Cancer and Vaccines: Am I Protected During an Outbreak?

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Topics include: Self-Advocacy and Empowerment

With the resurgence of measles, cancer patients with compromised immune systems are concerned about their risk of exposure to the highly contagious illness. How can people living with cancer protect themselves against the recent outbreak? Is revaccination recommended? Tune in to hear expert Dr. Sasha Stanton share what patients need to know about measles, immunity and vaccines to help prevent serious infections.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

And greetings from Southern California.  I'm Andrew Schorr with Patient Power.  And with me is one of my dear patient advocacy friends, Cherie Rineker, who is joining us from Lake Jackson, Texas, near Houston.  Cherie, welcome back to Patient Power. 

Cherie Rineker:

Hey, Andrew.  I'm so happy to be invited back again. 

Andrew Schorr:

So, Cherie, you and I were talking as we were all watching the news about the epidemic we're worried about related to measles when we thought it was wiped out.  You have children, we have children, our viewers, many of them, have children, and we wondered as cancer patients how does all this affect us.  And as I recall, when you were growing up you and your mom, you were not into medical care at all, right? 

Cherie Rineker:

My mother—yes, Andrew.  My mother was not at all based on her religious beliefs.  It was either prayer or nothing, and I believe when we were young she wasn't really into it.  So we did get some of her earlier ones, but I remember some shots that other kids got around 11, 12, and we didn't get them, and I didn't like that at that time, and it was not my choice. 

But after I left home and I got back into holistic medicine, I did kind of follow that route but instead of from a religious point of view more from what the holistic schools were teaching me, that shots and immunization was bad. 

Andrew Schorr:

Okay.  So there are people who still wonder about that and often cite data that is not reliable or proven, and so now here we are with measles again.  But as cancer patients, and you as a myeloma patient, we've been through transplant and CAR T.  Me, who gets, like you, IVIG and all this to boost our immune systems, we wonder are we at risk of measles or whatever else or what—how do we protect ourselves. 

So joining us is an expert in that.  And joining us from Seattle, Washington, and the University of Washington is Dr. Sasha Stanton, who actually is doing research related to vaccines particularly for cancer patients.  Welcome, Dr. Stanton. 

Dr. Stanton:

Hi.  How are you both? 

Andrew Schorr:

Well, fortunately, we're doing okay, but like many cancer patients this whole measles concern brings all of this deal about immunity up for us.  So when we develop cancer, and you're a medical oncologist, our immune system has let us down, right? 

Dr. Stanton:

Absolutely.  And in all kinds of cancers we are believing that your immune system is letting you down.  Even—my cancer is breast cancer, but breast and ovarian, some of that is that your body has not caught those tumors and gotten rid of them with your immune system. 

Andrew Schorr:

Okay.  So here we've got measles, but all kinds of infections, how do we protect ourselves?  I mean, there's debate whether we should have live vaccines or not.  You know, shingles vaccine, should we have measles booster shots.  And I'll just throw into it, what if somebody, and Cherie has got through transplant, what about if you've had a transplant for one of the blood?related cancers?  Do you need all your shots again, and what shots should you get?  So help us understand about protecting ourselves. 

Dr. Stanton:

So—and talking to both of you I understand that you guys are pretty up on vaccines, live vaccines and activated vaccines, but when you—first of all, when you're just looking at basic cancer—should never say basic.  When you're looking at cancer patients, patients who are like my breast cancer patients getting chemotherapy, they actually—it doesn't affect their immunity.  So if you were vaccinated as a child with measles, measles, mumps, rubella, with all of the childhood vaccinations, you should be fine with the current measles vaccine.  And if you have any concerns you can ask your oncologist or your primary care doctor to check titers and see if you still have that immunity or not. 

Andrew Schorr:

I had that, and I still did have immunity. 

Dr. Stanton:

Fantastic.  So transplant gets into another issue.  So with transplant, either autotransplant where you get your own cells back or allotransplant where you get somebody else's cells, you now have had a lot more chemotherapy than we typically would give for breast cancer, for ovarian cancer or for transplant.  And with that you do need to redo some of your vaccines and it is typically depending on how far out from a transplant you are.  And each of the centers may have their rules for that.  With our center we want you—we can give you the inactive vaccines within that first—after that first year.  Some centers say six months to a year. 

The live vaccines, you need to be off of immunosuppression for aloe, so you would need to be farther out, more like two years out.  For autos, it's usually you get the inactive, and then about two years out you start getting the live vaccines, you can start getting the live vaccines again. 

Andrew Schorr:

Okay.  I do have a question just related about measles for a second.  Some people have said, though, and maybe even with a flu vaccine, well, if our immune system is not so great do we need a booster or do we need even more than one shot? 

