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Last update: 05/15/2008

Immunization Guide
Rituxan & Flu Shots | Household Contact | Shingles Vaccine | Small Pox Vaccination | Glossary

TOPIC SEARCH: memory cells AND chemotherapy | pneumonia revaccination

CDC immunization guide:

Should I Receive a Flu shot if I've had, or will soon have, Rituxan treatment?

Lacking formal studies, no definitive answer exists. Rituxan depletes normal b-cells for as long as 6 to 12 months and therefore could have an effect on how well immunizations will work. 

The following informal guidance has been given to at least some patients:

Before Rituxan?  The consensus seems to be Yes. Rationale:  If your body creates antibodies to the viruses, subsequent use of Rituxan will not affect these antibody producing b-cells, because they do not express CD20.

After Rituxan? The consensus seems to be that flu shots may not work optimally if given shortly after Rituxan, but it might still be beneficial, and it's not likely to do any harm.  The time it takes for b-cells to return to sufficient numbers is not known, and could vary significantly. We speculate that flu vaccination might induce cellular (t-cell) immunity when b-cells are depleted. Since Rituxan can deplete memory b-cells (PMID: 15238091), we think you should ask your doctor if past 5- or 10-year immunizations should be repeated when b-cell levels return.  

How long should I avoid exposure to others who have 
been immunized when I'm immune suppressed?

The answer to this question may depend on the type of immunization.  See resources below. 

Please consult with your physician, or contact the CDC (800-342-2437).

Shingles immunization?

WebMD

"Up to one in ten older patients won't be candidates for the vaccine because of weakened immune systems due to cancer therapy, organ transplants, HIV/AIDS, or other causes. The vaccine contains live but weakened varicella virus that could overwhelm the immune systems of those patients.." 

Smallpox immunization?

Information on Live Virus Vaccines and Vaccinia  cdc.gov

"The smallpox vaccine is not recommended for people who have weakened immune systems, including people with leukemia or human immunodeficiency virus (HIV) infection or people undergoing treatment with certain drugs or with certain skin conditions. In rare cases, people who fall into these groups can have serious complications from the vaccine." 
 

 

Immunizations for Patients With Lymphoma, Hodgkin's Disease, Myeloma and Leukemia

Adapted from: Guide for Adult Immunization, 3rd edition, American College of Physicians:  Patients who have a malignant lymphoma, Hodgkin's lymphoma, myeloma, chronic lymphocytic leukemia 
or related conditions often do not have normal immunity to some infections because of their disease and necessary treatments. These patients should [often] receive certain immunizations to help boost their immunity.

It is also recommended by the CDC that people in close or direct contact with immune compromised patients receive immunization vaccines, such as loved ones, family members, and health care providers.

NOTE:  Guidelines are subject to change, and can vary depending on the clinical circumstances. So, as always, it's best to seek advice on immunizations from your doctor.

... However, a few types of immunizations - those using live organisms - can be dangerous and must be avoided.

... Please keep one copy of these recommendations with your own health records and take a copy to your family physician. Patients who are currently receiving chemotherapy or radiation should wait until six months after treatment before receiving immunizations except for influenza vaccine which should be taken every year. If you have any questions about these recommendations be sure to discuss them with your Oncologist.

Resources

Glossary of related terms

Attenuated - to reduce the virulence (infectivity) of a pathogenic microorganism used in a vaccine in order to make it safe or safer. 

“Close contact” [in respect to avoiding exposure] means anyone living in your household. It also means anyone you have close, physical contact with, like a sex partner or someone you share a bed with. (Close contact does not mean friends or co-workers.)  CDC