Influenza and Pneumonia Vaccination for Adult patients undergoing treatment for Cancer

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The Influenza (Flu) Vaccine

The flu vaccine is aimed at protecting people who are most at risk from catching or spreading flu. As the strain of flu virus changes every year this means it is necessary to have the flu vaccine annually during the autumn or early winter. There are 2 different types of influenza (flu) vaccine recommended this year for adults by the Department of Health, both of which are inactivated vaccines (they do not contain live flu virus). For those under the age of 65 the Quadrivalent Influenza Vaccine is recommended. For those over the age of 65 the Adjuvanted Trivalent Influenza Vaccine is recommended.

Should people who are having cancer treatment have a flu vaccine?

Yes. The Department of Health and Cancer Research UK recommend vaccination for people who are immunosuppressed because of disease or treatment. It is especially important this year, during the COVID-19 pandemic to have a flu vaccine. It is essential to be protected from flu as those who develop both flu and COVID together tend to be more unwell and are more likely to need to be admitted to hospital. If you are having, or have recently finished, cancer treatment you should ask about the vaccine.

Can the flu vaccines actually cause flu?

No. Most types of flu vaccination do not contain any live virus, so they cannot cause flu. However, you should not have the intra-nasal (into the nose) flu vaccine as this does contain live flu virus.

Is there a higher risk of side effects for people who are having cancer treatment?

No. Side effects may include soreness and warmth at the vaccination site and, less commonly, a slight fever and aching muscles for a couple of days after the vaccination.

Patients on Immunotherapy

Due to the way that immunotherapy works, there is a possible risk of an increased reaction to your immunotherapy a few days after you receive your flu vaccine. It is very important that you are aware of the possible increased risk of reaction with immunotherapy treatment. Any new or worsening symptoms or side effects should be reported to your specialist cancer nurse, or Acute Oncology Team (Telephone: 01908 660033 and ask for bleep 1090).

When should I have the flu vaccine if I am on cancer treatment?

If you are due to start treatment and have not already had the flu vaccine you should have it at least 2 weeks before you begin treatment. This is to allow time for your body to produce antibodies which help protect against the flu virus. If this is not possible, vaccinating between courses of chemotherapy / immunotherapy is safe and effective. For it to be effective it should be given just before your next cycle of chemotherapy /immunotherapy or within a couple of days afterwards. The vaccine may be given at any point during a course of radiotherapy.

Is there anyone who should not have the flu vaccine?

Yes. You should not be vaccinated if you have an allergy to eggs.

Should my family have the flu vaccine?

Yes. Anyone else that lives with you should also have the flu vaccine to protect you. This can be arranged by their GP or practice nurse. You should avoid contact with children who have had the ‘live’ nasal flu vaccine for 7 days.

Will the vaccine protect me from all types of flu?

The flu vaccine protects against certain strains of flu. Whilst it has been developed carefully for the types most likely to be present each year, it does not protect against all strains of flu. Pneumococcal Vaccine Your doctor might suggest that you have the pneumococcal vaccine if your immunity is low. The pneumococcal vaccine protects against pneumococcal infections. These infections could lead to illnesses, such as pneumonia or blood poisoning (septicaemia). There are two different types of pneumococcal vaccine. These are the Pneumococcal polysaccharide vaccine (PPV) and pneumococcal conjugate vaccine (PCV). These are not live vaccines.

You should have both vaccines (PCV then PPV 2 months later) if:

• you have severe low immunity, for example you have acute or chronic leukaemia
• you are to have your spleen removed (a splenectomy) or your spleen is not working well

When should I have it?

The pneumococcal vaccine is available at any time of the year. Check with your doctor when it is best to have it in your situation. Generally, it is advised that you have the vaccine at least 2 weeks before starting chemotherapy, immunotherapy, or radiotherapy. If you have already started treatment, discuss with your Doctor but usually this can be given the week before your next cycle of treatment. If you did not receive a pneumococcal vaccination before treatment, you can have it after completion but you should wait at least 3 months after your cancer treatment has finished or 6 months after stem cell transplant. The flu & pneumococcal vaccines are both intramuscular injections therefore if you have a low Platelet count, are on blood thinning medication or have a clotting problem the timing for your vaccination may vary and will need to be discussed and coordinated with your treatment. Your platelet count must be greater than 30 for you to receive an intramuscular injection. Adults who are severely immunocompromised (including anyone with leukaemia, myeloma or genetic disorders affecting the immune system or after bone marrow transplant) usually have a single dose of PCV followed by PPV.