This pinned post replaces our earlier reference post about vaccinations for those with CLL/SLL. It has been divided into four sections, presented as a pinned post plus three replies.
Part 1 - GENERAL ADVICE & INFORMATION is contained in this main post
Special thanks to Jm954 and PaulaS for their invaluable contributions to this and the earlier post.
VACCINATIONS FOR THOSE WITH CLL - PART 1
GENERAL ADVICE & INFORMATION
People with CLL have a weakened immune system and are more vulnerable to infections. Because infections can be a major cause of death in CLL patients, vaccinations to help protect us are very important.
More advanced disease and treatments can increase our risk of infection and decrease our response to vaccines so early vaccination, wherever possible, is best. Even at advanced stages of disease, there still may be a surprisingly good response.
When you are first diagnosed it’s important to do a ‘vaccination audit’ to ensure you are up to date with your vaccinations and you should aim to stay up to date with any boosters from then on.
Revisit your vaccination status before you start any treatment and aim to get any outstanding vaccines or boosters first. You should aim for a minimum of 2 weeks prior to any treatment.
SPECIFIC ADVICE FOR THOSE WHO HAVE BEEN GIVEN CHEMOTHERAPY:
"If inactivated vaccines are given during chemotherapy, they should not be considered valid doses and individuals should be vaccinated again after treatment. Revaccination of individuals after chemotherapy or radiation is generally unnecessary if the prior vaccination occurred before chemotherapy, with the exception of hematopoietic cell transplant recipients."
Kevin Y. Wang, Pratik Shah, Brandon Skavla, Fatima Fayaaz, Jeffrey Chi & Joanna M. Rhodes (2022) Vaccination efficacy in patients with chronic lymphocytic leukemia, Leukemia & Lymphoma, DOI: 10.1080/10428194.2022.2133538. Here is the abstract: tandfonline.com/doi/abs/10....
GENERAL ADVICE FOR ALL WITH CLL:
“Live” vaccines should NEVER be given to people with CLL.
“Non-live” vaccines that are safe and advised for people with CLL include:
Influenza - Get the injected non-live flu vaccine NOT the live nasal spray
COVID-19
Pneumococcal - Different pneumococcal vaccination protocols are in place in different countries. See healthunlocked.com/cllsuppo...for more information
In June 2024, the CDC/ACIP voted to change its Adult RSV Vaccine Recommendations. It recommended that the RSV vaccine only be available in the US to those 75 years and older and adults aged 60 to 74 years who are at increased risk of severe RSV disease. It also recommended that those who have already received the vaccine should not receive a booster. See: medpagetoday.com/meetingcov...medpagetoday.com/infectious... and healthunlocked.com/cllsuppo...
In the UK, from 1 Sep 2024, all adults turning 75 years of age on or after 1 September 2024 (born on or after 1 September 1949) should be offered RSV vaccination on or shortly after their 75th birthday. This is a year-round, ongoing programme. There is an interim catch up programme for those aged 75-79 years of age (Individuals aged 75 years old to 79 years old on the 1 September are eligible as part of the catch-up campaign. These individuals remain eligible until the day before turning 80 years of age with the exception of those who turn 80 within the first year of the programme, who are eligible until 31 August 2025.) healthunlocked.com/cllsuppo... For information about those at risk under 75, see healthunlocked.com/cllsuppo...
In Australia in 2024, the RSV vaccine is "recommended for all adults aged 75 years and older, as well as adults aged 60-74 years who may be at higher risk of severe disease, to protect against illness and complications from RSV infection. The RSV vaccine is not funded on the National Immunisation Program" at present but is available on private prescription. betterhealth.vic.gov.au/res...
See Parts 2 & 3 for more information about safe vaccines.
Do NOT take the following live vaccines:
Chicken Pox - Varicella
Cholera - oral vaccine
Dengue fever
Influenza - FluMist a nasal spray usually given only to children is live; non-live flu vaccines are safe
Japanese Encephalitis Virus - Imojev vaccine is live; JEspect is non-live and safe
Measles/Mumps/Rubella (MMR)
Polio - oral vaccine
Rotavirus - Rotarix and RotaTeq are both live oral vaccines
Shingles - Zostavax is live; the newer vaccine, Shingrix, is non-live and safe
Smallpox - ACAM2000™ is live; JYNNEOS® is non-live and safe
TB - BCG vaccine
Typhoid - oral vaccine
Yellow fever
We may need to avoid people who’ve had live vaccines (eg children who’ve received the “live” flu nasal spray or people who’ve received the “live” shingles vaccine) as they may shed the virus. In the case of the flu nasal spray, this could be for at least one week up to two weeks - some medics advise 3 weeks to be on the safe side. healthunlocked.com/cllsuppo...
Always check with your haematologist in case there are other reasons why you shouldn't have particular vaccines. eg. when you are taking certain treatments or after certain treatments. It’s not that vaccinations are dangerous at these times, but they may not work so well. Note, though, that:
"People with severe neutropenia (absolute neutrophil count <0.5 × 10^9 per L) should not receive any vaccines, to avoid an acute febrile episode."
Some with CLL take prophylactic antiviral and/or antibiotic medication, the most common being valaciclovir or aciclovir to help prevent shingles. This is often prescribed to trial patients with a prior history of chicken pox or shingles.
A brochure for GPs produced by Oxford University Hospitals in the UK recommends "If a [CLL] patient has a history of shingles, then they should still receive lifelong Aciclovir as secondary prophylaxis in addition to the Shingrix vaccine."
The antibiotic Bactrim (a combination of sulfamethoxazole and trimethoprim) is also commonly prescribed to help prevent a certain type of pneumonia (pneumocystis-type).
Your CLL doctor is the best person to help you decide if you need these medications. Usually, they aren’t given unless you are in treatment for your CLL although some people continue them beyond treatment.
If you are prescribed an antibiotic or antiviral when you start your CLL treatment, be cautious about being taken off those prophylactic medications during or at the end of your CLL treatment. Many here have reported bad shingles or pneumonia episodes after stopping prophylactic medications, especially if they had a history of a previous, associated infection.
In January 2023, the US announced that Evusheld is not currently authorised for emergency use there and other countries that were using it have stopped. As of February 2023, Astra Zeneca is trialling another prophylactic, injected monoclonal antibody treatment for protection against Covid-19. We await further information about it and other treatments in development.
(Last updated Sept 2024)
CONTINUED IN PART 2- Vaccines recommended annually or more often
Written by
CLLerinOz
Administrator
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The ideal time to get a flu vaccine is early enough in the autumn/fall each year to be just ahead of any flu wave in your area and late enough to maximise your protection throughout the season. The timing can be difficult so most people with CLL opt to get their vaccination early in autumn/fall soon after the vaccine becomes available.
CLL specialists advise some patients to get a second annual flu vaccine to extend their protection. Check with your specialist about this.
Different countries offer a different suite of flu vaccines before each flu season. Always avoid the live attenuated nasal vaccine, FluMist.
Safe, non-live vaccines are usually trivalent or quadrivalent (covering three or four strains of influenza). They might also be adjuvanted or non-adjuvanted.
In general, an adjuvanted vaccine has more ‘power’ than a non-adjuvanted one. Sometimes, the dosage of a non-adjuvanted vaccine might be increased to raise its efficacy. In that case, there might be very little difference between the non-adjuvanted and adjuvanted vaccines if they cover similar strains.
Now there are also cell-based flu vaccines as well as egg-based flu vaccines. At present, that difference is of most importance to those who might be allergic to an egg-based vaccine.
The general advice, then, is to get a ‘high dose’ non-live flu vaccine recommended for immunocompromised and/or older people. Be guided by your country’s recommendations. Links to UK, US and AU guidelines can be found in Part 4 of this post.
It’s also important that our nearest and dearest get an annual flu vaccine. They’ll get better responses than us and if they don’t get the flu, they won’t give it to us. In the UK, partners and carers are entitled to have flu jabs on the NHS. You may wish to ask for children to receive the non-live injectable flu vaccine to save the risk of them shedding the virus to anyone close to them who is immunocompromised.
For more information about influenza, its prevention and treatment in cancer patients, including in those with conditions like CLL, please read "Overcoming Barriers to Influenza Treatment in the Oncologic Setting" which you'll find on the Clinical Care Options website at: clinicaloptions.com/oncolog...
Antivirals are available for post-influenza treatment. Read this article for more information on that topic: theconversation.com/i-think...