Dr. Stanton:

So that is where getting that vaccine during chemotherapy can be an issue because if you're too close to when you've had your immune system not fantastic you're not going to get a great response if you do get vaccinated.  So with patients who are getting chemo, again, like colon cancer, breast cancer, really, the recommendations from the CDC is wait for about three months after chemo before getting a vaccine. 

If you were exposed to measles we also have measles antibody that can be given, and that is a path of immunity to try to address if you have no immunity and need to be acutely treated when you're exposed.  But the immunosuppressed patient should not be getting vaccinated, particularly with measles because it is a live vaccine. 

Andrew Schorr:

Okay.  What about—I mentioned shingles.  So there's a shingles vaccine now, shingles shot.  So what about that?  And help us understand this deal about whether something is live or killed as a vaccine. 

Dr. Stanton:

Absolutely.  So the killed vaccine is giving you the virus, parts of the virus, not an actual active virus that needs to replicate to get an immune response.  Live vaccines are actually giving you virus that has to grow a little in your body to induce that immune response, and that's where if your immune system isn't good enough to control it on its own the concern is that you would have a lot of complications from having a virus that is still living. 

Now, having said that, and I've looked this up recently because one of my breast cancer patients has a two?year?old and needed—her daughter was needed to get her MMR, if you live in a household with a patient who is immunosuppressed you can still get the vaccine.  So her daughter is still on schedule and got her vaccines as planned. 

Andrew Schorr:

Okay.  So, Cherie, you were recently on a flight from Colorado, and you fly around, I've been to other places in the country with you, do you worry in your health condition with myeloma about just being around a lot of people in a big steel tube? 

Cherie Rineker:

Yes, I do, and as a past flight attendant I know the circulated air and everything, and I would say about 70 or 80 percent of the time I'd come home with RSV, acute bronchitis twice in the last four months, so being around people is a—can be a scary thing.  But I also don't want to stop living my life and just live it on the couch to try and be safe. 

Andrew Schorr:

So there we go.  And, Dr. Stanton, so first of all, with this population of cancer patients, people like me, people like Cherie who are watching this, everybody's different.  Some people are in active treatment, some people aren't, but what would you say, should we??sounds like with measles if you're worried about it get the titer test, which we did, simple blood test, and they'll tell you whether you have immunity. 

And then, other kinds of things we should be doing?  I mean, hand washing is not going to cut it to avoid measles, right?  But for a lot of other things it will, right? 

Dr. Stanton:

Absolutely.  And, Cherie, you're absolutely correct.  Never just stop living because living is the most important thing you can do.  You should definitely be getting your flu shots and your pneumonia shots.  Make sure you're up to date on those.  Again, I often have to say for my patients who are immunosuppressed because they're on active chemotherapy not to get a flu shot where you're also having active chemotherapy.  It's not that it will hurt you, it's just that it may not be as effective because you're immunosuppressed. 

But the other thing to consider is absolutely for the flu and for RSV, wash your hands.  If you know that somebody is sick, try not to kiss them on the mouth or share drinks with them.  I mean, all the, unfortunately, recommendations we have to give you when you're on chemo, following those still. 

Andrew Schorr:

What do you tell patients who are traveling about masks?  Because if I'm in LAX up the road from me in San Diego, and I'm watching Asian people come off a flight from China, most of the young people have been wearing a mask on the flight.  Should we as cancer patients be wearing masks? 

Dr. Stanton:

I usually don't make my cancer patients wear masks.  It's interesting where—I did residency at Memorial Sloan Kettering, and on our transplant floor at Sloan we had the providers wearing masks because really what you're trying not to do is have someone coughing on you with a virus more than the mask helping you.  I don't necessarily understand why all the Asians wear it, and I see it too, that that's what they're doing, because usually when we mask up people it's because we don't want your secretions getting out into the rest of our population. 

So on an airplane, though, I have changed places with people if someone is—I know someone is a cancer patient because their hair is gone or—and there's someone coughing up along next to them, I just figure get them out of the direct contact.  My immune system can handle it. 

Andrew Schorr:

Okay.  But going back to measles for a second, it doesn't sound like you have a big worry.  In other words, many of us will, hopefully, will have been revaccinated if we had transplant for instance, or we may well have the titer because we had measles when we were younger, right? 

Dr. Stanton:

Exactly.  So for a lot of the chemotherapies outside of transplant what you need to get for a strong immune response is you need memory T cells.  So those are lymphocytes that are able to—they've seen either measles as a child or they've seen the vaccine and then they are able to, if they ever see it again, activate and kill it.  And most of the chemotherapies that we give, colon, lung, breast, don't destroy those memory T cells.  So as long as you have titers, you're fine. 

Some people born before—or who were growing up before 1970 may not have had a second measles booster as a child, and that's where you hear some people in the news saying they don't have immunity or they've lost immunity, and there are rare people who don't have immunity.  They just for some reason don't respond to the vaccine, and this is in the normal population.  But if you have had your vaccine as a child and your second booster at about 10 or 11 years old and you've not had a bone marrow transplant or are on chemotherapy that affects your T cells particularly, you should be okay. 

