Cesaro Simone, Giacchino Mareva, Fioredda Francesca, Barone Angelica, Battisti Laura, Bezzio Stefania, Frenos Stefano, De Santis Raffaella, Livadiotti Susanna, Marinello Serena, Zanazzo Andrea Giulio, Caselli Désirée
Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Ospedale Borgo Roma, P.le L.A. Scuro 10, 37134 Verona, Italy.
Paediatric Hematology Oncology, Regina Margherita Hospital, P.zza Polonia 94, 10126 Torino, Italy.
Biomed Res Int. 2014;2014:707691. doi: 10.1155/2014/707691. Epub 2014 Apr 29.
Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children.
A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed.
During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.
疫苗接种是预防传染病的最重要工具。化疗引起的免疫抑制可能会影响儿童疫苗接种的效果。
意大利儿科血液肿瘤学协会（AIEOP）支持性护理工作组的一组专家通过关于儿科癌症患者疫苗接种的指南解决了这个问题。对1980年至2013年间发表的文献进行了综述。
在强化化疗期间，疫苗接种对甲型和乙型肝炎有效，而类毒素、蛋白质亚基或细菌抗原疫苗接种应推迟到强度较低的阶段，以获得足够的免疫反应。在此阶段，除水痘外，不建议接种减毒活疫苗。家庭成员应按照推荐的疫苗接种计划进行接种，包括类毒素、灭活疫苗（也包括脊髓灰质炎疫苗）和减毒活疫苗（水痘、麻疹、腮腺炎和风疹疫苗）。在化疗结束时，有报告称针对疫苗可预防疾病的血清抗体水平不足，而免疫记忆似乎得以保留。一旦免疫恢复完成，通常在6个月后，对加强免疫或疫苗接种的反应通常良好，这使患者能够得到保护，也有助于群体免疫。