2. COVID-19
Note this October 2024 post Patients with CLL are immunocompromised and recommended to receive COVID-19 vaccination regardless of treatment status or specific therapy, referencing a letter by authors including the internationally highly respected CLL specialists Drs Jennifer Brown and John Seymour, regarding a study confirming the advantage of COVID-19 vaccination during treatmenthealthunlocked.com/cllsuppo...
Different parts of the world vary regarding what Covid-19 vaccines are available and this is constantly changing as new vaccines are approved.
Get whatever vaccine you can that you are scheduled to receive (so long as it’s not a live vaccine) because the best vaccine is the one you can get.
Currently, most people with CLL have received a primary course of 3 vaccines plus follow-up boosters. In 2024, the current vaccines are based on the XBB.1.5 variant of SARS-CoV-2.
The timing between doses varies from country to country but a minimum period of three to four months has been usual. Lately, that interval has been getting longer and six months is now more common for the immunocompromised. Be guided by your country’s recommendations. The immunocompromised often get approved for boosters ahead of the general population. Stay up to date.
Advice about when to get a scheduled Covid-19 vaccination after being infected with Covid-19 varies from country to country. In some, it's possible to get vaccinated once you've recovered from your infection and feel well enough. In others, there's up to a minimum six month wait. Check your country's guideline. The interval may be shortened in some circumstances (eg if you are starting treatment or before overseas travel).
You do not have to wait three months after being infected with Covid-19 to take vaccines for other conditions but should wait until you have cleared your Covid infection and have no fever or respiratory symptoms.
COVID-19 vaccines and myocarditis -Risk of myocarditis from COVID-19 infection is over 7 times that from COVID-19 vaccination. Vaccination risk is highest with Moderna: healthunlocked.com/cllsuppo...
In addition to vaccines listed in Part 2, the following vaccines are recommended:
3. PNEUMOCOCCAL
Guidelines for pneumococcal vaccination vary from country to country based on which vaccines are available.
Where it’s available, the recommended vaccine is now PCV21*. Otherwise, it's PCV20. Vaccination is then complete. * See details in US section Part 4
Where neither's available, other possibilities include:
Prevnar15 (PCV15) followed ≥ 1 year later by Pneumovax 23 (PPV23 also known as PPSV23). Immunocompromised patients may be approved for Pneumovax 23 ≥ 8 weeks after PCV15). Vaccination is then complete.
OR
Prevnar13 (PCV13) followed ≥ 8 weeks later by Pneumovax 23 (PPV23/PPSV23) followed ≥ 5 years later by another dose of Pneumovax 23 (PPV23/PPSV23). Depending on your location, you might be considered for further vaccination 5 years after this.
OR
If you have had only Pneumovax 23 (PPV23/PPSV23) and no other pneumonia vaccine, you may receive one dose of either PCV20 or PCV15 (if available) ≥ 1 year after the last PPSV23 vaccine. Another PPSV23 is not then needed. Vaccination is complete.
OR
If you have had only Pneumovax 23 (PPV23/PPSV23) and neither PCV20 nor PCV15 is available, you may have PCV13 followed ≥ 8 weeks by PPSV23. An interval of ≥ 1 year is recommended before receiving PCV13. (Note that in some places the second dose of PPSV23 is not given after an initial dose of PPSV23 followed at least a year later by PCV13)
In some places, PCV20 may be recommended for those who have had PCV13 at least 5 years earlier.
See Part 4 for information specific to the UK, USA and Australia.
4. SHINGLES
The primary risk factor for getting shingles is a weakened immune system.
If you've had chickenpox as a child (the CDC predicts that over 99% of people born before 1980 have), then ZVZ can reactivate at a later date and cause shingles.
If it is available where you live, consider Shingrix. Do NOT accept the “live” vaccine called Zostavax. Shingrix requires two doses, with an interval of 2-6 months.
Some people report uncomfortable side effects from Shingrix, particularly after the second dose (although for some, it’s after the first), but they usually pass fairly quickly.
On the other hand, “about 10 to 18% of people who get shingles experience PHN (postherpetic neuralgia), the risk increasing with age.” “PHN occurs in the areas where the shingles rash was, even after the rash clears up. It can last for months or years after the rash goes away. The pain from PHN can be so severe and debilitating that it interferes with daily life.” Vaccination is preferable.
Apart from the terrible pain caused by shingles and the risk of ongoing PHN (postherpetic neuralgia), in 2022 research found that shingles is also associated with an increased risk of stroke and heart attack. brighamandwomens.org/about-...
As explained in Part 1 of this post, some with CLL receive prophylactic antiviral treatment to protect them against shingles.
From 1 Sept 2023 in the UK, Shingrix will be available to the immunocompromised from the age of 50 and above. It has replaced the live Zostavax vaccine and will also be available to the immunocompetent who are 60-79. See the links in Part 4 for more information.
In the US, Zostavax is no longer available. Shingrix is the standard vaccine on offer there.
In Australia. Shingrix is now available through the NIP to the immunocompromised aged 18+ and to others based on the following: health.gov.au/sites/default...
5. HAEMOPHILUS INFLUENZAE TYPE B (Hib)Hib is a very nasty bug that can cause many infections including pneumonia and meningitis. The vaccine often comes as Hib/MenC, which is a combination of Hib and Meningococcal C vaccines.
6. MENINGOCOCCAL C (often combined with HiB)
Meningococcal C vaccine is often combined with the HiB vaccine (HiB/MenC). Vaccines for other strains of meningitis may also be recommended, such as Meningitis B and Meningitis ACWY.
The CDC recommends Hep B vaccination for "most adults” so this is something worth discussing with your haematologist. However, be sure to AVOID the attenuated (live) hepatitis vaccines. Note that testing positive for hepatitis can rule you out of a clinical trial.
OTHER VACCINES
Other “non-live” vaccines might be recommended for travel purposes or in the event of a disease outbreak. In the latter case, specific groups might be deemed at higher risk of infection and therefore eligible for vaccination.
A 2022 outbreak of polio in New York led to an alert about polio vaccines in areas where it is circulating.
Most people are vaccinated against polio as children.
“If you have already been fully vaccinated, you probably do not need a booster at this time. Vaccinated adults who are at increased risk of exposure to poliovirus should talk to their health care provider about whether they may need a booster.” (See the Polio entry in Part 4 for more information)
Note: In some places, a live, oral polio vaccine is still available - avoid it.
To read more about the kind of barriers you might meet trying to get your pneumococcal vaccines in Australia and how to overcome them, visit: healthunlocked.com/cllsuppo...
Q. Can I get PCV20 if I've previously had PCV13 + PPV23?
A. Currently, the US guidelines say you can get PCV20 if you've previously received PPV23 but NOT received PCV13. If you have received PCV13 + PPV23 then you may be considered for another PPV23 vaccine if you are immunocompromised and if at least five years have passed since your last PPV23 vaccine. healthunlocked.com/cllsuppo...
Q. Should I get my flu and COVID-19 (and RSV) vaccines at the same time?
Pneumococcal vaccination update for those in the US
A CDC/ACIP (Advisory Committee on Immunization Practices) meeting this week (27 June 2024) voted to update its recommendations for Pneumococcal vaccination for appropriate adults in the US.
"CAPVAXIVE (V116) is now recommended for all adults age 65 and older and for adults 19 to 64 with certain risk conditions, and for those over 65 previously vaccinated with other pneumococcal vaccines"
"Specifically, the ACIP voted to recommend a single dose of CAPVAXIVE for:
Adults 65 years of age and older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown;
Adults 19-64 years of age with certain underlying medical conditions or other risk factors who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown; (Note: the previously approved PCV20 is a pneumococcal conjugate vaccine)
Adults 19 years of age and older who have started their pneumococcal vaccine series with PCV13 (pneumococcal 13-valent conjugate vaccine) but have not received all recommended PPSV23 (pneumococcal 23-valent polysaccharide vaccine) doses."
"Additionally, shared clinical decision-making is recommended regarding use of a supplemental dose of CAPVAXIVE for adults 65 years of age and older who have completed their vaccine series with both PCV13 and PPSV23."
"This is the first pneumococcal vaccine that is specifically designed to protect against the serotypes that primarily infect older adults. Data has shown that the serotypes included in this vaccine are responsible for approximately 84% of IPD in adults aged 50 years and older. The vaccine covers 21 serotypes, including eight that are not targeted by any other available pneumococcal vaccines, specifically serotypes 15A, 15C, 16F, 23A, 23B, 24F, 31, and 35B."
