Immunization Guidelines

Guidelines for Immunization for Pediatric Hematology/Oncology Patient Population
General principles:
·        Communication between the child’s home physician and pediatric hematologist/ oncologist is essential.  Accurate
          immunization records of each child must be obtained at diagnosis and kept up-to-date.
·        At diagnosis, baseline immune status testing should include antibody titers of varicella, hepatitis B, hepatitis C EIA,
         cytomegalovirus (CMV IgG), herpes simplex virus (HSV), human immunodeficiency virus (HIV), and Epstein-Barr virus
         (EBV).  Measurement of routine antibody titers (e.g., diphtheria, pertussis, tetanus) is not necessary.
·        Monitor patients carefully for infection, making no assumptions about susceptibility or protection from specific illnesses.  A
          history of childhood infection or previous vaccination may be irrelevant, as children immunized prior to or during therapy
          may lose or never have attained protective antibody titers.
·        Vaccinate at the time when the maximum immune response can be anticipated.  It is recommended that vaccination be
          withheld until three to four weeks after the completion of intensive chemotherapy, and ideally, ANC and absolute lymphocyte
          counts are greater than 1 x 109 cells/L.
·        Continue routine immunization for non-immune household contacts including measles, mumps and rubella vaccine
          (MMR), as this maximizes the protection of the cancer patient whose own responses to vaccination may be suboptimal. 
          In addition to routine immunizations, recommend varicella vaccine at diagnosis of the patient (if not previously vaccinated),
          and annual influenza vaccine to the household contacts, as applicable.
·        Consider the vaccination status of both the donor and recipient of a bone marrow transplant.
·        Avoid live vaccines unless data is available demonstrating safety, or the risk of natural infection is greater than the
          risk of vaccination (live vaccines include varicella, measles/mumps/rubella, BCG, oral typhoid and yellow fever).
·        Consider passive immunization for certain pathogens (including measles, hepatitis A, hepatitis B, and varicella) using
          immune serum globulin, pathogen specific immune globulin or intravenous immune globulin. 
·        Refer to Table 6 for suggested intervals “washout period” required between immune globulin administration and measles
·        Application of topical anesthetic creams (i.e., EMLA®, Ametop®) prior to immunizations is acceptable.

Link to APPHON/ROHPPA Immunization Guidelines (November 2018-updated July 2019)

Maritimes Immunization Guidelines:

Transplantation (Hematopoietic Stem Cell Transplantation (HSCT)) Immunization Recommendations:

  • Pre-Transplantation
  • Post-Transplantation
  • Routine Vaccines:
  • Flu
  • DTaP-IPV/Hib
  • Pneu-C & Pneu-23
  • MenC-ACYW
  • Hep B+ A
  • HPV
  • MMR-V 

Link to Transplantation (Hematopoietic Stem Cell Transplantation (HSCT)) Immunization Recommendations - 2018

Newfoundland and Labrador Immunization Guidelines

Immunization for Special Populations:

8.1            Immunization Post Bone Marrow Transplantation/Stem Cell Transplant
8.2            Immunization of Asplenic Population
8.3            Immunization Recommendations for Patients with Chronic Kidney Disease
8.4            Guideline for the Preplacement Communicable Disease Screening of Healthcare
8.5            Immunizations for Individuals New to Canada

Link to Newfoundland and Labrador Immunization Guideline - 2014