# Vaccination before, during and after cancer treatment

Source: https://onco.cc/protocols/vaccination-around-cancer-treatment/  
OnCo record `vaccination-around-cancer-treatment` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Before cancer treatment, the team should check which vaccines a person has had and bring them up to date, ideally two to four weeks before. Non-live vaccines such as the flu jab can still be given during treatment. Live vaccines, such as MMR, chickenpox and the nasal flu spray for the patient, must be avoided during treatment and for months after. Family vaccines protect the patient too.

## Summary

ASCO (2024, adults) asks clinicians to determine vaccination status and bring newly diagnosed adults up to date on seasonal and age- and risk-based vaccines (moderate, strong), ideally 2 to 4 weeks before treatment, with non-live vaccines allowed during or after chemotherapy, immunotherapy, hormonal treatment, radiation or surgery (moderate, strong). The Green Book (UK, all ages) gives inactivated vaccines at least two weeks before immunosuppressive treatment where possible, and otherwise at any time with re-immunisation considered after recovery. Live vaccines are contraindicated in acute and chronic leukaemia and lymphoma, during and for 6 months after immunosuppressive chemotherapy or radiotherapy, for 12 months after immunosuppressive biologics such as rituximab, for 24 months after a stem cell transplant (and longer with GVHD or ongoing immunosuppression), and for 3 months after high-dose corticosteroids (above 40 mg prednisolone a day, or 2 mg/kg/day in children under 20 kg, for more than a week). Live attenuated nasal influenza vaccine cannot be given to patients with cancer (ASCO).

Revaccination after transplant starts at 6 to 12 months (influenza, COVID-19 and pneumococcal from 3 months), after CD19 or BCMA CAR-T no sooner than 3 months for influenza and COVID-19 and 6 months for other non-live vaccines (very low, weak), and after B-cell depleting therapy COVID-19 only, at 6 months (moderate, strong). Household contacts should be fully vaccinated, including MMR, varicella and rotavirus, with hand washing after nappy changes for rotavirus; contacts of severely immunocompromised patients such as transplant recipients in isolation get inactivated rather than live influenza vaccine. Children with immunodeficiency attending school do not need to be kept away when classmates are immunised. For children, ASCO does not apply (it covers 19 and over); the Indian Academy of Pediatrics advises against live vaccines during and up to 6 months after chemotherapy and recommends only annual inactivated influenza vaccine for all children during chemotherapy.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: vaccines during chemotherapy; flu jab during chemotherapy; live vaccines and cancer; immunisation and chemotherapy; household contacts vaccination; vaccination of children with cancer
- Tags: protocol; vaccination; infection-prevention; paediatric

## Connected records

- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/), [Revaccination after transplant: the schedules, and where the UK and the US differ](https://onco.cc/technologies/rejuv-tx-revaccination/)
- terms: [Hypogammaglobulinaemia and infection risk after B-cell therapies](https://onco.cc/terms/hypogammaglobulinaemia/), [Vaccinations around lymphoma treatment: the ones to have first, and the ones not to have at all](https://onco.cc/terms/lymphoma-living-vaccinations/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- drugs: [Rituximab](https://onco.cc/drugs/rituximab/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)

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