Issues in Chemotherapy

1. Elizabeth A. Van Dyne, MD 1. Kaiser Permanente Medical Center Los Angeles, CA 1. 1. Pickering LK, 2. Baker CJ, 3. Kimberlin DW, 4. Long SS Immunizations in Special Clinical Circumstances . American Academy of Pediatrics. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed.Elk Grove Village, IL: American Academy of Pediatrics; 2009:72–86 2. 1. Pickering LK, 2. Baker CJ, 3. Kimberlin DW, 4. Long SS Varicella-Zoster Infections. American Academy of Pediatrics. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed.Elk Grove Village, IL: American Academy of Pediatrics; 2009:714–727 3. 1. Meckler G, 2. Lindemulder S Fever and Neutropenia in Pediatric Patients with Cancer . Meckler G, Lindemulder S. Emerg Med Clin North Am. 2009;27:525–544 [OpenUrl][1][CrossRef][2][PubMed][3] 4. 1. Hughes WT, 2. Armstrong D, 3. Bodey GP, 4. et al 2002 Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer . Hughes WT, Armstrong D, Bodey GP, et al. Clin Infect Dis. 2002;34:730–751 [OpenUrl][4][FREE Full Text][5] Children who have cancer may be severely immunocompromised by the oncologic process and the immunosuppression that results from chemotherapy. Their increased susceptibility to infection directs the scheduling of vaccine administration and the urgent treatment of the febrile child. Live (attenuated) vaccines should not be given to patients undergoing immunosuppressive therapy, specifically chemotherapy and radiation treatment. Live vaccines include those manufactured to protect against Salmonella typhi ; influenza (live intranasal vaccine); measles, mumps, rubella (MMR); varicella; rotavirus; polio (oral vaccine); yellow fever; and smallpox. The recommendation is to wait at least 3 months after completion of the last immunosuppressive treatment before administering live vaccines, and many oncologists wait 6 to 12 months. Because the time to immune reconstitution depends on the type of chemotherapy given, the dosage, and the patient's degree of responsiveness to treatment, the recommendations must be tailored to the individual patient and his or her circumstances. Vaccination with inactivated vaccines can be completed without increased risk of infectious complications, but the timing is important because the immune response may be inadequate in immunocompromised patients. An adequate response is usually achieved from 3 months to 1 year following the … [1]: {openurl}?query=rft.jtitle%253DEmergency%2Bmedicine%2Bclinics%2Bof%2BNorth%2BAmerica%26rft.stitle%253DEmerg%2BMed%2BClin%2BNorth%2BAm%26rft.aulast%253DMeckler%26rft.auinit1%253DG.%26rft.volume%253D27%26rft.issue%253D3%26rft.spage%253D525%26rft.epage%253D544%26rft.atitle%253DFever%2Band%2Bneutropenia%2Bin%2Bpediatric%2Bpatients%2Bwith%2Bcancer.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.emc.2009.04.007%26rft_id%253Dinfo%253Apmid%252F19646652%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/j.emc.2009.04.007&link_type=DOI [3]: /lookup/external-ref?access_num=19646652&link_type=MED&atom=%2Fpedsinreview%2F32%2F2%2F86.atom [4]: {openurl}?query=rft.jtitle%253DClin%2BInfect%2BDis%26rft_id%253Dinfo%253Adoi%252F10.1086%252F339215%26rft_id%253Dinfo%253Apmid%252F11850858%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/ijlink?linkType=FULL&journalCode=cid&resid=34/6/730&atom=%2Fpedsinreview%2F32%2F2%2F86.atom