After a Stem Cell Transplant the patient is likely to lose some or all of the natural, or man-made disease immunities they used to have. Quite simply this is because the high dose chemotherapy killed off many or all of the antibody producing, and memory cells responsible for conferring immunity upon us.
Although getting new immunizations is not required it is well advised since many of the childhood diseases we thought were behind us could rear their ugly head again. You can have your blood titres done to find our which ones are really required and which are not.
Webmasters note: 18 months after my SCT in 2002 I had all my titres done (see results below) As you can see by my titres many of of my vaccinations were not required. I had them done anyway just to be sure.
|Pneumococcal Antibody||Test not considered medically necessary|
|Tetanus||Protection adequate, vaccine not required|
|Diptheria||Protection adequate, vaccine not required|
|Rubella (German measles)||Protection adequate, vaccine not required|
|Mumps||Protection adequate, vaccine not required|
|Hep A and B||No antibody (never vaccinated previously)|
|Rubeola (Red measles)||Protection adequate, vaccine not required|
|Pertussis||No immunity, vaccination needed.|
The following recommendations are adapted by Sunnybrook Regional Cancer Centre in Toronto from the Fred Hutchinson Cancer Centre, and the American Society for Blood and Marrow Transplantation, and they apply to both Autologous and allogeneic transplant patients. Other cancer centres could very well have a different schedule.
Patients can be tested beforehand to find out which vaccines are needed and which ones are not required due to adequate antibody levels in the blood. The tests for these is a simple blood test known as a titre. The following vaccines only need to be given if the titres show a lowered or absent level of protective antibodies for the disease mentioned.
1. Antibody titres normal: For patients with normal prevaccination antibody levels to tetanus, diphtheria, strep, pneumonia, haemophilus, one vaccine (booster) is given for each vaccine. If preimmunization level to Hepatitis B surface antibody is positive, no additional Hepatitis B vaccine is given.
2. Immunization of household contacts: The household members and the immunocompromised individual in particular must be carefully counseled to avoid exposure to fecal-oral contamination, essentially by practicing good personal hygiene. If polio vaccine needs to be given to household members within the patient's first year after transplantation we strongly recommend the inactivated vaccine be used. If the oral vaccine is given, close contact between the household member and transplant recipient should be avoided for approximately 2 months after vaccination. If a household member receives the varicella vaccine and then develops lesions, the transplant recipient needs to be isolated while the lesions are still present.
3. Live virus vaccination: Live virus vaccines (oral polio vaccine - OPV, measles, mumps rubella, BCG, yellow fever, and smallpox) carry risk in immunocompromised hosts and should be avoided. Measles, mumps and rubella should not be given within the first two years post-transplant nor any time the patient continues on immunosuppressive therapy, or has active graft versus host disease (GVHD). At the present time we do not recommend routine use of varicella vaccine in this population until other information is available.
The topic of re-immunizing SCT/BMT patients isn't entirely straightforward. While the schedule above is common it is also important to take other factors into consideration. Below you will find a very in-depth discussion from the Blood Journal about what should be considered.