FPIN's Clinical Inquiries

Immunogenicity of Childhood Vaccines after Pediatric Cancer


Am Fam Physician. 2020 Dec 1;102(11):online.

Clinical Question

Do children who have undergone treatment for cancer retain immunity from childhood vaccinations?

Evidence-Based Answer

Children treated for cancer do not retain full immunity from previous vaccinations; therefore, it is likely beneficial for children who survive cancer to be revaccinated six to 12 months after immunosuppressive therapy. (Strength of Recommendation [SOR]: C, based on disease-oriented outcomes and consensus guidelines.) A measles, mumps, and rubella (MMR) booster is recommended for children who have undergone treatment for acute lymphoblastic leukemia, especially those who were diagnosed and treated before five years of age. A dose of 13-valent pneumococcal vaccine (PCV-13) is recommended after completion of immunosuppressive therapy, and a dose of hepatitis B vaccine is recommended six months after completion of chemotherapy. Universal revaccination should be considered because it is likely more cost-effective than titer-directed revaccination. (SOR: C, based on disease-oriented outcomes and consensus guidelines.)

Evidence Summary

A 2018 retrospective, cross-sectional Saudi Arabian study of 57 children who had undergone treatment for acute lymphoblastic leukemia and had received all scheduled MMR vaccinations evaluated MMR immunity at least 12 months posttreatment and the subsequent response to a booster vaccination.1 Posttreatment baseline titers showed that 35 patients (61.4%) were seropositive/immune to all three vaccine components and that 22 (38.6%) were negative/susceptible to at least one vaccine component. The 22 seronegative children were given one MMR booster, and titers were redrawn six to nine months afterward. Postbooster seroconversion rates were 57.1% for measles, 87.5% for mumps, and 78.6% for rubella, which are lower than initial postvaccine seroconversion rates. No significant differences in baseline characteristics were found between responders and nonresponders. No serious adverse effects were reported. Patients diagnosed

Address correspondence to Elizabeth Close, MD, FAAFP, at elizabeth.close@erlanger.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Fouda AE, Kandil SM, Boujettif F, et al. Humoral immune response of childhood acute lymphoblastic leukemia survivors against the measles, mumps, and rubella vaccination. Hematology. 2018;23(9):590–595....

2. Hung TY, Kotecha RS, Blyth CC, et al. Immunogenicity and safety of single-dose, 13-valent pneumococcal conjugate vaccine in pediatric and adolescent oncology patients. Cancer. 2017;123(21):4215–4223.

3. Fayea NY, Kandil SM, Boujettif K, et al. Assessment of hepatitis B virus antibody titers in childhood cancer survivors. Eur J Pediatr. 2017;176(9):1269–1273.

4. Kamboj M, Shah MK. Vaccination of the stem cell transplant recipient and the hematologic malignancy patient. Infect Dis Clin North Am. 2019;33(2):593–609.

5. Kimberlin DW, Brady MT, Jackson MA, et al., eds. Red Book: 2018–2021 Report of the Committee on Infectious Diseases. 31st ed. American Academy of Pediatrics; 2018.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.



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