A table comparing pneumococcal serotypes covered in PCV7, PCV10, PCV13, PCV15, PCV20, PCV21 according to their invasive disease potential appeared in a paper which is available online ahead of publication in Infectious Diseases Now. Robert Cohen, Corinne Levy, Emmanuelle Varon, The latest news in France before distribution of third-generation pneumococcal conjugate vaccines, Infectious Diseases Now, Volume 54, Issue 5, 2024, 104937, ISSN 2666-9919, doi.org/10.1016/j.idnow.202... ( sciencedirect.com/science/a... ) (Note: CAPVAXIVE is also known as PCV21.)
Findings In this cohort study of more than 240 million Medicare beneficiaries 65 years or older with and without underlying medical conditions across 50 US states and the District of Columbia, beneficiaries who received PCV13 had a 6.7% lower risk of pneumonia hospitalization overall, including 5.8% to 7.5% lower risk in adults with underlying medical conditions, compared with beneficiaries who did not receive any pneumococcal vaccines.
Percentages can be deceiving ,what does it mean in absolute numbers? How many out of 100,000 people vaccinated versus unvaccinated where hospitalized with pneumococcal infections?
I agree. There's the base fallacy rate used in arguing against vaccinations for example. That's why I included the reference for the study published in Jama Network for those interested in reading about this.
The recombinant shingles vaccine (Shingrix) was associated with a larger reduction in dementia than the live shingles vaccine (Zostavax), an analysis of more than 200,000 U.S. older adults showed.
Key Takeaways
- The recombinant zoster vaccine (Shingrix) was associated with a 17% increase in time without a dementia diagnosis, compared with the live vaccine.
- This translated into 164 additional days without a dementia diagnosis.
- The findings support hypotheses about shingles vaccination and dementia prevention.
Community experiences with respect to bad reactions to the Shingrix vaccinations. Some of us can have a few days where we feel very ill, but it's a minority who are so impacted.
I have received Evusheld twice now. First time was a month after I had Covid then a follow up 3 months later. Prof Tam in Melbourne was very quick to recommend all his patients had it.
Your Local Epidemiologist, Katelyn Jetelina has provided a Cliff notes update of the outcome from the 13th September ACIP meeting with the CDC, which will influence which COVID-19 boosters will shortly be recommended by the CDC. There was no specific mention in theses notes for the immune compromised, unfortunately:-
Today ACIP—an external advisory committee to CDC—had a much-anticipated meeting with one goal: determine who is eligible for an updated Covid-19 vaccine this fall in the United States.
This goes to the CDC Director for approval. Then, technically, you’ll be able to get a vaccine. However, access may be delayed or challenging, and waiting may make sense for some (more on this later).
After last fall’s updated Covid-19 vaccine, 2 myocarditis cases were verified out of ~650,000 doses. This is a much smaller rate for than the primary series. (We think this is because the increased time interval between doses reduces risk.) However, there is limited data, so this estimate has some uncertainty.
Long Covid remains a risk.
Updated vaccines worked last fall.
Vaccines are cost-effective for those >65 years old.
This is the first time the government is not paying for Covid-19 vaccines. Pfzier/Moderna is charging ~$120-129 per dose and Novavax is ~$130.
Updated vaccine formula remains a good choice.
Pharma companies showed increased antibodies against currently circulating variants, including the newer BA.2.86. (see image)
Addendum: Just prior to the ACIP meeting, the FDA "fully approved the monovalent messenger RNA vaccines (aimed at omicron XBB subvariants of SARS-CoV-2) for people aged 12 years or older and authorized them for emergency use among people aged 6 months to 11 years. The vaccines are now given in one dose instead of two, but the FDA authorized additional doses for certain immunocompromised groups of people.
:
Omicron XBB viruses have emerged to become the predominant SARS-CoV-2 viruses globally and in the U.S. and currently make up all circulating lineages in the U.S.
Moderna and Pfizer-BioNTech in August announced that their updated shots are effective against EG.5 and FL.1.5.1, among other XBB viruses."
Katelyn Jetelina 'Your Local Epidemiologist' has provided "A response to Florida Surgeon General's anti-human remarks" here: open.substack.com/pub/yourl...
She ends with Common ground
It’s important to acknowledge there are points we agree on:
- Medication (i.e., Paxlovid) is an important tool.
- FDA should push for more evidence. This has been a loud theme from VRBPAC—the external committee to the FDA—throughout the pandemic. Why aren’t we getting T cell data? Why aren’t we getting B cell data? Why can’t we find correlates of protection for antibodies? We should demand data from pharma companies.
- We should always work towards better vaccines. Thanks to the $5 billion Operation Next Gen we are developing next-generation vaccines that prevent transmission (like nasal vaccines) or are variant-proof (like pan-coronavirus vaccines).
Bottom line
Framing public health as anti-human is an incredibly dangerous game to play.
Health policy decisions need to be grounded in an accumulation of evidence that provides a comprehensive picture of reality. He combines legitimate points with profoundly foolish ones, which muddles the picture, creates a sense of false equivalency, and makes it difficult for the general public to discern the truth.
Keep this in mind when decision-making about Covid-19 vaccines this fall.
Neil
10.4 to 18.7 fold rise by day 29 for XBB1.5, XBB.1.16, EG.5.1 and BA.2.86
Thanks, Neil. It's an excellent guide and gives a lot of very helpful, reliable information about the vaccines that will be available in the US this Fall and, hopefully, elsewhere before too long.
Katelyn Jetelina 'Your Local Epidemiologist' has provided a subsequent update which answers some FAQs about the next vaccination round including how long to wait after vaccination/infection before getting one of the new vaccines.
lankisterguy recently shared a link to that update in this post:
Also this week, Patient Power featured an article about why CLL patients need to remain vigilant and stay protected with measures that include being up to date with COVID-19 vaccinations.
That article discusses two retrospective cohort studies published online on Aug 31 2023 that "drive home the point that people with cancer, and particularly those with blood cancer, have been at elevated risk . . . These studies, which examined data during previous waves of the pandemic, should encourage continued vigilance among cancer patients as new variants arise, researchers say."
“People with cancer need to know that COVID-19 is not over for them. Unfortunately, it remains a threat to their health and well-being, and this is especially true for people with blood cancer” [Lisa Hicks, MD, MSc, FRCPC]. “Because the world has opened up and masking is much less prevalent, it is more important than ever that people with cancer take actions to protect themselves from COVID-19”
Sequentially for those who remained seronegative after their most recent dose, seroconversion occurred in 40.6% (13/32) after D4, 46.2% (6/13) after D5, 16.7% (1/6) after D6, and none (0/1) after D7 or D8 (supplemental Table 1).
However, importantly, and in contrast to those with no detectable antispike antibody, patients with CLL with detectable but low-level antispike antibodies frequently achieved a higher level of antibody with subsequent doses and the level typically progressively increased with each subsequent vaccine dose (Figure 1A,C). Hence, the ultimate seroconversion rate for CLL was 94.2%, of whom 79.1% achieved antispike antibody levels ≥1000 AU/mL; 54.1%, ≥5000 AU/mL; and 34.1%, ≥10 000 AU/mL. The later and higher antispike antibody levels were commonly associated with neutralization activity against all major COVID-19 variants, including Delta and Omicron.
Early Estimates of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Attributable to Co-Circulating Omicron Variants Among Immunocompetent Adults — Increasing Community Access to Testing Program, United States, September 2023–January 2024
Receipt of updated COVID-19 vaccine provided approximately 54% increased protection against symptomatic SARS-CoV-2 infection compared with no receipt of updated vaccine. Vaccination provides protection against JN.1 and other circulating lineages.
"The findings emphasize the value of personalized vaccination approaches for different groups of immunocompromised individuals. The positive association between booster doses and improved immunogenicity suggests that regular boosters are essential for building up adequate immunity in this vulnerable population. Furthermore, the interplay of infection history, IGRT, and immunosuppressive treatments indicates the need for taking these factors into consideration in managing these patients. Additional consideration should be given to the prevailing SARS-CoV-2 variants in society, and accordingly, updated vaccines towards the latter.
This post is pinned so it will appear in our list of pinned posts which you can see to the right of your screen (or by scrolling to the bottom of your screen, depending on what type of device you are using) whenever you are viewing any post in our community.
If you also want to save it, you can do that by using the 'save' option immediately underneath the main post. Our pinned post about how to navigate the site gives more detail: healthunlocked.com/cllsuppo...
