Flu Shots During Breast Cancer Treatment

Is Influenza Immunization Safe During Chemotherapy?

Can you get a flu shot during breast cancer treatment?. Istockphoto.com/Stock Photo©Brian McEntire

Can you get a flu shot during cancer treatment?  One breast cancer survivor asked this question:

I had chemo and radiation treatments for breast cancer, and I still have neutropenia. Can I get a seasonal flu shot?

-- Heather Carr

Recovering from cancer treatments is hard enough, but avoiding the flu should be fairly easy if you take the right steps. Knowing your health situation is important to making the decision about flu vaccines.

Be sure to take simple precautions to guard against flu germs, in any case.

Flu Shots During Cancer Treatment

Flu shots can be safe, and even recommended during cancer treatment, but type and timing deserve a few words of discussion.

Importance of Influenza Prevention for Cancer Patients

Influenza can be a serious disease for people going through cancer treatment.  As it stands, in the general population between 10 and 30% of people will develop influenza A or B each winter, and of these, roughly 200,000 will be hospitalized.

When your immune system is low due to neutropenia, you are more at risk for infections. Your body will have a harder time fighting back against germs and bacteria - including the flu virus.  We don't know if people going through cancer treatments such as chemotherapy are more likely to catch the flu, but we do know that the infection can be more serious than if you were otherwise healthy.

For most immunizations, it's best to wait until you are through with treatment, but with the flu that isn't always a choice.  Since the flu virus is seasonal, there is a best time to receive the shot (usually in the fall months), and you must be immunized each year to keep up with changes in the flu virus which occur.

  Knowing that the flu vaccine is important, there are several things to consider, and it's very important to talk to your oncologist before getting immunized.

Don't Spray Your Flu Away - Choose the Right Vaccine

There are 3 choices in general for influenza vaccination.  These include:

  • Nasal spray flu vaccine (FluMist) - The U.S. Department of Health & Human Services recommends that anyone with a weakened immune system avoid the nasal spray flu vaccine. The nasal spray form of flu vaccine contains weakened, but live flu viruses (called attenuated viruses) and could in theory cause an infection in people who have immune systems that are compromised.
  • Traditional flu shot - The traditional flu shot is recommended for people over the age of 6 months, and is given into a muscle.  The 3 types of flu shots available all contain killed viruses, and therefore would not cause someone to develop influenza.
  • Intradermal flu shot - In 2011 a new vaccine became available for healthy people between the ages of 18 and 49.  This vaccine is given intradermally (just under the skin) rather than into a muscle, and uses a shorter needle.  Due to dysfunction of the immune system during chemotherapy, this is not the best choice for most people in cancer treatment.
  • High dose flu shot (Flu-Zone High Dose) - Flu-Zone is a high dose influenza vaccine that has been approved for people over the age of 60.  Some studies suggest that this vaccine might be the one of choice for people going through chemotherapy as it may provide better protection against the flu.

Talk to your oncologist before getting a flu vaccine, and ask which immunization she would recommend and if it is compatible with your treatment.

Why the Concern About Flu Shots for Cancer Patients

As long as the live virus vaccine (nasal spray) is not used, there is little concern of the vaccine causing infection or serious side effects.

  The main concern is that if the vaccine is given when the immune system if functioning poorly it may not be effective.  In other words, the immunization may not result in your body creating antibodies to protect you from the flu virus when you are exposed in the future.

The flu shot is okay in being a killed virus, but the intradermal flu shot may not "be strong enough" for someone going through cancer treatment.  It's still a little early to know for certain, but it appears that the high dose flu shot may do a better job of creating immunity for people coping with cancer.

Flu Shots and Chemotherapy

It's usually recommended that a flu shot be given 2 weeks prior to beginning chemotherapy.  If that isn't possible, ask your doctor what she recommends.  There has been thought about giving the vaccine as far out from chemotherapy as possible between cycles, but this is an active area of research.

Keep in mind that the flu shot may not be as effective if you are receiving chemotherapy.  For example, if you are taking daily oral Cytoxan, which is very suppressive of T cell function, the flu vaccination is not likely to help you. But if you're having one of the taxanes – Taxol, Docetaxel – your immune system should respond well to the flu shot.

Flu Shots and Surgery

The flu shot isn't considered to be harmful if given prior to surgery, so if you've noticed a lump, or are in the process of checking out an abnormal mammogram don't worry about getting a flu shot.

Flu in Contacts

It's often overlooked that contacts -- especially children -- of people with cancer can benefit from being immunized against the flu.  Exposure to contacts who have been given the flu shot isn't usually a problem.  Due to being a live but weak virus, contacts should inquire before receiving the flu nasal spray, especially contacts of people who will be going through high dose chemotherapy.

Exposure Recommendations

If you didn't get a flu shot, don't panic.  There are medications which can decrease the symptoms of the flu if started quickly enough in the process.  If you've been exposed to someone who has the flu (with exposure meaning closer than 6 feet of distance between you) call your doctor.  She may recommend a medication to prevent the flu.  If you have symptoms of a flu infection such as a fever, sore throat, a cough, or body aches, call as well, and ask if you should receive a medication to help shorten your illness.

General Flu Prevention Tips

Any infection, including the flu, can be of concern during chemotherapy and other cancer treatments.  Practice infection prevention techniques such as:

  • Careful hand washing.  Many people do not wash their hands in a way that adequately prevents against infection.  Check out these hand washing tips for lowering the risk of infection.
  • Avoid people who are sick.  If friends are sick, ask that they delay their visit until their symptoms have subsided.
  • Avoid crowded malls and other places in which you will have close contact with others.
  • Consider wearing a mask when out and about, or when you visit your doctor's office.

Check out these tips of reducing your risk of infection during chemotherapy.


American Cancer Society. Should I Get a Flu Shot? Updated 07/21/14. http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/infectionsinpeoplewithcancer/should-i-get-a-flu-shot

American Society of Clinical Oncology. Cancer.Net Should I Get a Flu Shot? 10/02/14. http://www.cancer.net/blog/2014-10/should-i-get-flu-shot

Centers for Disease Control and Prevention. Preventing Infections in Cancer Patients. Updated 09/30/15. http://www.cdc.gov/cancer/flu/

Eliakim-Raz, N., Vinograd, I., Zalmanovici-Trestioreanu, A., Leibovici, L., and M. Paul. Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database of Systematic Reviews. 2013. 10:CD008983.

Jamshed, S., Walsh, E., Dimitroff, L., Santelli, J., and A. Falsey. Improved immunogenicity of high-dose influenza vaccine compared to standard-dose influenza vaccine in adult oncology patients younger than 65 years receiving chemotherapy: A pilot randomized clinical trial. Vaccine. 2015 Dec 22. (Epub ahead of print).

Vinograd, I. et al. Clinical effectiveness of seasonal influenza vaccine among adult cancer patients. Cancer. 2013. 119(22):4028-35.

Wumkes, M. et al. Serum antibody response to influenza virus vaccination during chemotherapy treatment in adult patients with solid tumours. Vaccine. 2013. 31(52):6177-84.

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