癌症免疫指南：化疗和造血干细胞移植后的疫苗推荐

背景

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.

建议

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

。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.

定时

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 澳大利亚免疫手册.
^ 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 国家免疫计划（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  Administer 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 MVEC：减毒活疫苗和免疫球蛋白或血液制品 before administering for more information.
 shaded boxes indicate  居住。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 掐 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 掐.
# 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 Administer 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, 瓦克斯利斯

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

家庭联系人

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

,

新冠肺炎.

资源

• 澳大利亚免疫手册：免疫功能低下者的疫苗接种
• MVEC：流感疫苗建议
• MVEC：COVID-19
• MVEC: Immunosuppression
• MVEC Administration of vaccines
• MVEC：针头恐惧症
• MVEC：减毒活疫苗和免疫球蛋白或血液制品
• VICS (Victorian Integrated Cancer Services): New cancer diagnosis pack for RCH patients