Should I Get the Flu Vaccine During Cancer Treatment?

A person gets a flu vaccine injected into the arm.

Fall is upon us, which means vibrant leaves, sweater weather, and football. It also means flu season, which typically starts in December, is around the corner.

It’s hard to ignore ongoing public health messages in the media stressing the importance of getting the influenza vaccine. Commonly known as the flu, influenza is a highly contagious viral infection of the nose, throat, and lungs that can cause serious health complications, and in some cases may be fatal. People with certain types of cancer may be more at risk for getting the flu.

According to the Centers for Disease Control (CDC), the flu vaccine is the most effective way to protect yourself against the flu. But should people undergoing cancer treatment be vaccinated? We asked Mini Kamboj, Director of MSK’s Infection Control Program, to explain.

Six Ways MSK Protects Cancer Patients from Infections
Because people with cancer have a higher-than-normal risk of developing infections, our infection control experts have developed a number of innovative programs.

Influenza Can Hinder Your Cancer Care

“It is not known whether infections due to the influenza virus occur more frequently in people who are undergoing cancer therapy than in the average person who is otherwise healthy,” explains Dr. Kamboj. “What we do know is that if you’re undergoing treatment, flu-related complications are more common, and can lead to hospitalization and a delay in your cancer care.”

If your immune system is not able to fight off the flu virus, it increases your risk for developing a bacterial infection such as pneumonia, which requires hospitalization, intravenous antibiotics, and postponement of certain cancer treatments like chemotherapy.

“We want to make sure that your cancer care runs smoothly,” she says.

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Cancer Treatment and Immunity

Even if you’re not actively in treatment, having cancer can diminish your immune system’s ability to fend off illness. For example, blood cancers such as leukemia and lymphoma and cancer in the lymph nodes (where the bulk of disease-fighting blood cells live) can lower immunity.

And if you are receiving cancer treatment, you’re at increased risk for complications from influenza. For example, radiation for lung cancer may raise your chances of developing flu-related respiratory conditions such as pneumonitis. Steroid medications, which are often prescribed for people undergoing radiation therapy, and chemotherapy are also known to weaken your immune defenses.

“For most people, it’s best to protect yourself and get the flu vaccine regardless of the type of cancer treatment you’re receiving,” says Dr. Kamboj.

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Helping Others Stay Well

When you’re receiving cancer treatment, you’re also in close proximity to healthcare workers and other patients who might be more vulnerable to complications from the flu. Experts agree that getting the flu shot not only shores up your immunity but also protects others.

“When we educate patients about getting vaccinated, we highly encourage family members and caregivers to get the vaccine too, especially if there are young children in the household,” notes Dr. Kamboj.

Older people, especially those undergoing cancer treatment, are at higher risk for getting the flu and for developing health complications because of it. A high-dose flu vaccine is available for people age 65 and over. Clinical studies have shown that it provides greater protection against the flu in the elderly population compared to the standard vaccine.

If you're undergoing [cancer] treatment, flu-related complications are more common and can lead to…a delay in your cancer care.
Mini Kamboj Infectious Disease Specialist
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When to Decline the Vaccine

The CDC recommends that everyone over six months of age get the flu vaccine. Aside from some soreness at the site of the injection, there are few risks associated with it. However, there are times when it should be declined or postponed.

For example, people who have had severe allergic reactions to eggs, such as anaphylaxis, should request an egg-free version of the vaccine.

“Also, someone undergoing very intensive chemotherapy, such as after a bone marrow transplant, should not get the flu shot,” warns Dr. Kamboj. “The vaccine is not likely to offer any protection in this setting, and if certain blood counts such as platelets are extremely low, bleeding at the site of the injection can occur.”

Vaccination guidelines state that people should wait at least four months after transplant to receive the flu shot.

Once flu season is officially declared, New York State law requires unvaccinated healthcare workers to wear a mask when they are near patients in hospitals and other medical facilities. “Unvaccinated individuals visiting patient-care areas at MSK are also asked to wear a mask to further reduce the risk of transmission among our patients,” notes Dr. Kamboj.

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If You Have Cancer, Get the Inactivated Vaccine

Some people are afraid that the flu vaccine will make them sick with flu-like symptoms such as cough, fever, muscle aches, and fatigue.

“It’s important to understand that there are different types of influenza vaccines,” explains Dr. Kamboj. “The inactivated vaccine that we offer to our patients does not cause the flu.”

Another type of influenza vaccine contains live, weakened strains of the influenza virus. This vaccine can produce a mild or low-grade infection so that the body makes antibodies against the virus. “We do not offer this particular live vaccine to our healthcare workers or to our patients, whose immune systems are down and should not be challenged with an active virus,” says Dr. Kamboj.

It takes about two to four weeks after receiving the influenza vaccination for protection to kick in.

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An Ounce of Prevention

“People should know that the flu shot is not going to protect them against other circulating viruses that cause respiratory illness or the common cold during the fall and winter,” notes Dr. Kamboj. “You might still get the sniffles or even a respiratory condition from these viruses.”

Hand hygiene significantly reduces your risk of getting sick and spreading germs. “Wash your hands several times a day! It’s underrated, but it’s so important,” she stresses. “You don’t even need antibacterial cleanser. Regular soap is just as good and is known to kill both influenza and other cold viruses.”

