Blood cancer and immunizations for children and teens

The U.S. Centers for Disease Control and Prevention (CDC) recommends seasonal influenza (flu) shots for cancer patients and survivors and anyone who has contact with a cancer patient. Unless contraindicated by your child’s oncologist, LLS encourages blood cancer patients and survivors to get their flu shot every year. 

Talk to your child’s treatment team about what vaccines are recommended for your child. During cancer treatment, your child may need to delay getting certain vaccines. Some vaccines may need to be repeated or your child may need an additional booster.  

Siblings and other people in your home should continue to receive all their regularly scheduled vaccinations. However, tell the healthcare team if anyone will be receiving a live vaccine. Vaccines that contain a live virus include MMR (measles, mumps, and rubella), varicella (chicken pox), and the flu nasal spray. Ask what precautions you should take to protect your child with cancer. 

Flu shot 

An annual flu shot is recommended for all children older than 6 months, even children receiving cancer treatment. Your child should receive the flu shot, which is made from the dead virus. Your child must not be given the nasal spray vaccine because the spray contains the live flu virus.  

The live virus can be dangerous for immunosuppressed patients. Everyone in your home and people who spend time with your child should also receive the flu shot, not the nasal spray vaccine. By protecting everyone in your home from the flu, you further protect your child who has cancer. Ask the healthcare team what precautions you should take if someone in the home does receive a live vaccine or will not get the flu shot.  

Flu shots and stem cell transplant patients 

The CDC and the American Society for Blood & Marrow Transplantation (ASBMT) recommend flu shots for all bone marrow, stem cell, and cord blood transplant survivors beginning one year post-transplant and continuing every year thereafter. Although most transplant centers follow the current CDC guidelines regarding flu shots, some recommend flu shots even earlier than one year after the transplant. 

For more information about the flu and special considerations for people who have cancer, visit the CDC's Cancer and Flu page. 

Flu prevention tips 

Take the following precautions to help prevent the flu both for your child and the people around them: 

• Contact your primary care doctor and oncologist to see if an antiviral drug is recommended for your child
• Avoid contact with people who have the flu, which is spread mainly by person-to-person contact. The CDC recommends that people who are coughing and sneezing stay home from work or school and limit contact with others to keep from infecting them.
• Follow general public health advice about avoiding crowds
• Remind your child to cover their nose and mouth with a tissue when they cough or sneeze. Throw the tissue away right after use.
• Remind your child to wash their hands often with soap and water, especially after they cough or sneeze. If they don't have access to soap and water, use alcohol-based hand cleaners.
• Your child can reduce the spread of germs by avoiding touching their eyes, nose, or mouth
• As a precaution, store a supply of food, medicines, alcohol-based hand rubs, and other essential supplies  

Immunizations and allogeneic stem cell transplant patients 

Children treated with an allogeneic stem cell transplant, which uses stem cells from a healthy donor, will need to be revaccinated, even if the child received the vaccines in the past. Children who did not receive an allogeneic stem cell transplant may not need to repeat all of the vaccines that they received in the past, but they may need new vaccines or boosters to complete the recommended vaccination schedule for their age-group. 

Antibody titer test 

After completing cancer treatment, your child’s healthcare team may order an antibody titer test for your child. This test checks for the presence of antibodies in the blood. Antibodies are proteins that help the body fight against infection. The presence of specific antibodies in the blood can show whether or not your child has immunity to a certain disease. The results of the antibody titer test help the healthcare team to determine which vaccines or boosters your child needs. 

The healthcare team will create a catch-up schedule for your child to receive the necessary vaccines. Depending on the treatment, some children can begin vaccinations 3 to 6 months after treatment ends. A child who has received a stem cell transplant may need to wait longer. The healthcare team that administered the stem cell transplant should be consulted to create an appropriate vaccination schedule for your child. 

COVID-19 vaccine 

Talk to your child’s healthcare team about the COVID-19 vaccine. Children who have a weakened immune system are more likely to have complications due to COVID-19. Everyone in your home and people who spend time with your child should receive the COVID-19 vaccine. By protecting everyone in your home from COVID-19, you further protect your child who has cancer.  

Other immunizations 

Your child’s immunization schedule depends on several factors, including the treatment they're receiving and whether they're in remission. For example, people with blood cancer who are undergoing chemotherapy or radiation therapy should avoid getting live vaccines.