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Practical revaccination guidelines for Bangladeshi children with cancer treated with cancer chemotherapy- A proposal

Journal of Pediatrics & Neonatal Care
Ashis Kumar Ghosh, SM Rashed Zahangir Kabir, Abu Naser Mohammad Al-Amin, Farha Diba, Ismot Ara Zannat, Farida Yasmin, Marufa Akter Panna, Syeda Sharmin Ara

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Introduction: Childhood cancer may be immunocompromised as a result of the primary disease itself and the use of intensive chemotherapy (CT) with or without radiotherapy (RT). The damage to the immune system varies with the age of the patient, the type of cancer, and the type of CT used to treat it. Children with cancer need to be immunized against the common vaccine-preventable diseases after completion or during ongoing treatment of cancer. However, the immunization schedule for these children needs to be developed in our country. There are many guidelines from around the world to address this issue, however, there is no such comprehensive guideline from Bangladesh for the needs of our children with cancer. The aims of this paper will be to address the rationale, methodology, relevant literature review, and process of development of updated guidelines for the vaccination of pediatric cancer patients. This document will help the pediatric oncologist and vaccine experts to prepare a contemporary revaccination guideline for the children of Bangladesh, which will help pediatricians to choose the best immunization program against vaccine-preventable diseases in children with cancer. Objective:To review the current evidence on the revaccination of children and advice the best guidelines which are used in foreign countries for immunization of children with cancer. To inform the policy of immunization practices for contracts. Methodology: Reviewing the available literature, especially those pieces of literature and guidelines from developing nations, a proposal has been drafted for Bangladeshi children. This proposal has mentioned guidelines used in developed and developing countries, which will help to generate a nationally relevant guideline for immunization of children with cancer. This proposal does not mention an immunization plan for children treated with targeted therapy, immunotherapy, or Bone Marrow Transplantation (BMT). Proposal: Most of the available guidelines mentioned live vaccines are contraindicated during and up to 6 months after the chemotherapy. Non-live vaccines are also best given after 6 months. Annual inactivated influenza vaccine is recommended during chemotherapy whereas hepatitis B vaccine is recommended only for previously unimmunized children. Post-treatment re-immunization or catch-up schedule largely depends on the prechemotherapy immunization status. Sibling immunization should continue uninterrupted except for the oral polio vaccine which needs to be substituted by the injectable vaccine. Inactivated influenza vaccine is recommended and varicella vaccine is encouraged for all contacts including siblings.


BCG, bacillus calmette-guerin; OPV, oral polio vaccine; MMR, mumps measles rubella; HAV, hepatitis A vaccine