कैंसर प्रतिरक्षण दिशानिर्देश: कीमोथेरेपी और हेमेटोपोएटिक स्टेम सेल ट्रांसप्लांट के बाद वैक्सीन की सिफारिशें

पृष्ठभूमि

Cancer (also known as malignancy) is a disease involving the uncontrolled growth of an abnormal group of cells. These abnormal cells can damage organs and blood vessels, spread to other areas of the body, and if left untreated can be fatal.

Cancers also impact an individual’s immune function, making them more vulnerable to infections. Additionally, treatment of cancers (e.g. chemotherapy, immunosuppressive therapies or haematopoietic stem cell transplants (HSCT)) can cause immune suppression, which may result in the loss of protection previously gained from past infections or vaccinations.

Recommendations

Vaccination is generally withheld during कैंसर treatment due to an inability to mount an effective immune response. However, despite anticipating a diminished response, मैंndividuएls are still encouraged to receive annual

और COVID

19 

(if indicated) throughout treatment due to the

risk of severe disease if infected.

Vaccines should be withheld in individuals with severe neutropenia (neutropenia refers to below normal levels of neutrophils/white blood cells; severe neutropenia is defined as an absolute neutrophil count of <0.5 x 109/L) due to the risk of febrile neutropenia, which is a medical emergency.

Timing

Following the completion of treatment, re‑vaccination (completion of a full primary course) or booster doses (top‑up doses) are recommended to optimise protection. The type of cancer treatment received, the age of the recipient, previous vaccine history, and any other co‑morbidities will inform the number of vaccine doses/schedule required.

Vaccines can be administered from 3 months after completion of treatment and when the underlying illness is in remission (in consultation with the treating oncologist). Live-attenuated vaccines may need to be delayed if there is ongoing immune suppression or in instances where blood products or immunoglobulins have been administered. Influenza vaccines should continue to be administered annually.

Table 1: Immunisation guideline for children (≤ 18 years) who completed chemotherapy with the last < 2 years

* Booster doses for children who received their primary course of vaccines before diagnosis/treatment. Children who did not previously receive a full primary course should follow a catch up schedule as per the ऑस्ट्रेलियाई टीकाकरण पुस्तिका.
^ Vaccination can commence > 3 months after completion of treatment and if underlying illness is in remission. Once vaccines are completed, children should continue to be vaccinated as per the राष्ट्रीय टीकाकरण कार्यक्रम (NIP).
# If the child is > 4 years of age but < 10 years of age, they must also complete a single dose of Infanrix‑IPV/Quadracel > 6 months later.
Ω  एdminister only once child is > 6 months of age. refer to MVEC: COVID

19 for age

appropriate brands. Additional doses may be considered for individuals with ongoing immunocompromise.
β There are recommended intervals between the administration of live

attenuated vaccines and blood products. Please refer to एमवीईसी: लाइव-एटेन्यूएटेड टीके और इम्युनोग्लोबुलिन या रक्त उत्पाद before administering for more information.
 shaded boxes indicate  रहना

attenuated vaccines, which should only be given on consultation with oncologist.

Table 2: Immunisation guideline for children (≤ 18 years) who received a HSCT within the last < 2 years

* Regardless of previous vaccine history, re‑vaccination with a full primary course is required for children post‑HSCT. Following this, the जापानी should be followed to ensure an individual is up to date with booster doses.
^ Vaccination can commence > 3 months after completion of treatment and if underlying illness is in remission. Once vaccines are completed, children should continue to be vaccinated as per the जापानी.
# Dose 3 Infanrix hexa completes the primary schedule. If the child is > 4 years of age but <10 years of age, they must also complete a single dose of Infanrix‑IPV/Quadracel > 6 months later.
Ω एdminister only once child is > 6 months of age. Refer to MVEC: COVID‑19 for age‑appropriate brands. Additional doses may be considered for individuals with ongoing immunocompromise.
β

here are recommended intervals between the administration of live‑attenuated vaccines and blood products. Please refer to MVEC: Live‑attenuated vaccines and immunoglobulins or blood‑products before administering for more information.
shaded boxes indicate live‑attenuated vaccines, which should only be given on consultation with oncologist.

Considerations

Whilst Infanrix hexa, वैक्सेलिस और Priorix tetra are not routinely administered to individuals aged 10 को 18 years, they are preferentially used by some immunisation specialists to reduce the number of injections required by children following cancer treatment. मैंndividual vaccines instead of combination vaccines may be used so long as all antigens are accounted for.

घरेलू संपर्क

Family members and other household contacts of individuals undergoing cancer treatments should ensure they are up to date with all recommended vaccines, particularly

, पर्टुसिस, और COVID-19.

संसाधन

• ऑस्ट्रेलियन इम्युनाइजेशन हैंडबुक: उन लोगों के लिए टीकाकरण जो प्रतिरक्षा में अक्षम हैं
• एमवीईसी: इन्फ्लुएंजा वैक्सीन सिफारिशें
• एमवीईसी: कोविड-19
• MVEC: Immunosuppression
• MVEC Administration of vaccines
• एमवीईसी: नीडल फोबिया
• एमवीईसी: लाइव-एटेन्यूएटेड टीके और इम्युनोग्लोबुलिन या रक्त उत्पाद
• VICS (Victorian Integrated Cancer Services): New cancer diagnosis pack for RCH patients