Skip to main content

Advertisement

SpringerLink
Log in

Immunization of Children with Cancer in India Treated with Chemotherapy — Consensus Guideline from the Pediatric Hematology-Oncology Chapter and the Advisory Committee on Vaccination and Immunization Practices of the Indian Academy of Pediatrics

  • Recommendations
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Justification

Children with cancer need to be immunized against the common vaccine-preventable diseases after completion and sometimes during ongoing treatment of cancer. However, the immunization schedule for these children needs to be altered due to disease and treatment related immune-suppression. Consequently, there are many guidelines/practice statements from around the world to address this issue, however, there is no such comprehensive guideline from India catering to the need of Indian children with cancer.

Process

A guideline was drafted after reviewing the available literature. The draft guideline was discussed and modified in a meeting attended by pediatric oncologists from the PHO chapter and vaccine experts from the ACVIP of the IAP. Subsequently, the modified draft was reviewed and recommendations were finalized.

Objective

To review the current evidence and generate a nationally relevant guideline for immunization of children receiving chemotherapy for cancer.

Recommendations

Live vaccines are contraindicated during and up to 6 months after end of chemotherapy. Non-live vaccines are also best given after 6 months from the end of treatment for durable immunity. Annual inactivated influenza vaccine is the only vaccine recommended for all children during chemotherapy whereas hepatitis B vaccine is recommended only for previously unimmunised children with risk of transfusion associated transmission of infection. Post-treatment re-immunization/catch-up schedule largely depends on the pre-chemotherapy immunization status. Sibling immunization should continue uninterrupted except for oral polio vaccine which needs to be substituted by the injectable vaccine. Inactivated influenza vaccine is recommended and varicella vaccine is encouraged for all contacts including siblings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Craft AW. Childhood cancer — mainly curable so where next? Acta Paediatr. 2000;89:386–92.

    CAS  PubMed  Google Scholar 

  2. Arora RS, Prabha S, Moulik NR, Bagai P. A survey of immunization practices in children with cancer in India. Pediatr Hematol Oncol J. 2016;1:2–5.

    Article  Google Scholar 

  3. Chowdhury P, Vashishtha VM. Immunization in special situations: In: IAP Guidebook on immunization [2013-14] — By Advisory Committee on Vaccines and Immunization Practices [ACVIP], Indian Academy of Pediatrics. National Publishing House, Indian Academy of Pediatrics, Gwalior. 2014;365–84.

    Google Scholar 

  4. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58:309–18.

    Article  Google Scholar 

  5. Royal College of Paediatrics and Child Health [RCPCH]. Immunization of the immunocompromised child—Best practice statement. United Kingdom: RCPCH; 2002:10–3.

    Google Scholar 

  6. Patel SR, Chisholm JC, Heath PT. Vaccinations in children treated with standard-dose cancer therapy or hematopoietic stem cell transplantation. Pediatr Clin North Am. 2008;55:169–86.

    Article  Google Scholar 

  7. Patel SR, Ortín M, Cohen BJ, Borrow R, Irving D, Sheldon J, et al. Revaccination of children after completion of standard chemotherapy for acute leukemia. Clin Infect Dis. 2007;44:635–42.

    Article  CAS  Google Scholar 

  8. Cesaro S, Giacchino M, Fioredda F, Barone A, Battisti L, Bezzio S, et al. Guidelines on vaccinations in paediatric haematology and oncology patients. Biomed Res Int. 2014;2014:707691.

    Article  Google Scholar 

  9. Allen UD. Immunizations for children with cancer. Pediatr Blood Cancer. 2007;49:1102–8.

    Article  Google Scholar 

  10. The Australian Immunization handbook, 10th Edition. 2013: 148–57. Available from: http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/7B28E87511E08905CA257D4D001DB1F8/$File/Aus-Imm-Handbook.pdf. Accessed June 10, 2019

  11. Naqvi A, Fadoo Z, Alvi S. Vaccination guidelines for children with cancer and hematopoietic stem cell transplantation living in resource-poor countries. Pediatr Blood Cancer. 2010;54:3–7.

