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  In this article
 »  Abstract
 »  Introduction
 »  Influenza Vaccin...
 »  Pneumococcal Vac...
 »  Meningococcal Va...
 »  Haemophilus i...
 »  Rabies Vaccination
 »  Conclusion
 »  References
 »  Article Tables

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Year : 2010  |  Volume : 47  |  Issue : 3  |  Page : 339-343

Important vaccines used as tools for tertiary prevention in oncology patients

Wiwanitkit House, Bangkhae, Bangkok - 10160, Thailand

Date of Web Publication28-Jun-2010

Correspondence Address:
V Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok - 10160
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.64716

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 » Abstract 

For the prevention of many diseases, vaccination is considered to be a good method. At present, a number of vaccines are available. The concept of vaccination for oncology patients as a tertiary prevention protocol was introduced recently. A literature review on this topic was performed. For reviewing, the author used the electronic search for the keyword "vaccine" and "cancer" on PubMed for inclusion of the previously published articles and further search of reference papers on vaccines as tools for tertiary prevention in oncology patients was done. In this article, the important vaccines for oncology patients are briefly discussed. There are many interesting vaccinations that are useful for tertiary prevention in oncology patients.

Keywords: Cancer, tertiary prevention, vaccination

How to cite this article:
Wiwanitkit V. Important vaccines used as tools for tertiary prevention in oncology patients. Indian J Cancer 2010;47:339-43

How to cite this URL:
Wiwanitkit V. Important vaccines used as tools for tertiary prevention in oncology patients. Indian J Cancer [serial online] 2010 [cited 2022 Jul 4];47:339-43. Available from:

 » Introduction Top

Several infectious diseases are part of public health problems today. People of all age groups have a chance of getting an infection. At present, the concept "prevention is better than cure" can be applied for the management of infectious diseases. There are many methods for the control of infectious diseases; however, an effective means is vaccination. There are many vaccines available at present and these vaccines can be good preventive tools for infectious diseases.

The principle of vaccination is active immunization. The basic concept of vaccination for oncology patients is similar to that for healthy subjects. However, there are some specific concerns for the oncology patients. [1] The topics on immunologic response and adverse immunologic-induced side effects are widely discussed elsewhere. [2],[3] However, the clinical usefulness of vaccination as a tertiary prevention in oncology patients is still accepted. [1] Any vaccine can be given to the oncology patient if there is an indication and no contraindication. Nevertheless, there are some vaccines that are specifically recommended for the oncology patients. These vaccines are summarized and discussed in this specific article. For reviewing, the author used the electronic search for the keyword "vaccine" and "cancer" on PubMed for inclusion of the previously published works and further search for reference papers on vaccines as tools for tertiary prevention in oncology patients was done. Five important vaccinations, which are widely used for the prevention of serious and problematic infections among the oncology patients are detailed in this report.

 » Influenza Vaccination Top

Influenza is a viral infection of the respiratory tract. The clinical signs and symptoms of high fever with respiratory manifestations are common. In some serious cases, the lower respiratory tract involvement can be observed. Severe pneumonia could be present, which can lead to death. In oncology patients, infection by influenza could be a serious problem. It is proposed that the oncology patients might have increased risk of serious clinical outcomes if they are afflicted with influenza. [4]

The influenza vaccination [3] is recommended for oncology patients. The first recommendation was made by a gynecologist. This was for the tertiary prevention in a patient with uterine cancer. [5] It is proven that patients getting vaccinated had a significant longer survival period. [6] However, the oncologists presently seem to neglect the usage of influenza vaccination. [7] There is an urgent need to increase the awareness of the benefits of influenza vaccine among the general oncologists. [8] Because influenza vaccination can reduce the infection rate and mortality due to influenza among oncology patients, it is suggested that all oncology patients should get this vaccine. [3]

Important trials on the efficacy and safety of influenza vaccination in oncology patients are summarized and listed in [Table 1]. [9],[10],[11],[12] There are many reports confirming the safety of influenza vaccination in oncology patients, either adult or infant. [13],[14] Although vaccine is administered to the oncology patients who undergo chemotherapy, its efficacy and safety need not be doubted. [15] In conclusion, the influenza vaccination is effective and safe for oncology patients. However, it should be noted that there have never been any reports on the oncology patients with severe immune impairment; hence, the vaccination cannot be guaranteed for its efficacy and safety in such cases. Hence, this vaccination is mainly recommended for oncology patients during the period they are free from immunosuppressive therapy. [3],[11] An annual intramuscular injection of influenza vaccine of the same dosage (0.5 mL) as is given to healthy individuals is recommended to be administered.