Alcohol-based hand gels are also convenient when soap and water aren’t accessible.

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Commenting is disabled for this blog post.

Why would they get a vaccine that has never been proven to work. If the individual is going through chemo which can cause heat problems why would they take the risk considering this:

Here is an astonishing bit of science:
Ann Med. 2007;39(5):392-9.
Residual adverse changes in arterial endothelial function and LDL oxidation after a mild systemic inflammation induced by influenza vaccination.

Researchers wanted to investigate why people seem to have more heart problems in the first weeks after an acute inflammatory event.

What did they use to induce inflammation in the healthy male human volunteers?

A flu shot.

What did they discover?

Cardiovascular function can be abnormal for at least two weeks after getting a flu shot.

Dear redpill1,

We sent your question to Dr. Kamboj and she responded:

“Vaccines are immune triggers by mechanism. We are not aware of any clinical studies that establish a link between cardiovascular events after influenza vaccination. For additional resources regarding vaccine safety, efficacy, and current CDC recommendations, please see the following link”

Thank you for your comment.

I have stage 1 lymphoma and took the shot. Was it ok to do so i have had the sniffles before and after the shot

We recommend you discuss your concerns with your doctor. Thank you for your comment.

" A new high-dose influenza vaccine is now available for people age 65 and over."
What is the name of this particular vaccine and can we request it.

Dear Miss Curious, the new flu vaccine for people age 65 and over is called Fluzone high dose influenza vaccine. If a patient over age 65 needs a flu vaccination at MSK, they automatically receive the high dose vaccine without having to request it. Thank you for your comment.

Chemotherapy itself and steroids given before and after chemotherapy suppress the immune system. How Does the body responds to the inactivated influenza vaccine to generate the immune response against the influenza virus when body immune system is suppressed.

Dear Khawaja, we sent your inquiry to MSK infectious disease specialist Dr. Mini Kamboj and she responded:

“While some patients who are undergoing chemotherapy mount a lower antibody titre to the vaccine than patients who have completed treatment, the key is that they still mount a response and the vaccine offers protection from the flu.”

We recommend that you discuss any specific concerns you may have about getting the flu vaccine with your personal physician. Thank you for reaching out to us.

Is it safe to have a flu shot while on Pembrolizumab ... immunotherapy?

Dear Emily, we sent your inquiry to infectious disease specialist Dr. Mini Kamboj and she responded:

“Yes, it is safe - please discuss with your physician if you have any specific concerns” or contraindications to receiving the flu vaccine.

Thank you for reaching out to us.

For someone who just had chemotherapy that very day, is there a recommendation on the timeframe for vaccination. How long should one wait? Of course we are not talking about the live strain.

Dear Candace, we sent your inquiry to MSK infectious disease specialist Dr. Mini Kamboj and she responded:

” The optimal timing of flu vaccine in relation to chemotherapy has not been determined. We encourage immunization once the vaccine is available and there are no other medical contraindications to receiving the vaccine.”

Please talk to your doctor to see if and when it would be appropriate for you to get vaccinated. Thank you for reaching out to us.

My 75-year-old mother is being treated with Oxaliplatin and Gemcitabine for stage IV bile duct cancer (or pancreatic), which has metastasized to her liver. Her first set of chemotherapy infusions was on Oct 18 (Gemcitabine) and Oct 19 (Oxaliplatin). Her next set of infusions is schedule for Nov 1 and Nov 2. It's an every other week regimen. Is it okay for her to get a flu shot now, say Oct 29 or 30th? Or can you recommend a best time in between treatments? Thank you.

Dear CM, we recommend that your mother ask her oncologist to see if and when she should receive the flu vaccine. Thank you for reaching out to us.

Can the high dose influenza vaccine be given to individuals under 65 who have received chemotherapy?

Dear Stephen, we recommend that you discuss which type of vaccine is appropriate with your medical oncologist. Thank you for your comment.

My mom has stage IV stomach cancer and her Oncologist recommended all family members get the flu shot but after I got mine the pharmacist mentioned we have to wait 4 weeks to be around her. Is that true?

We forwarded your question to Dr. Kamboj, who responded, “Thanks for getting the flu shot. It not only protects you from the flu, but also those around you. One type of flu vaccine is a live attenuated virus formulation administered as a nasal spray or mist. Since this is a live virus, it is potentially transmissible to others. We generally recommend that caregivers who receive the nasal flu mist vaccine stay away from highly immunocompromised patients who require protective isolation, such as transplant recipients. From the description, you received the flu shot (or injectable vaccine), which contains killed inactivated virus and does not pose a similar risk of transmission to others. It is safe for you to be around your mother. Stay healthy!” Thank you for your comment and best wishes to you and your family.

Is it ok for a patient above 65 to receive a flue shot while undergoing radiation therapy for endometrium cancer after hysterectomy ? The patient is on the 13 day of the radiation treatment and is worried that the flu shot might make her sick.

Dear Alicja, this is something the patient should discuss with her doctor. Thank you for your comment.

In reference to "Concerned daughters" concern regarding being around a transplant patient after taking a live virus, does this apply to the MMR vaccine as well?
As someone who just went through a transplant
Do i have to keep my children away for a few weeks after they took the MMR?