Thanks so much for writing this post, CLLerinOz . I was struggling to keep up with all the changes recently, and am very grateful to you for taking over the task! I know what a lot of work it involves..
Thanks for all your hard work, not only on the original post, which helped countless people, but also for your support and input into the drafting process for this new post. 😀
Thank you CLLerinOz , Jm954 and PaulaS for this very helpful, comprehensive post!!!
Your list is our list with the added need for us to get a recommendation for how close/far we can spread them apart.
We are aware that several can be given at the same time (ow!), however I believe there are a couple that need to be parsed separately… and, since some may illicit symptom-like discomfort, we want to be sure to allow time for recovery between jabs.
Re: TDap - We we’re told by a pediatrician to make sure that anyone who plans to spend regular time around a baby should also have this one up to date.
When you are in 'catch up' mode after diagnosis and have to get a few vaccines at once, as a general rule, there is usually no reason why more than one vaccine can't be given in the same visit. Technically, there is no limit and only a very small number of vaccines are exceptions to this. The one which is of particular interest to CLL patients relates to pneumococcal vaccination and the scheduling of these vaccines is covered in Part 3 of this post.
If you are getting more than one vaccine in the same site (eg arm), it's recommended that they be separated by at least an inch so any localised reaction is less likely to overlap. Another alternative is to use different sites (eg arms) for each vaccine so, at least, you'll know which vaccine is responsible if you have a localised reaction like swelling. Using two arms is particularly important if you get a pneumococcal vaccine at the same time as the DTP vaccine as each can cause a local reaction.
Where time allows, though, and it's only a case of, say, two vaccines, some people, particularly those who have a history of reacting to vaccines, prefer to split them across separate visits. This enables them to deal with just one vaccine at a time and also has the benefit of allowing them to identify which, if any, vaccine causes them to experience any adverse event.
I just looked back at my own vaccination record and see that I received D/T/P, Hib and Pneumococcal on the same day, and remember both arms were involved. I don't recall any adverse reaction.
I did split my latest flu and Covid-19 vaccinations, even though it was possible to have them together, and this was just a personal preference at the time.
very informative post thank you, my haematologist said getting the new pneumonia vaccine probably wouldn’t work for me, so he didn’t recommend it, also interesting the part about BCG, this is the treatment I was receiving for bladder cancer, but I have had to stop this when starting acalabrutinib and having heart problems, I’m wondering now if it was all linked. Dave
Good morning, wow, I am blown away by your thorough, organized and timely post. What an amazing gift to our community. Thank you for all your hard work to help us stay safe and make good decisions. You are a treasure.
I've updated our main post (above) with an important piece of vaccination information for those who have received (or are about to receive) Chemotherapy treatment for CLL.
Thank you CLLerinOz, for this post - came upon it when searching re live vaccines. I am a nurse and my serology has come back that I've had negative exposure to mumps & rubella. I'm sure I had mumps as a child (I'm now 59), but anyhoo, my new employer wants me to have the MMR vaccine. I had it 11 years ago pre CLL and chemo. As it's a live vaccine should I decline it? I'm trying to research it and finding various confusing answers! I finished FCR Oct 2017 and remain in a stable remission, thankfully, at this stage.Thank you 😊
It's common for healthcare workers to be asked to be vaccinated against certain conditions by their employers and MMR is usually one of those vaccines. However, as you've noted, it is also a vaccine that those with a compromised immune system are advised not to receive as it is a live vaccine.
Although you completed FCR some time ago, your immune system remains compromised and live vaccines are not recommended for you.
It's hard to find a definitive statement in answer to your specific question about how you deal with this in your employment sector. Anything I've seen that is of a more general nature recommends that those who are unable to be vaccinated with MMR on the basis of their compromised immunity and who suspect they have not previously been vaccinated or infected should remain vigilant against infection and seek medical treatment asap should they suspect they have been infected.
You may need something in writing from your CLL specialist to satisfy your employer of your exemption. I see you're in New Zealand. Perhaps someone there will see this who may have advice specific to your location or others may know more about how this requirement is dealt with in your industry elsewhere.
Thank you CLLerinOz for your reply 🙂 The reason I asked you is because I now live in Australia, or paradise, as I call it. 😉Yes, I am well aware of the vaccine requirements in my role and I'm not concerned at all with addressing it with my employer, but thank you for addressing that. I am really unsure whether I should proceed to having a live vaccine, given my post chemo compromised immune system. You have kindly answered that for me and I will now proceed to getting a dispensation from my hematologist in NZ. I feel very fortunate that I'm one of the few people I know who hasn't yet had covid, so hoping my immune system isn't too compromised given that fact!
Three cases of tetanus, including one causing death, have been reported in New South Wales in Australia this year. Although these are the first cases reported there since 2019, NSW Health put out an alert this week to remind people to check that their tetanus vaccination status is up-to-date.
NSW Health, in line with guidelines in the Australian Immunisation Handbook, recommends that:
"A tetanus-containing vaccine booster is recommended for all adults at 50 years of age and at 65 years of age if it is more than 10 years since the last dose.
Vaccination is recommended every 10 years for travellers to countries where health services are difficult to access. Travellers with a higher risk of a tetanus-prone wound are recommended to be vaccinated every 5 years.
Adolescents and adults who have never had a tetanus-containing vaccine are recommended to receive 3 doses of tetanus-containing vaccine with at least 4 weeks between doses, and booster doses at 10 years and 20 years after the primary course."
Very good info. I am meeting next week with my oncologist to discuss when we start my v+o treatment. As Neil has suggested be sure your vac are up to date. I have done that with my Primary care Dr. I am up to date with one possible addition. I have had Prevnar13 and 23. Prevar 20 is not live but I haven't found if you should take before starting treatment. CDC recommends talking to your Dr. My primary suggests I should get it. I'll talk to my oncologist this week . Are you aware of any specific info regarding this vac and CLL. Thanks
Well done for getting up-to-date with your vaccinations before starting your venetoclax + obinutuzumab treatment.
In its article about vaccinations for people with CLL, the CLL Society says this about someone in your situation:
“CLL/SLL patients who previously received a dose of PCV13 should have a PPSV23 at least eight weeks later. If you were younger than 65 when the first dose of PPSV23 was given and have not turned 65 years old yet, you should receive a second dose of PPSV23 at least 5 years after the first dose of PPSV23. This is the last dose of PPSV23 that you should be given before 65 years of age. Once you turn 65 and at least 5 years have passed since PPSV23 was last given, you should receive a final dose of PPSV23 to complete all pneumococcal vaccinations. At this time, additional pneumococcal vaccines are not being recommended by the CDC.”
You can read the full article, including information about Prevnar 20, here:
Interesting - I was approved to take the live oral cholera vaccine after completion of my CLL treatment for travel to Lebanon during the outbreak there last year.
There are two main types of cholera vaccines and different countries approve different types and brands. In 2021, a report found that cholera vaccination recommendations in Europe "vary considerably between countries" pubmed.ncbi.nlm.nih.gov/333...
One type of cholera vaccine consists of live attenuated bacteria and this type of vaccine is not usually recommended for people who are immunocompromised.
In a previous discussion you explained that your doctor checked your immunoglobulin levels before deciding to proceed with giving you the live vaccine. Other factors may have included the time you had available. The live vaccine is only one dose which needs to be taken at least 10 days before travel. The non-live vaccine involves two doses that have to be taken 7 to 14 days apart. In addition, your body would usually take a couple of weeks after vaccination to develop protection against diarrhoea due to cholera.
Vaccination should be seen as a complement to other disease prevention measures. As far as efficacy is concerned, in tests with healthy participants, the live vaccine "was shown to be 90.3% effective against V. cholerae 10 days after vaccination and 79.5% effective 90 days after vaccination." ncbi.nlm.nih.gov/pmc/articl...
For the non-live vaccine, "Most people will produce enough antibodies to protect against diarrhoea due to cholera. However, as with all vaccines, 100% protection cannot be guaranteed. About 85% of people can expect to be protected against cholera in the 6 months following initial vaccination. This decreases to 52% at the end of the second year, when a booster should be given." nps.org.au/assets/medicines...
For the benefit of others reading this, I'll give a bit more detail about the two main vaccines that are used in travellers to help protect against cholera:
1. Live Vaccine- its safety and efficacy has not been tested in people who are immunocompromised
Vaxchora™ is a live vaccine, used mostly in the US in people aged 2-64 and in the EU in those aged >2 who are travelling to an area of active cholera transmission.
