The duration and severity of immune dysfunction after the cessation of chemotherapy are not known. Preliminary studies suggest that immune recovery, both humoral and cellular, is slow and at variable rates depending on the underlying diagnosis and type of therapy Abnormalities in children with ALL and Hodgkin disease may be more pronounced and longer lasting than in children with solid tumors. Some recovery is evident in the majority of children 3-12 months from the end of therapy.
1. DTaP, OPV, MMR, H. influenzae type b, pneumococcal and
meningococcal vaccines, varicella, and HBV require
2. Killed vaccines (boosters) may be resumed 6-12 months
after the cessation of therapy and live virus vaccines at 1 year.
IMMUNIZATIONS OF SIBLINGS OF CHILDREN WITH CANCER
In general, siblings should continue to receive all their immunizations as per the guidelines of the American Academy of Pediatrics, with the exception of the live polio vaccine. IPV should be given in lieu of OPV at the designated times. If the sibling received only IPV in the primary series, a booster with OPV is recommended when the patient completes therapy and felt to be at minimal, if any, risk i.e. 1 year off therapy.
Varicella vaccine is recommended for siblings over the age of 12 months. Transmission of vaccine-type varicella from healthy children to immune-compromised siblings has not been documented. Additionally, transmission of the virus has been known to occur only when the vaccine causes a rash (incubation time 1 month), which occurs in less than 5% of immune-competent children. The vaccine type infection is spread not via respiratory secretions but by direct contact with skin lesions, and the transmission rate is less than one-fourth that of the wild-type vaccine.
To reduce exposure to their siblings with cancer, this population should be targeted for immunization with the influenza vaccine.