 » Pneumococcal Vaccination Top

Pneumococcal infection is an important bacterial infection. The main clinical manifestation of pneumococcal infection is respiratory presentation. The lung involvement is common and can lead to death. The risk population for this infection is the immunocompromised host, including the oncology patient. [16] Pneumococcal infection should be included in the differential diagnosis of fever of unknown origin in oncology patients. [17] Increased risk for development of severe infection and subsequent mortality is seen in oncology patients. [18]

The pneumococcal vaccination is recommended for the oncology patients. However, the rate of usage of pneumococcal vaccination among oncology patients is low. [7] Similar to the use of influenza vaccination, there is a concern on how to increase the awareness of the general oncologists in using pneumococcal vaccination as a tertiary prevention for their oncology patients. [7] Omlin et al noted that repeated assessments of the pneumococcal vaccination status in oncology patients could increase the rate of vaccination. [19] There are many reports confirming the safety and efficacy of using pneumococcal vaccination among the oncology patients. Use of pneumococcal vaccination is recommended in oncology patients at any period, as it is safe to use whether they are undergoing chemotherapy or not. [20],[21],[22] The main problem of this vaccination in oncology patients is the low immunogenicity. In a recent prospective, randomized trial of safety and immunogenicity, the response to pure polysaccharide pneumococcal vaccine was still low despite immune enhancement with multiple doses of granulocyte-macrophage-colony-stimulating factor. [22] This vaccination is still recommended because there is evidence that receiving the vaccine can significantly reduce the prevalence of disease among oncology patients. [23],[24] Nevertheless, there is a recent interesting report that priming with a conjugate vaccine might be a means to increase the immune response to pneumococcal vaccination for the oncology patients. [24],[25] The dosage of vaccination for the oncology patients is the same as that given to healthy individuals.

 » Meningococcal Vaccination Top

Meningococcal infection is another important bacterial infection. The main clinical manifestation of meningococcal infection is the neurologic presentation. The neurologic involvement is common and can lead to death. The risk population for this infection includes oncology patients. [26] The meningococcal vaccination is recommended for the oncology patients. [27] There are some reports confirming the safety and efficacy of using pneumococcal vaccination among oncology patients. [28]

This vaccine is proved to have a better immunogenicity property in oncology patients than the meningococcal vaccine. [23] In oncology patients undergoing chemotherapy, revaccination has to be recommended. Patel et al noted that "Revaccination of children after standard chemotherapy is important, and protection can be achieved in the majority of these children using a simple schedule of 1 vaccine dosage at six months after completion of leukemia therapy." [29] The dosage of vaccination for the oncology patients is the same as that given to healthy individuals.

 » Haemophilus influenzae Type B Vaccination Top

H. influenzae type B (HIB) is another important bacterial infection. This can induce both respiratory and neurologic manifestations. An increased risk of severe manifestation of HIB among the oncology patients is documented. Unlike the other vaccines, HIB vaccine is important for children. The pediatric patients with cancer should get HIB vaccine. [30] On the other hand, there is also a concern about the induction of leukemia in children who get HIB vaccine. [31] However, the safety and efficacy of using HIB vaccination among oncology patients are confirmed. [32],[33],[34] There is evidence that this vaccine has high immunogenicity. [23] Protective immune response to the HIB vaccine if administered within a year of initiation of chemotherapy is still favorable. [34] Loss of antibodies after the treatment of cancer is very low compared with other vaccines. [35] The dosage of vaccination for the oncology patients is the same as that given to healthy individuals..

 » Rabies Vaccination Top

Rabies is a serious neurologic infection. This occurs mainly due to bite by mammals. Most of the rabies cases occur in the tropical areas of the world and the animals that bring rabies to human beings are mainly dogs and cats. The treatment for rabies is usually the administration of postexposure vaccination. A basic rule is to administer the vaccine to those bitten by these animals and having a wound or bleeding. The vaccine can be given via either intramuscular or intradermal routes.

For sure, the oncology patients who live in the endemic area of rabies may be exposed to the risk of getting in contact and bitten by animals infected with rabies.[36],[37] In such cases, the use of postexposure rabies vaccination is recommended. The dosage of vaccination for the oncology patients is the same as that given to healthy individuals.. Since rabies vaccination is not a preexposure prophylaxis and mainly used in the tropical countries, there is limited evidence on this specific vaccination for oncology patients. However, there must be an additional administration of rabies immunoglobulin as passive immunization. [38],[39]

 » Conclusion Top

In addition to the general infections, oncology patients have a risk for some specific preventable infections. This article stresses an important point that oncology patients should be vaccinated with certain vaccines because of the importance of preventing certain diseases. An important concern is that all patients with cancer do not mount a good immune response to vaccination and so, the clinical response is doubtful. In this specific article, 5 important widely used vaccines are summarized to provide an "evidence for practice" [Table 2] and [Table 3]. It can be seen that oncology patients have a high risk for getting severe infections and vaccination seems to be quite useful.