The FDA package insert for Vaxchora™ states: "The safety and effectiveness of VAXCHORA have not been established in immunocompromised persons. The immunologic response to VAXCHORA may be diminished in immunocompromised individuals. VAXCHORA may be shed in the stool of recipients for at least 7 days. There is a potential for transmission of the vaccine strain to non-vaccinated close contacts (e.g., household contacts). Use caution when considering whether to administer VAXCHORA to individuals with immunocompromised close contacts." fda.gov/media/128415/download
The European Medicines Agency states that "People who were born with problems with their immune system or are receiving treatment that weakens the immune system must not take Vaxchora." ema.europa.eu/en/medicines/...
As a live attenuated vaccine, concomitant administration of Vaxchora™ with systemic antibiotics is not recommended since these compounds may be active against the vaccine strain. Hence it is not recommended to administer Vaxchora™ to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination. This may also limit the utility of Vaxchora™ in outbreaks where the use of antibiotics may be an important part of the outbreak response." ncbi.nlm.nih.gov/pmc/articl...
2. Inactivated, Non-live Vaccine - people who are immunocompromised can receive this vaccine
Dukoral™ is a non-live vaccine that is "authorized in Europe, Australia, Canada, Switzerland, New Zealand, Thailand, and the United Kingdom" but is not available in the US. It is most commonly given to travellers "whose activities or medical history put them at increased risk, including:
- aid workers
- people going to areas with cholera outbreaks who have limited access to safe water and medical care
- those for whom vaccination is considered potentially beneficial (people who do not fit into the above groups, but are still considered at higher risk)." mail.travelhealthpro.org.uk...
Dukoral™ consists of 4 different inactivated strains (types) of V. cholerae serotype O1, and a "purified recombinant DNA-derived B-subunit of the cholera toxin". People who are immunocompromised can receive it but the vaccine may provide a lower level of protection than it does for people with healthy immune systems. precisionvaccinations.com/v...
In 2022, it was reported that the world was experiencing the highest number of cholera outbreaks in recorded history at the same time as a shortage of cholera vaccines. The following article that appeared in Deutsche Welle in April 2022 explains more about that: dw.com/en/why-is-the-world-...
Thank you for the reminder and the extra info - this is more than what my doctors explained and incredibly helpful for assessing the situation next time!
To make a decision about RSV vaccination, the CDC recommends using shared decision-making (SCDM), which means that health care providers should talk to eligible individuals about whether RSV vaccination is appropriate for them. cdc.gov/vaccines/vpd/rsv/hc...
The above link also answers other frequently asked questions about RSV vaccination.
Until studies are available for the immune compromised, it's possible there will be some variance in the position taken by CLL specialists. healthunlocked.com/cllsuppo...
In a notice sent to clinicians on September 05, 2023, the CDC noted "increases in respiratory syncytial virus (RSV) activity across some parts of the Southeastern United States in recent weeks . . . Historically, such regional increases have predicted the beginning of RSV season nationally, with increased RSV activity spreading north and west over the following 2–3 months."
In that statement, the CDC recommended that:
"Vaccination should be prioritized in adults ages 60 years and older who are most likely to benefit, including those with certain chronic medical conditions associated with increased risk of severe RSV disease, such as heart disease (e.g., heart failure, coronary artery disease), lung disease (e.g., chronic obstructive pulmonary disease [COPD], asthma), and immunocompromising conditions. Adults with advanced age and those living in nursing homes or other long-term care facilities are also at increased risk of severe RSV disease and may benefit from RSV vaccination." (my emphasis) emergency.cdc.gov/han/2023/...
Efficacy of the new vaccines has been measured at 82-86% but, as with all vaccines, those who are immune compromised may not achieve this result.
RSV vaccines are expected to be more durable than flu vaccines and should offer protection in those who are not immune compromised throughout the RSV season and perhaps for the following year's season, too. To date, I'm not aware of any studies that show how durable the vaccines might be for the immune compromised although it will possibly be shorter.
Other posts with more detailed information about RSV vaccination include:
On 7 June 2024, the FDA announced that it has expanded the approval of GSK's respiratory syncytial virus (RSV) vaccine (Arexvy) to include adults ages 50 to 59 at risk of RSV-related lower respiratory tract disease (LRTD) due to underlying conditions.
Thanks to AussieNeil for the heads up about this change and for a link to a MedPage article about the expanded approval which I've included in the information about RSV in the main post above.
"GSK has also filed regulatory submissions to extend the use of its RSV vaccine to adults aged 50-59 at increased risk in Europe, Japan and other geographies with regulatory decisions undergoing review. Trials evaluating the immunogenicity and safety of the vaccine in adults aged 18-49 at increased risk and immunocompromised adults aged 18 and over are expected to read out in H2 2024."
The FDA has also announced approval of an mRNA vaccine for RSV, making it the first mRNA vaccine approved for a condition other than COVID.
"Moderna says it expects to have mResvia available for eligible populations in the US by the 2024–2025 respiratory virus season, which begins around September. It has also filed for approval with regulators in multiple other markets around the world."
"The FDA’s approval of mResvia is based on results from a phase 3 trial conducted in around 37,000 adults aged 60 or older in 22 countries. The vaccine efficacy against RSV lower respiratory tract disease was reported as 83.7%, and no serious safety concerns were identified."
Scott Roberts, an infectious disease expert at School of Medicine, US, told Chemistry World, ‘The significance here is that we have another vaccine mechanism that differs from the GSK and the Pfizer – those are inactivated protein subunit vaccines, and this is a totally separate mechanism,’ he says. ’RSV really impacts the extremes of age, and it leads to deaths on the order of influenza,’ he points out. ‘The reason people don’t think about RSV is that until now, we’ve had nothing [we could] do about it.’
"Roberts also highlights the possible – and as-yet unconfirmed – link between adults who received the Pfizer and GSK vaccines and conditions such as atrial fibrillation, Guillain-Barre Syndrome and other neurological conditions; ‘if anybody has a history of those conditions, the obvious answer would be to switch to the mRNA vaccine, which, based on my read of the trial was really well tolerated,’ he says."
In Australia, the RSV vaccine is currently "recommended for all adults aged 75 years and older, as well as adults aged 60-74 years who may be at higher risk of severe disease, to protect against illness and complications from RSV infection. The RSV vaccine is not funded on the National Immunisation Program" at presentbut is available on private prescription.
Based on a recent discussion in May in the House of Lords in the UK, it was hoped there could be an announcement there soon about including the RSV vaccine on the NHS from autumn 2024. However, at around the same time that indication was given, a general election was called. The RSV vaccine is currently available in the UK on private prescription. hansard.parliament.uk/lords...
RSV (Respiratory Syncytial Virus) Vaccination June 2024 Update for those in the US
I've updated our main post to reflect a new recommendation regarding the RSV vaccine in the US.
ACIP has made changes to its recommendations, moving away from shared decision-making to a risk-based approach. As a result, it now recommends that:
"All adults ages 75 years and older should receive a single dose of any respiratory syncytial virus (RSV) vaccine, and adults ages 60 to 74 years who are at increased risk of severe RSV disease should receive a vaccine, according to a unanimous 11-0 vote by the CDC's Advisory Committee on Immunization Practices (ACIP).
Also, people who have already received the RSV vaccine are not recommended to receive a booster, based on data that showed another dose did not improve outcomes."
These changes replace the previous recommendation that adults aged 60 and older could receive RSV vaccination after engaging in shared clinical decision-making with their healthcare provider.
I had even more meningitis vaccinations than that. The one they normally give teenagers. And I got RSV privately since I am in the UK and it is not yet available on the NHS.
It's good that those who can afford it can at least access the RSV vaccine privately in the UK.
I'm wondering if you might have been considered more at risk for your meningococcal vaccinations due to personal circumstances or because of where you live or travel intentions. In Australia, CLL isn't routinely included in the list of specified medical conditions associated with increased risk of invasive meningococcal disease.
Interesting. I live in inner London and at the time was parent to a teenage child. The local hospital is supervising me. I got a meningitis vaccination that they are giving all teenagers.
Londoners may be interested in the fact I used a pharmacy in Hampstead to get the RSV vaccination and it cost me £230.
For those in the US, this is a reminder that the 2024 vaccination schedule that was released in November 2023 is now available and effective.
The main changes since the previous schedule was released that are relevant for those with CLL are the addition of new vaccines for respiratory syncytial virus (RSV), released in the Fall 2023, and the 2023-2024 formulation of the updated COVID vaccine (both mRNA and protein-based adjuvanted versions).
