What Should CLL Patients Know About Vaccines?

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Topics include: Living Well

Should CLL patients get vaccinations?  Are there risks involved?  Andrew Schorr asks Dr. Nicole Lamanna, of Columbia University Medical Center, about flu, pneumonia and shingles vaccinations.  Dr. Lamanna suggests: “Don’t worry. Be Smart. Be preventative.”  Dr. Lamanna discusses when to get vaccinated, when to be cautious, and how to be smart about your decisions. 

Provided by CLL Global Research Foundation, which received support from AbbVie Inc., Genentech Inc., Gilead Sciences, Janssen Pharmaceuticals, Inc., Pharmacyclics, Inc. and Teva Pharmaceuticals.

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Transcript

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:   

But one burning question we get all the time, Nicole, I want to ask you, especially this time of year, vaccines, flu shot, shingles.

Give us the scoop on that for us.

Dr. Lamanna:      

I was just going to bring it up to follow up what Michael was saying.  So I, too, encourage my folks that go on vacation. I often say that since we’re the CLL folks, let us worry about your CLL while you’re actually enjoying vacation. I say that I have to actually live vicariously through many of my patients who are going away a lot more than I am. So I want you to enjoy your lives. And so I encourage that. And I agree. If I think they’re going somewhere where they may not have access, I give them names and make sure they have a stash of antibiotics to take with them and that they know where to go.

But the point is not to worry.  That isn’t supposed to be a setup for worrying. That is just being smart and having some reassurance. In terms of vaccines, absolutely.  So what we talk about is even though we can run some fancy tests on your blood, oftentimes, these really aren’t true surrogates of what’s going on in your immune system.  So you may have low levels but never get sick and, on contrary, be the opposite.

So it’s really important to try to be preventative about it. So everything we’re doing is trying to be preventative and look forward ahead to things that we can maybe fix or change or alter.  So flu shots, absolutely recommended.  Clearly, if you have had an allergy and are intolerant, then that’s a different issue.  But we recommend a flu shot.  Everybody goes, well, but I got the flu shot, and I still got the flu.  Yes, that can happen, too. So they’re not perfect. They only cover the strains from the year before.  But even the patients who got the flu shot and still got a case of the flu, in theory, you’re supposed to have actually a less severe case of the flu.

So we still recommend that. The pneumonia shot is once every five years. And, of course, they have a newer pneumococcal vaccine right now. So you can get that.  Now, live vaccines have always been controversial. 

Andrew Schorr:                  

And that’s shingles, right? 

Dr. Lamanna:      

And that’s the shingles vaccine. So I’ll have patients, who have come in, and their internist gave it to them, and then they’re all panicked. I mean, it’s a theoretical risk that, if we’re introducing and giving you a live vaccine, that you might reactivate and then have a case of shingles.

So that’s the reason why we tell our folks, theoretically, who are immunosuppressed not to get a live vaccine. But for those who might have accidentally got it, if it’s happened, it’s happened. I recommend for my patients, if you’ve had a case of shingles, then I actually recommend lifelong prophylaxis to my patients. And so there are different ways that different physicians may coach you about that.  But so we, in general, don’t recommend live vaccines to our patients.

Andrew Schorr:                  

Shingles is super painful.  Anybody had shingles here?  A few. It’s like bad news. And, fortunately, mine was caught really early. I started out just with pain going in one line on side of the bed, and sitting with a doctor friend at lunch, and boom, I was on one of these antivirals.  Are we at higher risk for that, Nicole?

Dr. Lamanna:      

Yeah, absolutely.  And, in particular, for those of you who might be on treatment, you’re at a higher risk even more so.

So we recommend prophylaxis for our patients on therapy. And for sure if you had a case of shingles, it’s a virus. It’s a common virus, and it stays, and it lives within you.  So it’s there. And it’s present. And it comes out at times that your immune system is more suppressed or if you’re stressed. Remember, the cold sores, they come out.  So we try to suppress that, because we don’t want you left with a debilitating neuropathy. The rash is easy. We can handle the rash.  But the point is to not have a debilitating pain syndrome that lasts indefinitely. And that’s the reason why we want to prevent you guys from having an outbreak of zoster.  

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 April 18, 2016