Patients with cancer are vulnerable to infection, as chemotherapy, radiation therapy, and immune altering therapies can lead to neutropenia, lymphopenia, and altered immune competence while under active treatment.

Immune deficit can process from months to years after treatment.

Persistent immune deficits are particularly common in cancer survivors underwent organ or hematopoietic stem cell transplantation, CAR cellular therapies, monoclonal antibody treatment, or long-term immune maintenance therapies, as well as in those without recovery of normal bone marrow function after undergoing chemotherapy.

Cancers survivors should receive any vaccines they are missing and those that are appropriate for their age and health conditions.

Vaccinations in search patients should preferably not be live, but should be formulated from inactivity micro organisms, purified antigens, other bacterial components, or genetically engineered recombinant vaccines.

If possible, all vaccines that are indicated should be administered before the initiation of cancer treatment.

Vaccines should be giving at least two weeks before initiation of cancer treatment.

Both live and inactivated or recombinant vaccines maybe given at least three months of the completion of chemotherapy.

In survivors of hematopoietic blood stem cell transplantation, cellular therapy or anti-B cell antibody therapy delaying administration of both types of vaccinations for at least six months after the chemotherapy.

Vaccinations may not trigger an appropriate immune response in immunocompromise patients and cancer survivors, with residual immune deficits.

Certain vaccines, such as live attenuated vaccines are contraindicated in immuno suppressed patients and in those who are in close contact with the patient due to increased risk of prolonged shedding and disease presence.

Recommended vaccines for cancer patients and survivors include:

Inactivated influenza vaccine or recombinant influenza vaccine, annually.

Tetanus, diphtheria, pertussis vaccine

HPV vaccine if previously unvaccinated

Pneumococcal vaccine in all survivors 65 years and older

Hepatitis B vaccine for all adults up at age 60 years

Covid-19 vaccine

The recombinant shingles vaccine is safe and effective in cancer survivors and their close contacts.

The inactivated hepatitis A and recombinant hepatitis B vaccines are indicated for patients with certain clinical and social conditions that may increase the risk of contracting these viruses.

The Haemophilus influenzae and type b 0’meningococcal vaccines have applications and patients with asplenia as well as in stem cell transplant recipients.

Live attenuated vaccines such as measles, mumps, and rubella, oral typhoid, yellow fever, rotavirus, nasal influenza, and varicella are contraindicated or should be used with caution in actively immunocompromise cancer survivors and their close contacts.