It also provides comprehensive advice about pneumococcal vaccination by providing recommendations based on any vaccination someone might have already received.
The general schedule now also includes the mpox vaccine (Jynneos) and a new MenACWY-MenB combo vaccine with notes relating to the use of these vaccines in particular populations.
With respect to the risk from respiratory infections for which we have vaccinations, the USA's CDC maintains a RESP-NET interactive dashboard cdc.gov/surveillance/resp-n...
"Surveillance is conducted through a network of acute care hospitals in select counties or county equivalents in 12 states for RSV surveillance, 13 states for COVID-19 surveillance, and 14 states for influenza surveillance. The surveillance platforms for COVID-19, RSV, and influenza (known as COVID-NET, RSV-NET, and FluSurv-NET, respectively) cover more than 30 million people and include an estimated 8-10% of the U.S. population."
Caitlin Rivers maintains a "Force of Infection" Substack report to which you can subscribe. It too covers the above respiratory infections, plus she also covers stomach bugs and food recalls. Here's her US National Outlook report to the 15th February.
Vaccination of adults newly diagnosed with cancer essential for care.
Timing of vaccinations paramount for patients receiving newer treatments like CAR-T and B-cell therapies.
Other Snips:
“It’s crucial to emphasize the role of vaccinations, not just in preventing infections, but in reducing complications that can exacerbate cancer outcomes,” Amar H. Kelkar, MD, MPH, a stem cell transplantation physician in the department of medical oncology at Dana-Farber Cancer Institute, told Healio. “Effective vaccination strategies are a critical component of comprehensive cancer care.”
Infections cause the second most noncancer deaths among patients during treatment, Kelkar said.
Researchers used 102 publications posted between 2013 and 2023 to create the guidelines, which address various vaccines, including those for influenza, COVID-19, hepatitis B and human papillomavirus, among several others.
:
The authors strongly recommend clinicians determine the vaccination status of newly diagnosed adults with cancer for seasonal and age- and risk-based vaccines.
They also strongly recommend vaccinations should occur 2 to 4 weeks before any cancer treatment,
:
Individuals who live in the same household as an adult with newly diagnosed cancer, as well as close contacts, should be up to date on vaccinations, if possible, he added.
:
The guidelines panel strongly recommends adults who undergo hematopoietic stem cell transplantation be offered complete revaccination beginning 6 months to 1 year following treatment.
:
The panel strongly recommend adults who receive B-cell therapies get the COVID-19 vaccine no earlier than 6 months after treatment completion.
The following "Vaccine schedule recommendations and updates for patients with hematologic malignancy post‐hematopoietic cell transplant or CAR T‐cell therapy" was published in late 2023.
"ABSTRACT: Revaccination after receipt of a hematopoietic cell transplant (HCT) or cellular therapies is a pillar of patient supportive care, with the potential to reduce morbidity and mortality linked to vaccine‐preventable infections. This review synthesizes national, international, and expert consensus vaccination schedules post‐HCT and presents evidence regarding the efficacy of newer vaccine formulations for pneumococcus, recombinant zoster vaccine, and coronavirus disease 2019 in patients with hematological malignancy. Revaccination post‐cellular therapies are less well defined. This review highlights important considerations around poor vaccine response, seroprevalence preservation after cellular therapies, and the optimal timing of revaccination. Future research should assess the immunogenicity and real‐world effectiveness of new vaccine formulations and/or vaccine schedules in patients post‐HCT and cellular therapy, including analysis of vaccine response that relates to the target of cellular therapies."
TABLE 1 in the review lists "Recommended vaccines and timing post‐hematopoietic cell transplant (HCT) from established international guidelines"
TABLE 2 details a "Summary of studies examining seroprevalence of circulating immunoglobulin G against vaccine‐preventable infections"
TABLE 3 provides "Recommendations on revaccination timing post cellular therapy from expert international guidelines, expert center protocols, and expert opinion."
TABLE 4 contains a "Vaccination schedule for adult patients treated with chimeric antigen receptor T‐cell (CAR‐T) therapy"
"CONCLUSION: In summary, there are well‐recognized vaccine schedules for the HCT population, with new vaccine formulations including PCV20, aRZV, and bivalent booster COVID‐19 vaccines that require ongoing assessment. Revaccination post‐cellular therapies at present mostly follow the HCT schedule, but further research is required to optimize the timing of vaccine delivery and clarify which vaccines would be of most benefit to the cellular therapy patients."
Reynolds G, Hall VG, Teh BW. Vaccine schedule recommendations and updates for patients with hematologic malignancy post-hematopoietic cell transplant or CAR T-cell therapy. Transpl Infect Dis. 2023 Nov;25 Suppl 1(Suppl 1):e14109. doi: 10.1111/tid.14109. Epub 2023 Jul 29. PMID: 37515788; PMCID: PMC10909447.
As vaccines and recommendations can change, check with your specialist to determine what will be best for you.
CLLerinOz
Future approaches to vaccine research for those undergoing HCT/cellular therapies
Thanks for reposting this - in my original rush to vaccinate during Covid in 2020 at my diagnosis, I don't know that anyone thought about my TDAP status...so I may have a vaccine to get this summer (as I go look this up myself - I don't think I got that one)...
June 2024 Covid and Flu vaccination Update for those in the US
The US CDC has recommended updated 2024-2025 COVID-19 vaccines and updated 2024-2025 flu vaccines to protect against severe COVID-19 and flu this coming fall and winter.
"Data continue to show the importance of vaccination to protect against severe outcomes of COVID-19 and flu, including hospitalization and death."
"Last season, people who received a 2023-2024 COVID-19 vaccine saw greater protection against illness and hospitalization than those who did not receive a 2023-2024 vaccine."
US COVID-19 Vaccination Recommendation for 2024-2025
"CDC recommends everyone ages 6 months and older receive an updated 2024-2025 COVID-19 vaccine to protect against the potentially serious outcomes of COVID-19 this fall and winter whether or not they have ever previously been vaccinated with a COVID-19 vaccine."
"The virus that causes COVID-19, SARS-CoV-2, is always changing and protection from COVID-19 vaccines declines over time. Receiving an updated 2024-2025 COVID-19 vaccine can restore and enhance protection against the virus variants currently responsible for most infections and hospitalizations in the United States. COVID-19 vaccination also reduces the chance of suffering the effects of Long COVID, which can develop during or following acute infection and last for an extended duration."
Updated COVID-19 vaccines from Moderna, Novavax and Pfizer will be available later this year so keep an eye out for their availability.
US Flu Vaccination Recommendation for 2024-2025
"CDC recommends everyone 6 months of age and older, with rare exceptions, receive an updated 2024-2025 flu vaccine to reduce the risk of influenza and its potentially serious complications this fall and winter. "
"Most people need only one dose of the flu vaccine each season. While CDC recommends flu vaccination as long as influenza viruses are circulating, September and October remain the best times for most people to get vaccinated. Flu vaccination in July and August is not recommended for most people, but there are several considerations regarding vaccination during those months for specific groups" (see list in full statement - link below).
"For adults (especially those 65 years old and older) and pregnant people in the first and second trimester, vaccination in July and August should be avoided unless it won’t be possible to vaccinate in September or October."
"Updated 2024-2025 flu vaccines will all be trivalent and will protect against an H1N1, H3N2 and a B/Victoria lineage virus. The composition of this season’s vaccine compared to last has been updated with a new influenza A(H3N2) virus."
"It is safe to receive COVID-19 and flu vaccines at the same visit."
UK HAS ANNOUNCED WHO WILL BE ELIGIBLE FOR AN AUTUMN 2024 COVID-19 VACCINATION
The JCVI announced its recommendations for who is eligible to receive a COVID-19 vaccine in the coming Autumn 2024 vaccination period.
Unfortunately, those under 65 who do not have a risk factor will not be eligible. However, the following people will be eligible for vaccination in the coming autumn:
- adults aged 65 years and over
- residents in a care home for older adults
- individuals aged 6 months to 64 years in a clinical risk group (as defined in tables 3 or 4 in the COVID-19 chapter of the Green Book: gov.uk/government/publicati... )
"Those with a history of haematological malignancy including chronic leukaemia, lymphomas, and leukaemia" are eligible.”
"The eligibility is the same across the 4 nations of the UK (England, Scotland, Wales and Northern Ireland).
The vaccine should usually be offered no earlier than around 6 months after the last vaccine dose. If you are eligible, you can get protection from an autumn COVID-19 vaccination even if you have not taken up a COVID-19 vaccine offer in the past."
