Vaccines during cancer treatment: which ones, when and where

Why get vaccinated

People with cancer catch infections more easily, and these infections tend to be more serious. Pneumococcal pneumonia, for example, is much more common:

With flu, the risk of hospitalization is about four times higher, and the vaccine greatly reduces the risk of death. During treatment, the vaccine may protect a little less than usual, but it always protects.

Two kinds of vaccine

• Inactivated vaccines (made with the killed germ or just a piece of it). They are safe during treatment. Examples: flu, COVID-19, pneumococcal, hepatitis B, tetanus and whooping cough, HPV and shingles (herpes zoster).
• Live vaccines (made with a live but weakened germ). They should not be given during treatment, because they can cause the disease itself in someone whose defenses are low. Examples: yellow fever, MMR (measles, mumps and rubella), chickenpox, dengue and the oral polio drops.

When to get them

• The best time is before treatment starts: inactivated vaccines ideally at least two weeks before, and live vaccines about a month before, if they are needed.
• During treatment, inactivated vaccines can be given. Sometimes a dose needs to be repeated later.
• After treatment, live vaccines should be given only at least three months after the end of chemotherapy or radiation therapy, and with your team's approval.
• If you have a fever or very low defenses on your blood test, the vaccine should be postponed.

The most important vaccines

• Flu: every year. From age 60, there is a higher-dose version that protects better.
• COVID-19: every year, free through SUS, Brazil's public health system, for people with cancer.
• Pneumococcal: protects against pneumonia and meningitis. The schedule depends on which ones you have already had; your team will advise you.
• Shingles (herpes zoster): for people over 50, or from age 18 for those with weakened immunity. Two doses. Available at private clinics.
• Hepatitis B: a reinforced schedule, with a blood test afterwards to confirm protection.
• Tetanus, diphtheria and whooping cough: keep these up to date.
• HPV: three doses, for those in the recommended age range.
• Respiratory syncytial virus (RSV): a new vaccine for people aged 60 or older, given as a single dose.

Your family needs vaccines too

The people who live with you or care for you should keep their vaccines up to date, especially flu, COVID-19 and whooping cough. That way, they don't bring infections into the home.

• Family members can receive live vaccines, such as MMR and chickenpox. Only the oral polio drops should be swapped for the injectable version.
• If someone in the household gets the chickenpox vaccine and small blisters appear on their skin, they should avoid close contact with you until the spots dry up.

Where to get them

Many vaccines are available at public health centers. Others, recommended especially for people with cancer, are given at the CRIE (Reference Centers for Special Immunobiologicals, part of Brazil's public system), found in every state. To use a CRIE, you need a referral from your doctor. Some vaccines, such as shingles and RSV, are available only at private clinics.

Bring this guide to your next appointment and ask your team to review your vaccination record. Ideally, do this right at diagnosis, before treatment begins.

For information only. Your vaccine schedule should be set with your care team.