Andrew Schorr:

Okay.  That's the measles story.  Now, so, Cherie, you made this transition from, I don't know whether you would have called yourself an anti-vaxxer, but you definitely were not pursuing a lot of medical care and shots and things like that.  And even for your own daughter it took you a while to get around for her to have the HPV shots, right? 

Cherie Rineker:

Yeah, yeah.  I called myself a concerned vaxxer.  I was a conservative vaxxer, so I started a little bit later with my daughter and I spaced them out a little bit because my son had gotten the chickenpox, and I didn't realize that that could lead to shingles later in life, and I knew that that can kill.  And believe me, there was junk in the shots that I didn't want my kids to have.  I chose not to do it to her at first, but then later on I was persuaded to do it.  And with the SPV I was reluctant until my oncologist got very stern with me and said, Cherie, they finally got something to help not only with one but I believe two or three different…

Andrew Schorr:

The HPV, right? 

Cherie Rineker:

…give that to your daughter.  And I ran that by my daughter who said, a shot versus cancer, hmm.  Mom, I'll take the shots.  So we did that. 

Can I ask a quick question? 

Andrew Schorr:

Sure, please. 

Dr. Stanton:

CAR?T, so my mom probably never got me the second measles because—I probably got the first but not the second.  Then I was on a CAR T, which basically destroyed all my own T cells and gave me back CAR?T cells, and I've been so immunocompromised even a year after doing chemo that I still was borderline neutropenic.  So would immunization help me even with the lack of T cells and the lack of immunity that I have? 

Dr. Stanton:

I would say for CAR T particularly because it's so new and we're still trying to figure out particularly when you lose all your B cells knowing what that is doing.  B cells are a different population than memory T cells but also very important for developing and maintaining your immunity.  I would have your oncologist check your titers.  I would be a little worried yours would be low, and then talk to them about where you are with your immunosuppression and how far—whether you need to be revaccinated or can be revaccinated, depending on comfort.  CAR T is a tough one because it's so new. 

Andrew Schorr:

Well, folks, so most of us who are watching have been poked for blood tests a zillion times.  I bet I've had a thousand pokes, you probably too, Cherie, and so—especially with a blood cancer.  So if it's another poke to get the titers and understand where you are now, ask your doctor for that, and it can hopefully give you some confidence that you're doing okay. 

Going forward I just want to mention that what Dr. Stanton is working on in research at the University of California is developing vaccines that can help either prevent some types of breast cancer or recurrence of breast cancer, and they're looking at it, I think you told me, in ovarian cancer, maybe so others, so thank you for what you're doing.  And she's heavily into shots, vaccines and your immune system, but I think for those of us, ask your own doctor, it's always a good thing, do you need a titer checked to see where you are. 

And then the other advice, and if you have a child, I'll let you be on your soap box just a second, Dr. Stanton, many of the people in the medical community have just really been preaching how important it is for children to be vaccinated.  What would you say? 

Dr. Stanton:

Absolutely.  Absolutely.  Because of the importance of herd immunity and particularly for people who—well, first of all, so your child doesn't get measles, mumps, rubella, HPV.  I mean, those are very active things you can do to try to prevent cancer in your child and to prevent very devastating side effects of the viruses that we've gotten rid of. 

But the other importance is that herd immunity.  Basically if you keep about 95 percent of the population vaccinated, that 5 percent that can't get vaccinated, so the babies, the children who have leukemia and have had to have a bone marrow transplant, the adults that have had leukemia or a lymphoma and have had to have a bone marrow transplant, that really keeps them safe as well, vaccinating and making sure that the people who can be vaccinated have immunity and aren't getting these diseases. 

Andrew Schorr:

Right.  And that's not what's happening now, unfortunately, by choices that some families have made where people are exposed to a very contagious condition and getting it. 

Well, Dr. Sasha Stanton from the University of Washington, vaccine researcher, thank you so much for being with us.  Cherie, thanks for suggesting this topic, and all the best to you, Cherie.  We'll be back together again.  And hopefully we've answered some questions, and I just want to mention for our viewers, if you ever have things you're wondering about, just like Cherie was, write us, comments@patientpower.info.  Just send it, and we'll do our best to find an expert like Dr. Stanton. 

Cherie, anything else from you? 

Cherie Stanton:

I just want to say next Wednesday I'm seeing Dr. Lasky, and I'm having my titers checked.  Is that what it's called? 

Andrew Schorr:

There you go.  Okay, Dr. Barbara Lasky at MD Anderson, one of our favorites.  Thank you so much, both of you, for being with us.  In San Diego with Cherie in Lake Jackson, Texas, and also Dr. Stanton in Seattle, I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on August 20, 2019