"NHS England will confirm details on how and when eligible people can access the autumn vaccine in due course."
UPDATED COVID-19 VACCINATION INFORMATION FOR THOSE IN THE UK - JCVI recommendation for the UK Spring 2025, UK Autumn 2025 and UK Spring 2026 Vaccination periods:
Last week, the JCVI (Joint Committee on Vaccination and Immunisation) in the UK made its most recent recommendations regarding Covid-19 vaccinations. These recommendations will be considered before the upcoming UK Spring 2025 vaccination period and, while it's not yet certain whether the recommendations will be accepted for use in the UK, they have caused concern in some circles.
The recommendation for the UK Spring 2025 period is as follows:
"Using the bespoke, non-standard cost-effectiveness assessment developed by DHSC [Dept of Health and Social Care], JCVI advises that the following groups should be offered COVID-19 vaccination in spring 2025:
adults aged 75* years and over
residents in a care home for older adults
individuals aged 6 months and over who are immunosuppressed (as defined in the ‘immunosuppression’ sections of tables 3 or 4 in the COVID-19 chapter of the Green Book - assets.publishing.service.g...)"
The recommendation for the UK Autumn 2025 and UK Spring 2026 vaccination periods is as follows:
"Using the standard cost-effectiveness assessment, with an example price of £25 for the combined cost of vaccine and delivery, JCVI advises that vaccination should be offered to the following groups in autumn 2025 and spring 2026:
adults aged 75 years and over (see adult eligibility section below)
residents in a care home for older adults
individuals aged 6 months and over who are immunosuppressed (as defined in the ‘immunosuppression’ sections of tables 3 or 4 in the COVID-19 chapter of the Green Book)
This recommendation, if accepted, will mean that those with CLL will still be able to be vaccinated in the Spring 2025, Autumn 2025 and Spring 2026 through the UK's national Covid-19 vaccination program. However, most others in their household and amongst their close contacts and their community may not be able to get a free vaccine. There's no way of knowing until the final announcement is made but, usually, the JCVI recommendation is what's adopted.
One of the concerns about this latest UK advice relates to the JCVI's statement that most in the community have now built up strong immunity to Covid-19 based on 'hybrid immunity'. However, that isn't borne out by the ongoing waves being experienced around the world and the number of people who now fall 'under the curve' (ie who get infected each year) is still very high. It seems that most people are experiencing fewer acute symptoms, as the JCVI notes, and hospitalisation and mortality figures have dropped but the risk of long covid resulting from repeat infections and less recent vaccination remains a concern and that isn't addressed in the JCVI statement.
The other concern that has been expressed is that the JCVI is moving to a 'willingness to pay' model. The full document notes that:
"In accordance with the modelling undertaken by the University of Warwick, in the situation of a lower-than-example cost JCVI advises extending the universal offer to include people aged 70 to 74 years.
In the situation of a higher-than-example cost, JCVI advises universal vaccination of all people beginning at an age consistent with a cost-effective programme as indicated by the modelling undertaken by the University of Warwick. It is recognised that in this instance, the appropriate age threshold would be higher than 75 years.
Perhaps some of those who are keen to maintain protection through vaccination but who fall outside the recommended age groups will be prepared to pay for their vaccine. The BBC reported in October that "A number of High Street chemists and private clinics sell and administer the Pfizer Covid vaccine directly to the public. The cost varies from about £45 to £99. You need to be aged 12 or above, and must not have had a Covid vaccine in the previous three months." (The full article that also includes information about Novavax can be read here: bbc.com/news/health-55045639 )
"Critically Vulnerable Families" has written to the UK Government outlining its concerns. They highlight the fact that many who qualify for a flu vaccination will be precluded from getting a UK Spring 2025 Covid vaccine if the JCVI's recommendations are adopted.
As they say, watch this space and wait for the Government's announcement of what, exactly, will be on offer from Spring 2025 in the UK. In the meantime, the good news is that it looks as if free six monthly Covid-19 vaccinations will be continuing for those with CLL in the UK.
CLLerinOz
* this is a 10 year increase in age eligibility since the recommendation for the UK Autumn 2024 rollout
Indeed, plenty Covid around in the UK just now. As there was in a far away land I recently visited! 😉
Perhaps incidence and severity lessened by vaccination, hard to know, tricky measuring what isn't there. Namely the Covid cases prevented.
I'm not sure about vaccine uptake esp if it's going to cost. Not sure folk are even testing now if the get a respiratory illness... Behoves Us CLLers to remain vigilant on all fronts.
You're not wrong. Another wave is underway here in Australia and there are reports (some anecdotal, some documented) that primary schools, aged care facilities and hospitals are experiencing an uptick in cases, indicating that we're heading into another Xmas/New Year peak 🙁
In mid August 2024, the WHO announced a public health emergency of international concern (PHEIC) regarding MPOX (formerly known as Monkey Pox).
This is the second time such a warning has been made for Mpox. The first was raised in July 2022 and removed in May 2023 as cases decreased.
However, a new variant or ‘Clade’ of mpox has been circulating in Africa and that has led to the reintroduction of a global warning. The new variant appears to be more virulent with a higher death rate and there are reports that those most at risk include women and children under 15.
To date, the outbreak has spread through 13 countries in Africa, including a few that have never reported mpox cases before.
“Anyone can get mpox. It spreads from contact with infected:
* persons, through touch, kissing, or sex
* animals, when hunting, skinning, or cooking them
* materials, such as contaminated sheets, clothes or needles
* pregnant persons, who may pass the virus on to their unborn baby.”
There is also evidence it can be airborne and can be spread:
“face-to-face (talking or breathing”) and by “respiratory droplets or short-range aerosols from prolonged close contact”
“Several outbreaks of different clades of mpox have occurred in different countries, with different modes of transmission and different levels of risk.”
WHO Committee Chair Professor Dimie Ogoina said, “The current upsurge of mpox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, is an emergency, not only for Africa, but for the entire globe. Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself."
“Mpox has been reported in the DRC for more than a decade, and the number of cases reported each year has increased steadily over that period. Last year, reported cases increased significantly, and already the number of cases reported so far this year has exceeded last year’s total, with more than 15 600 cases and 537 deaths.”
“The emergence last year and rapid spread of a new virus strain in DRC, clade 1b, which appears to be spreading mainly through sexual networks, and its detection in countries neighbouring the DRC is especially concerning, and one of the main reasons for the declaration of the PHEIC.”
“The two vaccines currently in use for mpox are recommended by WHO’s Strategic Advisory Group of Experts on Immunization, and are also approved by WHO-listed national regulatory authorities, as well as by individual countries including Nigeria and the DRC.”
“Emergency Use Listing for mpox vaccines, which will accelerate vaccine access for lower-income countries which have not yet issued their own national regulatory approval. Emergency Use Listing also enables partners including Gavi and UNICEF to procure vaccines for distribution.”
In 2022, when Monkeypox started to spread more widely, the CLL Society provided the following advice.
“While monkeypox is concerning, demands our vigilance, and is dangerous to some in our community based on their increased risk of potential exposure because they work in a lab or medical setting, or their demographic, at this time monkeypox seems to pose a less significant risk to those with CLL/SLL compared to the present COVID-19 pandemic.” (See the CLL Society link in Part 4 for more information.)
There are currently at least two smallpox vaccines that are considered to be effective against monkeypox and more specific vaccines are in development.
ACAM2000™ is a live vaccine and should be avoided by people with CLL and their close contacts.
JYNNEOS® is a modified vaccinia Ankara strain vaccine (MVA-BN) that contains a virus that has been altered so it cannot multiply in the human body and is safe for people with CLL. It is given in 2 doses, at least 28 days apart, for people 18 years and over.
This April 2024 article by Raina MacIntyre, explains why we’re seeing an uptick in smallpox related illnesses like MPox:
“In the era of smallpox, there was widespread exposure to variola and mass vaccination, but vaccination against smallpox ceased in the 1970s and earlier in most countries. Smallpox vaccines are protective against other orthopoxvirus infections such as mpox. (14,15) However, 44 years after the eradication of smallpox was declared in 1980, waning vaccine immunity in older people, as well as accumulation of younger people who have never been vaccinated, means humans are now immunologically more susceptible to orthopoxvirus infections. (16,17) Mpox began to re-emerge in Nigeria in 2017. We calculated that population immunity had waned to a critical threshold of 2%, and this corresponds with the large epidemics seen thereafter. (18)” jglobalbiosecurity.com/inde...
