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Carolyn Vachani, RN, MSN, AOCN
Flu vaccine information is everywhere you turn these days, from the supermarket to the news. Many people with cancer may be wondering how they can best prevent getting sick and if they should be vaccinated against the flu, both seasonal and H1N1 (often called Swine flu). Here’s the facts…
According to Neil Fishman, MD, associate professor of Infectious Disease and director of Healthcare Epidemiology and Infection Control at The University of Pennsylvania, all immunosuppressed individuals should receive the influenza vaccines (both seasonal and H1N1). This includes people receiving cancer treatment. These patients should only receive the injected vaccines and not the inhaled forms of the vaccines, which use a live virus. It would be best to time the vaccine to when they are the least immunosuppressed in order to guarantee maximal response. So, they should not receive the vaccine during their nadir (the time when blood counts are at their lowest, typically 7-14 days after treatment). Talk with your healthcare team about the best time for you to get vaccinated. You can receive both the seasonal flu and H1N1 vaccines at the same time.
Dr. Fishman stresses that the novel H1N1 influenza virus is not any more dangerous than seasonal influenza at this point. It is no more deadly, but we need to take the same precautions we take for seasonal influenza.
Remember, while receiving cancer treatment, you are at an increased risk of getting infections, including colds and flus, particularly when your blood counts are low. What precautions should you take as a patient receiving cancer therapy? Most importantly, wash your hands often- it is the easiest, most effective way to prevent the spread of infections. Keep hand sanitizer in your bag, desk, car or anywhere you may not be able to access a sink for handwashing. Avoid touching your eyes, nose and mouth- that’s how germs get in. It is perfectly acceptable to not shake hands or ask people who are sick (or have sick people in their household) to not visit you. Ask any visitors to wash their hands upon arrival and, whenever possible, avoid places with crowds of people, particularly when your blood counts are at their lowest. Have other members of your household get vaccinated as well- you don’t want them bringing these infections into your house where it will be harder to avoid.
Even the best handwashers get sick, so don’t blame yourself if you do. Get plenty of rest and fluids and help prevent the spread of the flu to others by staying home when you are sick.
Now roll up your sleeve- this won’t hurt a bit!
Also see Ask the Experts: Exposure to People After Vaccines.
Tags: Cancer, Chemotherapy, Flu vaccine, H1N1
Thank you, Carolyn, for discussing my question about the novel H1N1 2009 flu out loud, and providing effective and timely communication once again between those at Oncolink and cancer patients.
One more question… Where might the pneumonia vaccination fit into the picture for cancer patients this year?
I spoke with Dr. Fishman, who said it is important for people with cancer (particularly those on therapy or post transplant) to get pneumovax. For those who don’t know, pneumovax prevents the most common strains of bacteria that cause pneumonia. Dr. Fishman does advise that you not get all 3 shots at once (seasonal flu, H1N1 and pneumovax). Since H1N1 has not reached providers yet, you could start with the other two.
The CDC reccommends pneumovax for adults over 65, smokers and “people with certain health problems” – this includes health problems or treatments that weaken the immune system. People with cancer may require a second dose of pneumovax, given 5 years after the first. Patients should discuss their need for re-vaccination with their healthcare team (transplant patients may require additional doses).
What are the recommendations for H1N1 and Flu vaccinations for cancer patients in remission? Are there recommendations for individuals who live in the same household of patients in remission?
Hi Cindy
People in remission (and their household members) can follow the CDC recommendations for the general public, so long as there are no other health issues that put you in a high risk group (pregnancy, lung condition, etc). http://www.cdc.gov/
If you completed treatments in the last 6 months, you may want to discuss your risk with your oncology team, as your immune system may not have fully recovered yet and they may want you to get vaccinated.
In addition, people with hematologic malignancies (leukemia, lymphoma, myeloma) and those who have had bone marrow or stem cell transplants (autologous or allogeneic), can have prolonged suppression of their immune systems after treatment (lasting 1-2 years or longer) and should discuss their risk with their oncology team.
A great new resource from the CDC:
The CDC is excited to announce the debut of http://cdc.gov/cancer/flu/ a new resource targeted toward cancer patients and survivors. Living with cancer increases a person’s risk for complications from having the flu. To help prepare you, anyone you know with cancer, or anyone who has had cancer in the past, CDC’s Division of Cancer Prevention and Control is answering some important questions about seasonal and 2009 H1N1 flu.