    Article  Google Scholar 

  12. Balasubramanian S, Shah A, Pemde HK, Chatterjee P, Shivananda S, Guduru VK, Soans S, Shastri D, Kumar R; IAP Advisory Committee on Vaccines and Immunization Practices, 2018–19. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018–19) and Update on Immunization for Children Aged 0 Through 18 Years. Indian Pediatr. 2018;55:1066–74.

    Article  CAS  Google Scholar 

  13. Martín Ibáñez I, Arce Casas A, Cruz Martínez O, Estella Aguado J, Martín Mateos MA. Humoral immunity in pediatric patients with acute lymphoblastic leukaemia. Allergol Immunopathol (Madr). 2003;31:303–10.

    Article  Google Scholar 

  14. Hersh EM, Whitecar JP, McCredie KB, Bodey GP Sr, Freireich EJ. Chemotherapy, immunocompetence, immunosuppression and prognosis in acute leukemia. N Engl J Med. 1971;285:1211–16.

    Article  CAS  Google Scholar 

  15. Fuks Z, Strober S, Bobrove AM, Sasazuki T, McMichael A, Kaplan HS. Long term effects of radiation of T and B lymphocytes in peripheral blood of patients with Hodgkin’s disease. J Clin Invest. 1976;58:803–14.

    Article  CAS  Google Scholar 

  16. Magrath IT, Simon RM. Immunosuppression in Burkitt’s lymphoma. II. Peripheral blood lymphocyte populations related to clinical status. Int J Cancer. 1976;18:399–408.

    Article  CAS  Google Scholar 

  17. Shetty AK, Winter MA. Immunization of children receiving immunosuppressive therapy for cancer or hematopoietic stem cell transplantation. Ochsner J. 2012;12:228–43.

    PubMed  PubMed Central  Google Scholar 

  18. Mackall CL. T-cell immunodeficiency following cytotoxic antineoplastic therapy: A review. Oncologist. 1999;4:370–8.

    CAS  PubMed  Google Scholar 

  19. Nilsson A, De Milito A, Engström P, Nordin M, Narita M, Grillner L, et al. Current chemotherapy protocols for childhood acute lymphoblastic leukemia induce loss of humoral immunity to viral vaccination antigens. Pediatrics. 2002;109:e91.

    Article  Google Scholar 

  20. Leung W, Neale G, Behm F, Iyengar R, Finkelstein D, Kastan MB, Pui CH. Deficient innate immunity, thymopoiesis, and gene expression response to radiation in survivors of childhood acute lymphoblastic leukemia. Cancer Epidemiol. 2010;34:303–8.

    Article  CAS  Google Scholar 

  21. Zignol M, Peracchi M, Tridello G, Pillon M, Fregonese F, D’Elia R. Assessment of humoral immunity to poliomyelitis, tetanus, hepatitis B, measles, rubella, and mumps in children after chemotherapy. Cancer. 2004;101:635–41.

    Article  Google Scholar 

  22. Stenvik M, Hovi L, Siimes MA, Roivainen M, Hovi T. Antipolio prophylaxis of immunocompromised children during a nationwide oral poliovaccine campaign. Pediatr Infect Dis J. 1987;6:1106–10.

    Article  CAS  Google Scholar 

  23. Katewa S, Sachdeva A. Vaccination in immuno-compromised children. In: IAP Textbook of Vaccines, 1st Edition, New Delhi Jaypee Brothers, New Delhi, 2014:507–15.

    Google Scholar 

  24. Ghosh N, Mannan MA, Monjur F, Rizwan F, Salim AF. Escalated regimen of hepatitis B vaccine in childhood hematological malignancies while on chemotherapy. Southeast Asian J Trop Med Public Health. 2010;41:555–61.

    PubMed  Google Scholar 

  25. Indian Academy of Pediatrics Committee on Immunization [IAPCOI]. Consensus recommendations on immunization and IAP immunization timetable 2012. Indian Pediatr. 2012;49:549–64.

    Article  Google Scholar 

  26. Verma R, Khanna P. Hepatitis A vaccine should receive priority in National Immunization Schedule in India. Hum Vaccin Immunother. 2012;8:1132–4.