 » References Top

1.Sagar SM, Lawenda BD. The role of integrative oncology in a tertiary prevention survivorship program. Prev Med 2009;49:93-8.  Back to cited text no. 1      
2.Graubner UB, Liese J, Belohradsky BH. Vaccination. Klin Padiatr 2001;213:A77-83.  Back to cited text no. 2      
3.Wiwanitkit V. Influenza vaccination for cancer patients: Tertiary prevention of mortality. Asian Pac J Cancer Prev 2009;10:717-8.  Back to cited text no. 3      
4.Takahashi M, Nagai M. [Estimation of excess mortality associated with influenza epidemics specific for sex, age and cause of death in Japan during 1987-2005]. Nippon Eiseigaku Zasshi 2008;63:5-19.   Back to cited text no. 4      
5.Sandherr M, Einsele H, Hebart H, Kahl C, Kern W, Kiehl M, et al. Antiviral prophylaxis in patients with haematological malignancies and solid tumours: Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO). Ann Oncol 2006;17:1051-9.  Back to cited text no. 5      
6.McBean AM, Yu X, Virnig BA. The use of preventive health services among elderly uterine cancer survivors. Am J Obstet Gynecol 2008;198:86.e1-8.  Back to cited text no. 6      
7.Lai H, Aronow WS, Gutwein AH. Prevalence of influenza vaccination and pneumococcal vaccination in elderly and high-risk patients seen in a university general medicine clinic. Am J Ther 2008;15:528-30.  Back to cited text no. 7      
8.Ring A, Marx G, Steer C, Prendiville J, Ellis P. Poor uptake of influenza vaccinations in patients receiving cytotoxic chemotherapy. Int J Clin Pract 2003;57:542-3.  Back to cited text no. 8      
9.Safdar A, Rodriguez MA, Fayad LE, Rodriguez GH, Pro B, Wang M, et al. Dose-related safety and immunogenicity of baculovirus-expressed trivalent influenza vaccine: A double-blind, controlled trial in adult patients with non-Hodgkin B cell lymphoma. J Infect Dis 2006;194:1394-7.  Back to cited text no. 9      
10.Ramanathan RK, Potter DM, Belani CP, Jacobs SA, Gravenstein S, Lim F, et al. Randomized trial of influenza vaccine with granulocyte-macrophage colony-stimulating factor or placebo in cancer patients. J Clin Oncol 2002;20:4313-8.  Back to cited text no. 10      
11.Ortbals DW, Liebhaber H, Presant CA, Van Amburg AL 3rd, Lee JY. Influenza immunization of adult patients with malignant diseases. Ann Intern Med 1977;87:552-7.  Back to cited text no. 11      
12.Goossen GM, Kremer LC, van de Wetering MD. Influenza vaccination in children being treated with chemotherapy for cancer. Cochrane Database Syst Rev 2009;2:CD006484.  Back to cited text no. 12      
13.Hsieh YC, Lu MY, Kao CL, Chiang BL, Lin DT, Lin KS, et al. Response to influenza vaccine in children with leukemia undergoing chemotherapy. J Formos Med Assoc 2002;101:700-4.  Back to cited text no. 13      
14.Esposito S, Cecinati V, Russo FG, Principi N. Influenza vaccination in children with cancer receiving chemotherapy. Hum Vaccin 2009;5:430-2.  Back to cited text no. 14      
15.Nordψy T, Aaberge IS, Husebekk A, Samdal HH, Steinert S, Melby H, et al. Cancer patients undergoing chemotherapy show adequate serological response to vaccinations against influenza virus and Streptococcus pneumoniae. Med Oncol 2002;19:71-8.  Back to cited text no. 15      
16.Flory JH, Joffe M, Fishman NO, Edelstein PH, Metlay JP. Socioeconomic risk factors for bacteraemic pneumococcal pneumonia in adults. Epidemiol Infect 2009;137:717-26.  Back to cited text no. 16      
17.Merad-Taoufik M, Antoun S, Ruffiι P. Fever and infectious complications in patient with lung cancer. Rev Pneumol Clin 2008;64:99-103.  Back to cited text no. 17      
18.Meisel R, Toschke AM, Heiligensetzer C, Dilloo D, Laws HJ, von Kries R. Increased risk for invasive pneumococcal diseases in children with acute lymphoblastic leukaemia. Br J Haematol 2007;137:457-60.   Back to cited text no. 18      
19.Omlin AG, Mόhlemann K, Fey MF, Pabst T. Pneumococcal vaccination in splenectomised cancer patients. Eur J Cancer 2005;41:1731-4.  Back to cited text no. 19      
20.Sinisalo M, Vilpo J, Itδlδ M, Vδkevδinen M, Taurio J, Aittoniemi J. Efficacy of pneumococcal vaccination on chronic lymphocytic leukemia: Should we rely on surrogate markers? Vaccine 2008;26:3959.  Back to cited text no. 20      
