Geneva University Hospitals, Faculty of Medicine.
Pediatric Oncology and Hematology Unit, Department of Women, Child and Adolescent, University Hospitals of Geneva.
J Pediatr Hematol Oncol. 2024 Jan 1;46(1):e51-e59. doi: 10.1097/MPH.0000000000002774. Epub 2023 Nov 3.
Children lose their vaccine-induced protection and are particularly vulnerable to vaccine-preventable diseases after chemotherapy. However, revaccination guidelines are heterogeneous, and there is often a lack of revaccination post-treatment.
We conducted a retrospective study of children with hematologic cancer to evaluate vaccine immunity before and after the end of treatment and to determine whether the current institutional revaccination program based on vaccine serology results was followed and effective.
Data of all children treated by chemotherapy between April 2015 and July 2021 were extracted from hospital medical records for analysis. Serum antibody levels and time of vaccination were evaluated for diphtheria, tetanus, Streptococcus pneumoniae , Haemophilus influenzae type b (Hib), measles, varicella, and hepatitis B.
We included 31 patients (median age, 9 years). At cancer diagnosis, 90% of children were protected against tetanus, diphtheria, and measles; 65% to 67% were protected against pneumococcus and varicella; and 25% against hepatitis B. At the end of chemotherapy, 67% to 71% of patients were protected against tetanus, varicella, and measles; 40% remained protected against hepatitis B; and 27% to 33% against pneumococcus and diphtheria. Patients were revaccinated at various times after the end of treatment but not systematically. During the first-year post-treatment, 20% to 25% of children remained unprotected against pneumococcus, measles, and hepatitis B, one third against diphtheria, but all were protected against tetanus and varicella.
An effective individualized vaccination program post-cancer based on serology results should be accompanied by an appropriate serology tracking method and follow-up to assess if booster doses are necessary. Our study supports vaccinating all children with a dose of the 13-valent pneumococcal conjugate at cancer diagnosis and at 3 months post-treatment with the combined diphtheria-tetanus-acellular pertussis/poliomyelitis vaccine/hepatitis B virus plus or minus Hib and 13-valent pneumococcal conjugate and meningococcal vaccine, including measles/mumps/rubella-varicella zoster virus vaccine if good immune reconstitution is present.
儿童在化疗后会失去疫苗诱导的保护，特别容易感染可通过疫苗预防的疾病。然而，疫苗再接种指南存在差异，并且治疗后通常缺乏再接种。
我们对患有血液系统恶性肿瘤的儿童进行了一项回顾性研究，以评估治疗前后的疫苗免疫情况，并确定是否遵循并有效实施了基于疫苗血清学结果的当前机构再接种计划。
从医院病历中提取 2015 年 4 月至 2021 年 7 月期间接受化疗的所有儿童的数据进行分析。评估白喉、破伤风、肺炎链球菌、流感嗜血杆菌 b 型（Hib）、麻疹、水痘和乙型肝炎的血清抗体水平和接种时间。
我们纳入了 31 名患者（中位年龄 9 岁）。在癌症诊断时，90%的儿童对破伤风、白喉和麻疹有保护作用；65%至 67%对肺炎球菌和水痘有保护作用；25%对乙型肝炎有保护作用。在化疗结束时，67%至 71%的患者对破伤风、水痘和麻疹有保护作用；40%对乙型肝炎有保护作用；27%至 33%对肺炎球菌和白喉有保护作用。患者在治疗结束后不同时间进行了再接种，但不是系统地进行。在治疗后第一年，20%至 25%的儿童仍然对肺炎球菌、麻疹和乙型肝炎没有保护作用，三分之一对白喉没有保护作用，但所有儿童对破伤风和水痘有保护作用。
应根据血清学结果为癌症后儿童制定有效的个体化疫苗接种计划，并辅以适当的血清学跟踪方法和随访，以评估是否需要加强剂量。我们的研究支持在癌症诊断时以及治疗后 3 个月为所有儿童接种一剂 13 价肺炎球菌结合疫苗，并在免疫重建良好的情况下接种联合白喉-破伤风-无细胞百日咳/脊髓灰质炎疫苗/乙型肝炎病毒加或不加 Hib 和 13 价肺炎球菌结合疫苗和脑膜炎球菌疫苗，包括麻疹/腮腺炎/风疹-水痘带状疱疹病毒疫苗。