    Article  CAS  Google Scholar 

  27. Palefsky JM, Gillison ML, Strickler HD. Chapter 16: HPV vaccines in immunocompromised women and men. Vaccine. 2006;24:S3/140-6.

    Article  Google Scholar 

  28. Succi RC, Farhat CK. Vaccination in special situations. J Pediatr [Rio J] 2006;82:S91–100.

    Article  Google Scholar 

  29. Zengin E, Sarper N. Humoral immunity to diphtheria, tetanus, measles, and hemophilus influenzae type b in children with acute lymphoblastic leukemia and response to re-vaccination. Pediatr Blood Cancer. 2009;53:967–72.

    Article  Google Scholar 

  30. Lee PI, Chen PY, Huang YC, Lee CY, Lu CY, Chang MH, et al. Recommendations for rotavirus vaccine. Pediatr Neonatol. 2013;54:355–9.

    Article  Google Scholar 

  31. Mavinkurve-Groothuis AM, van der Flier M, Stelma F, van Leer-Buter C, Preijers FW, Hoogerbrugge PM. Absolute lymphocyte count predicts the response to new influenza virus H1N1 vaccination in pediatric cancer patients. Clin Vaccine Immunol. 2013;20:118–21.

    Article  CAS  Google Scholar 

  32. Sung L, Heurter H, Zokvic KM, Ford-Jones EL, Weitzman SS, Freeman R, et al. Practical vaccination guidelines for children with cancer. Paediatr Child Health. 2001;6:379–83.

    Article  CAS  Google Scholar 

  33. Shahin K, Lina B, Billaud G, Pedone C, Faure-Conter C. Successful H1N1 influenza vaccination of children receiving chemotherapy for solid tumors. J Pediatr Hematol Oncol. 2012;34:e228–31.

    Article  CAS  Google Scholar 

  34. Bate J, Chisholm J, Heath PT, Breuer J, Skinner R, Manley S et al. PEPtalk: postexposure prophylaxis against varicella in children with cancer. Arch Dis Child. 2011;96:841–5.

    Article  Google Scholar 

  35. Shahmahmoodi S, Mamishi S, Aghamohammadi A, Aghazadeh N, Tabatabaie H, Gooya MM, et al. Vaccine-associated paralytic poliomyelitis in immunodeficient.

Download references

Funding

Funding: None

Author information

Authors and Affiliations

  1. Royal Marsden NHS Foundation Trust, Sutton, UK

    Nirmalya Roy Moulik

  2. Lady Hardinge Medical College, New Delhi, India

    Piali Mandal & Jagdish Chandra

  3. Sir HN Reliance Foundation Hospital And Research Centre, Mumbai, India

    Shweta Bansal

  4. D Y Patil Medical College, Pune, India

    Pramod Jog

  5. Aditya Superspeciality Hospital, Hyderabad, India

    S. Sanjay

  6. P D Hinduja Hospital, Mumbai, India

    Nitin Shah

  7. Max Super Speciality Hospital, Saket, New Delhi, India

    Ramandeep Singh Arora

Authors
  1. Nirmalya Roy Moulik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Piali Mandal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jagdish Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shweta Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pramod Jog
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Sanjay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nitin Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ramandeep Singh Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Contributors: RSA, NRM: conceptualised the guideline. NRM, JC, PM, RSA: a draft guideline was produced. The guideline was discussed in a meeting by nominated representatives of the PHO chapter (NS, SB) and the ACVIP (PJ, SS) of the IAP; NRM, RSA: following the meeting the guideline was modified and circulated amongst the authors (NRM, RSA, PM, JC, NS, SB, PJ and SS); NRM,RSA: The final modifications were made. All the authors approved the final manuscript.

Corresponding author

Correspondence to Nirmalya Roy Moulik.

Ethics declarations

Competing Interests: None stated.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moulik, N.R., Mandal, P., Chandra, J. et al. Immunization of Children with Cancer in India Treated with Chemotherapy — Consensus Guideline from the Pediatric Hematology-Oncology Chapter and the Advisory Committee on Vaccination and Immunization Practices of the Indian Academy of Pediatrics. Indian Pediatr 56, 1041–1048 (2019). https://doi.org/10.1007/s13312-019-1678-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-019-1678-0

Keywords

Search

Navigation