The Flu Vaccine for People with Cancer

i-got-my-flu-shotFlu 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.

This blog is an update of a previous post on this topic.

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