their need for re-vaccination with their healthcare team (transplant patients may require additional doses).
What are the recommendations for H1N1 and Flu vaccinations for cancer patients in remission? Are there recommendations for individuals who live in the same household of patients in remission?
Hi Cindy
People in remission (and their household members) can follow the CDC recommendations for the general public, so long as there are no other health issues that put you in a high risk group (pregnancy, lung condition, etc). http://www.cdc.gov/
If you completed treatments in the last 6 months, you may want to discuss your risk with your oncology team, as your immune system may not have fully recovered yet and they may want you to get vaccinated.
In addition, people with hematologic malignancies (leukemia, lymphoma, myeloma) and those who have had bone marrow or stem cell transplants (autologous or allogeneic), can have prolonged suppression of their immune systems after treatment (lasting 1-2 years or longer) and should discuss their risk with their oncology team.
A great new resource from the CDC:
The CDC is excited to announce the debut of http://cdc.gov/cancer/flu/ a new resource targeted toward cancer patients and survivors. Living with cancer increases a person’s risk for complications from having the flu. To help prepare you, anyone you know with cancer, or anyone who has had cancer in the past, CDC’s Division of Cancer Prevention and Control is answering some important questions about seasonal and 2009 H1N1 flu.
Thank you for information, I understand the importance of getting vaccinated. This year it was particularily difficult to get regular flu vaccine (I’ve got a H1N1); it seems that all places ran out of it very quickly before I was able to get it. Would you recommend where i could be able to get a regular flu vaccine? is it too late to get for this present year?
Hi Inna- I would guess you will have a tough time finding it at this point, but the major flu season is over, so you can wait til next season. They usually come out in September or October, so keep your eye out or ask at any doctor’s appointments if they have gotten it yet. Many of the pharmacies and supermarket pharmacies also get them- so keep your eye out when you are getting the groceries!
take care
FYI- This year, the regular flu shot includes H1N1, so you do not need two separate shots.