Humoral immunity to diphtheria, tetanus, measles, and hemophilus influenzae type b in children with acute lymphoblastic leukemia and response to re‐vaccination

Abstract

ObjectiveLoss of immunity to previous vaccination and timing of re‐vaccination in children receiving chemotherapy remains controversial. The aim of this study was to investigate the immunity to vaccine preventable diseases in children with acute lymphoblastic leukemia (ALL).ProcedureSixty‐one patients with ALL and 13 healthy siblings were enrolled. Three study groups included newly diagnosed patients (group 1), patients on maintenance chemotherapy (group 2), and patients that completed chemotherapy (group 3). Blood samples for baseline antibody titers were obtained from all the patients and controls. Patients in group 2 were vaccinated with diphtheria, tetanus, and hemophilus influenzae type b (Hib). Patients in group 3 and controls received the measles vaccine in addition to all the above vaccines. In groups 2 and 3, post‐vaccination antibody titers were also obtained.ResultsPatients and controls had no Hib vaccine during primary vaccination. After chemotherapy median antibody levels against diphtheria, tetanus, measles, and Hib were decreased but tetanus antibodies were still at the protective levels. Proportions of the patients with protective levels were 11.1%, 83.3%, 16.7%, and 16.7% for diphtheria, tetanus, Hib, and measles, respectively. Vaccination achieved protective antibody levels in 81%, 100%, 89.5%, and 70% of the patients for diphtheria, tetanus, Hib, and measles, respectively. Vaccine responses during maintenance were also satisfying.ConclusionWe recommend re‐vaccination after 3 months of cessation of chemotherapy. Administration of Hib vaccine may be beneficial after the first 3 months of maintenance chemotherapy especially in children with no primary vaccination followed by a second booster dose after cessation of therapy to increase immunity. Pediatr Blood Cancer 2009;53:967–972. © 2009 Wiley‐Liss, Inc.

Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients

“…There is limited experience on the use of vaccinations for Pneumococcus, Haemophilus, and Meningococcus [55–61]; in one case, a failure is reported [62]. Effective prevention remains based on prompt antibiotic treatment of febrile at-risk patients and isolation measures to prevent contact especially during periods of severe neutropenia.…”

Antibody responses to Hepatitis B and measles-mumps-rubella vaccines in children who received chemotherapy for acute lymphoblastic leukemia

“…A pilot study conducted in a country with a low-risk profile suggested a single booster dose should be applied six months after concluding chemotherapy (9) , but other authorsrecommend re-starting the vaccination protocol from the beginning three months after the end of treatment, followed by subsequent booster doses (10) . This study aimed to evaluate the antibody levels associated to potential protection against viral vaccine antigens to the hepatitis B and measles-mumps-rubella (MMR) vaccines in children treated for ALL after cessation of chemotherapy and after the application of a booster dose.…”

Surto de sarampo na regiao metropolitana de Campinas, SP

“…Patients with leukemia can have diminished levels of antibodies against vaccine antigens after chemotherapy. 1,5 There were some limitations to the active search, mainly concerned with losses associated with impossibility of establishing contact by telephone, refusals to respond to the questionnaire or access to doctors' notes. The individuals were interviewed up to three months after the symptoms, which could result in memory bias.…”