The latest PHEIC announcement by the WHO aims to limit the spread of Mpox by increasing vaccine and testing availability in the countries where the virus is spreading, while flagging the risk of spread to other parts of the world if the current outbreaks are not brought under control.
There’s an excellent article in The Conversation about the current situation with mpox. It’s written by Professor Raina MacIntyre who is NHMRC (National Health and Medical Research Council) Principal Research Fellow, Head of the Biosecurity Program at the Kirby Institute, and Professor of Global Biosecurity at UNSW.
Katelyn Jetelina in YLE Public Health Emergencies State of Affairs: August 20
Covid still high, mpox emergency, and parvovirus enters the chat
Katelyn has provided an excellent update on what we do and do not know about MPox.
Snippets:-
Recently, Clade I has spread to non-endemic African countries, and over the weekend, 1 travel case was detected in Sweden.
The majority of cases are the Clade Ia subvariant, with more than 80% of cases being among children and accounting for 85% of deaths. The second subvariant, Clade Ib, is spreading among adults.
What do we NOT know?
- What is Clade I’s dominant mode of transmission? There is overwhelming evidence that Clade II is spread through close contact, like sex. For Clade I, the at-risk population is different. Situation reports show transmission through multiple means: sexual contact, household contact, non-sexual contact (like healthcare exposures), and animal exposures. Experts on the ground do not see epidemiological evidence of airborne spread in Africa; they see, for example, cases of kids hunting squirrels or people in close contact in houses, like four kids in one bed. While there are documented cases of airborne transmission, what is possible isn’t always probable.
- How does the fatality rate apply to this Clade and other geographies? Historically, Clade I has a *very* high case fatality rate of 10% (compared to Clade II with <1%). However, it’s unclear whether this high rate is due to the intrinsic properties of the strain or is an artifact of under-detection, poor access to treatment, lack of healthcare, and poor nutrition in Africa. Data, such as an animal model and one small epidemiological study, have confirmed Clade I is more genetically virulent.
- How effective is TPOXX (the antiviral) against Clade I? A recent study in the Democratic Republic of the Congo found that while TPOXX was safe, it did not significantly shorten the duration of pox lesions in Clade I cases.
On 30 Aug 2024, the FDA announced that it has granted emergency use authorization to the updated Novavax COVID-19 Vaccine that includes a monovalent (single) component that corresponds to the Omicron variant JN.1 strain of SARS-CoV-2.
"Those who have been vaccinated with a prior formula of a COVID-19 vaccine from another manufacturer or with two or more doses of a prior formula of the Novavax COVID-19 vaccine are eligible to receive a single dose of the updated Novavax COVID-19 vaccine at least 2 months after the last dose of a COVID-19 vaccine.".
RSV Vaccine Tied to Fewer Hospitalizations, ED Visits in Older, High-Risk Adults
— However, questions remain about durability of vaccine protection, expert says
The respiratory syncytial virus (RSV) vaccine (Abrysvo) was linked with fewer hospitalizations and emergency department (ED) visits in older patients during the first season of the vaccine's rollout, according to a retrospective analysis.
From November 2023-April 2024, adjusted RSV vaccine effectiveness against hospitalizations or ED visits was 90% (95% CI 24-99) among adults ages 60 and older during the first 5 months of vaccine availability, reported Sara Tartof, PhD, MPH, of Kaiser Permanente in Pasadena, California, at the IDWeekopens in a new tab or window annual meeting in Los Angeles.
Also, in a secondary analysis, adjusted vaccine effectiveness against RSV-related acute respiratory illness (ARI) ED visits was 93% (95% CI 47-99) and 91% against RSV-related ARI ED visits or hospitalizations (95% CI 61-89).
Among test-positive cases, 99.7% were unvaccinated (n=371) and 0.3% (n=1) were vaccinated. Among the test-negative controls, 96.8% (n=480) were unvaccinated and 3.2% (n=16) were vaccinated.
Very timely reading this due to planned travel to South America, a million questions I had (and some nervousness as well) and a travel clinic booking coming up to discuss and decide on vaccinations needed. This adds to the picture I'd already put together. Thanks
LATEST UPDATES ABOUT COVID, PNEUMOCOCCAL AND RSV VACCINATIONSFOR THOSE IN THE US(OCT 2024)
Yesterday, the CDC announced its endorsement of the CDC Advisory Committee on Immunization Practices (ACIP)'s recommendation for those 65 years and older as well as those 6 months to 64 years who are moderately or severely immunocompromised to receive a second dose of the 2024-2025 COVID-19 vaccine.
"October 23, 2024 - Today, CDC Director Mandy Cohen endorsed the CDC Advisory Committee on Immunization Practices' (ACIP) recommendation for people 65 years and older and those who are moderately or severely immunocompromised to receive a second dose of 2024-2025 COVID-19 vaccine six months after their first dose. These updated recommendations also allow for flexibility for additional doses (i.e., three or more) for those who are moderately or severely immunocompromised, in consultation with their healthcare provider (a strategy known as shared clinical decision making)."
"The recommendation acknowledges the increased risk of severe disease from COVID-19 in older adults and those who are immunocompromised, along with the currently available data on vaccine effectiveness and year-round circulation of COVID-19. The recommendation also provides clarity to healthcare providers on how many doses should be given per year to people who are moderately or severely immunocompromised and is meant to increase coverage of this second dose for that group."
"Data continues to confirm the importance of vaccination to protect those most at risk for severe outcomes of COVID-19. Receiving recommended 2024-2025 COVID-19 vaccines can restore and enhance protection against the virus variants currently responsible for most infections and hospitalizations in the United States. COVID-19 vaccination also reduces the chance of suffering the effects of Long COVID, which can develop during or following acute infection and last for an extended duration." cdc.gov/media/releases/2024...
The CDC also endorsed the recommendation for a pneumococcal conjugate vaccine (PCV) for all PCV-naive adults ages 50 and older. This means that the age of those in the general population who can now access a PCV vaccine has been lowered from 65 to 50 years of age. People 19 to 49 with certain medical conditions can also access a PCV vaccine. For more information, visit: cdc.gov/media/releases/2024... and cdc.gov/pneumococcal/vaccin...
See healthunlocked.com/cllsuppo... for information about the pneumococcal schedule that might be relevant to your situation.
There's more more information about the above announcements in the following MedPage Today article: medpagetoday.com/infectious...(Registration may be required)
See also "Patients with CLL are immunocompromised and recommended to receive COVID-19 vaccination regardless of treatment status or specific therapy": healthunlocked.com/cllsuppo...
Still in the US, "The FDA expanded the approval of the bivalent RSV prefusion F (RSVpreF) vaccine (Abrysvo) to include the prevention of lower respiratory tract disease (LRTD) caused by respiratory syncytial virus (RSV) in high-risk adults ages 18 to 59 years, Pfizer announced on Tuesday".
"The approval expands on the vaccine's existing indications for the prevention of RSV-associated LRTD in adults ages 60 years and older and for pregnant individuals to protect infants at birth."
"There are currently two other RSV vaccines available -- GSK's adjuvanted RSV prefusion F protein-based vaccine (Arexvy) and Moderna's mRNA RSV vaccine (mResvia). The FDA expanded the approval of the GSK vaccine in June to include adults ages 50 to 59 at risk of RSV-LRTD due to underlying conditions. The Moderna vaccine is approved for people ages 60 and older to protect against LRTD."
Of note, the CDC currently recommends that all adults ages 75 years and older should receive a single dose of any RSV vaccine, and adults ages 60 to 74 years who are at increased risk of severe RSV disease should receive a vaccine."
COVID-19 Vaccination update for those in Australia:
This week, the Australian Government’s latest Pharmacy Bulletin confirmed that the Pfizer JN.1 COVID vaccine will be available in December.
Pharmacies participating in the National COVID-19 Vaccine Program will be able to start ordering supplies of the new vaccine today and eligible Australians will be able to book a vaccination and receive the JN.1 vaccine (instead of the older XBB.1.5 vaccine currently being used) from 9 December.
Vaccines are delivered to pharmacies in two ‘tranches’ so if your pharmacy isnt offering the newest vaccine in the second week of December, another near you might be.
There are signs that another wave of infection has begun with Victorian figures, for example, on the rise again in the community and Aged Care facilities. Social media today has reports that at least one Melbourne hospital has reintroduced mask wearing.
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Novel COVID-19 Vaccine Shows Promise for People with Leukemia and Lymphoma
