Immunisations and cancer treatment

Immunisation includes several vaccines children and adults routinely have to protect against infections.

Your resistance to infection can sometimes be low if you have or have recently had some cancer treatments. These include:

• chemotherapy

• radiotherapy

• some types of immunotherapy drugs

• some targeted cancer drugs

• long term steroids

• removal of the spleen

The effect of treatment on your ​immune system​ depends on the cancer drug and the dose of your drug or radiotherapy treatment. 

There are some vaccinations you shouldn't have when you have low immunity because they could make you feel very ill. You might also need to avoid contact with other people who have had certain types of vaccination.

This page is about vaccines as part of the immunisation programme and whether people with cancer should have them.

Researchers are also looking at vaccines as a possible way of treating cancer. We have more information on this.

Read more about vaccines to treat cancer

Having immunisations during treatment

There are two main types of vaccines:

• live vaccines

• inactivated (not live) vaccines

You shouldn't have immunisations with live vaccines while having cancer treatment and for some months afterwards. This is because live vaccines contain a very weak version of the illness they are vaccinating you against.

Flu vaccine

Many children have the flu vaccine as a nasal spray. The nasal spray contains a live but weakened form of the flu virus. If your child has cancer, talk to their healthcare team. The doctor may recommend that your child doesn’t have the nasal spray if they have a very weakened immune system. In this situation, your child might have the flu vaccine injection instead. This isn’t a live vaccine.

Adults with cancer also have the flu vaccine injection if they are having cancer treatment. Ask your doctor about the best time to have this. This will depend on your situation and the type of treatment you are having.

Read more information about the flu vaccine and cancer treatment

Pneumococcal vaccine

The pneumococcal vaccine protects against pneumococcal infections. These infections could lead to illnesses such as:

• an infection of the lung (pneumonia)

• blood poisoning (septicaemia)

• an infection of the protective membranes surrounding the brain and spinal cord (meningitis)

Your doctor might suggest you have the pneumococcal vaccine if your immunity is low.

There are two different types of pneumococcal vaccine. These are the:

• pneumococcal polysaccharide vaccine (PPV)

• pneumococcal conjugate vaccine

These are not live vaccines. You should have both vaccines (pneumococcal conjugate vaccine then PPV 2 months later) if you have severe low immunity. For example, you have acute or chronic leukaemia.

You should have PPV if you are due to have your spleen removed (a splenectomy) or your spleen is not working well.

When you 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.

Ideally, you should have the vaccine at least 4 to 6 weeks before:

• having your spleen removed

• starting chemotherapy or radiotherapy

If this is impossible, you can have it up to 2 weeks before treatment. 

You could have it afterwards if you did not receive a pneumococcal vaccination before treatment. But you should wait at least 3 months after chemotherapy or radiotherapy treatment has finished. You can have it 2 weeks after your spleen has been removed. 

Check with your specialist about the best time. This might vary depending on your situation. For example, people being treated for leukaemia should have pneumococcal conjugate vaccine from 6 months after chemotherapy. Those who have had a ​stem cell transplant​ should have pneumococcal conjugate vaccine around 9 to 12 months after their transplant.

You need to have PPV every 5 years if you have had your spleen removed or your spleen is not working well.

Travel vaccinations

You might need to have other vaccinations if you are travelling. Talk to your healthcare team about this before you have any.

Find out about travel vaccines

Contact with other people who have had vaccines

It’s usually safe for you to be in contact with people who have had live vaccines as injections. But there is a very small risk from people who have had live vaccines taken by mouth or by a spray into the nose.

Having immunisations after treatment

At the end of your treatment, your doctor or nurse will talk to you about what vaccinations you may be due and when you can have them.

You can’t have live vaccines until your immune system is working properly. So you may need to avoid live vaccines for 6 to 12 months after treatment. Or 2 years after a stem cell transplant.

Some people may need to repeat the vaccinations they had as a child. This includes those who have had either:

• a stem cell transplant

• ​CAR T-cell therapy​

This is because you lose your immunity to illnesses you have been vaccinated against in the past.

The timing of when these vaccinations start depend on the type of treatment you have had. It also depends if you have any side effects such as ​graft versus host disease​ . It can also vary slightly between hospitals. Your transplant team will let you know.