21.Lehne G, Hannisdal E, Langholm R, Nome O. A 10-year experience with splenectomy in patients with malignant non-Hodgkin's lymphoma at the Norwegian Radium Hospital. Cancer 1994;74:933-9.  Back to cited text no. 21      
22.Safdar A, Rodriguez GH, Rueda AM, Wierda WG, Ferrajoli A, Musher DM, et al. Multiple-dose granulocyte-macrophage-colony-stimulating factor plus 23-valent polysaccharide pneumococcal vaccine in patients with chronic lymphocytic leukemia: A prospective, randomized trial of safety and immunogenicity. Cancer 2008;113:383-7.  Back to cited text no. 22      
23.Melcher L. Recommendations for influenza and pneumococcal vaccinations in people receiving chemotherapy. Clin Oncol (R Coll Radiol) 2005;17:12-5.  Back to cited text no. 23      
24.Molrine DC, George S, Tarbell N, Mauch P, Diller L, Neuberg D, et al. Antibody responses to polysaccharide and polysaccharide-conjugate vaccines after treatment of Hodgkin disease. Ann Intern Med 1995;123:828-34.  Back to cited text no. 24      
25.Chan CY, Molrine DC, George S, Tarbell NJ, Mauch P, Diller L, et al. Pneumococcal conjugate vaccine primes for antibody responses to polysaccharide pneumococcal vaccine after treatment of Hodgkin's disease. J Infect Dis 1996;173:256-8.  Back to cited text no. 25      
26.Price VE, Dutta S, Blanchette VS, Butchart S, Kirby M, Langer JC, et al. The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: Practice considerations at the Hospital for Sick Children, Toronto. Pediatr Blood Cancer 2006;46:597-603.   Back to cited text no. 26      
27.Davies JM, Barnes R, Milligan D, British Committee for Standards in Haematology: Working Party of the Haematology/Oncology Task Force. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2002;2:440-3.  Back to cited text no. 27      
28.Yu JW, Borkowski A, Danzig L, Reiter S, Kavan P, Mazer BD. Immune response to conjugated meningococcal C vaccine in pediatric oncology patients. Pediatr Blood Cancer 2007;49:918-23.  Back to cited text no. 28      
29.Patel SR, Ortνn 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.  Back to cited text no. 29      
30.Ek T, Mellander L, Hahn-Zoric M, Abrahamsson J. Avidity of tetanus and HIB antibodies after childhood acute lymphoblastic leukaemia-implications for vaccination strategies. Acta Paediatr 2006;95:701-6.  Back to cited text no. 30      
31.Groves F, Sinha D, Auvinen A. Haemophilus influenzae type b vaccine formulation and risk of childhood leukaemia. Br J Cancer 2002;87:511-2.  Back to cited text no. 31      
32.Eigenberger K, Sillaber C, Greitbauer M, Herkner H, Wolf H, Graninger W, et al. Antibody responses to pneumococcal and hemophilus vaccinations in splenectomized patients with hematological malignancies or trauma. Wien Klin Wochenschr 2007;119:228-34.  Back to cited text no. 32      
33.Weinberg GA, Granoff DM. Immunogenicity of Haemophilus influenzae type b polysaccharide-protein conjugate vaccines in children with conditions associated with impaired antibody responses to type b polysaccharide vaccine. Pediatrics 1990;85:654-61.   Back to cited text no. 33      
34.Feldman S, Gigliotti F, Shenep JL, Roberson PK, Lott L. Risk of Haemophilus influenzae type b disease in children with cancer and response of immunocompromised leukemic children to a conjugate vaccine. J Infect Dis 1990;161:926-31.  Back to cited text no. 34      
35.van Tilburg CM, Sanders EA, Rovers MM, Wolfs TF, Bierings MB. Loss of antibodies and response to (re-)vaccination in children after treatment for acute lymphocytic leukemia: A systematic review. Leukemia 2006;20:1717-22.   Back to cited text no. 35      
36.Strady A, Lang J, Rotivel Y, Jaussaud R, Fritzell C, Tsiang H. Immunoprophylaxis of rabies: Current recommendations. Presse Med 1996;25:1023-7.  Back to cited text no. 36      
37.Burgmann H. Prevention and therapy of infections in tumor patients. Wien Med Wochenschr 2001;151:600-14.  Back to cited text no. 37      
38.Gibbons RV, Rupprecht CE. Postexposure rabies prophylaxis in immunosuppressed patients. JAMA 2001;285:1574-5.  Back to cited text no. 38      
39.Hay E, Derazon H, Bukish N, Scharf S, Rishpon S. Postexposure rabies prophylaxis in a patient with lymphoma. JAMA 2001;285:166-7.  Back to cited text no. 39      


  [Table 1], [Table 2], [Table 3]


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