CLL and vaccinations

[poing]

Is there any evidence whether vaccinations such as the seasonal flu vaccine are a good idea for CLL patients? It just seems to me that stimulating your immune system might not be such a great idea, so the risks of the vaccine might be higher. And the chance of the vaccine actually working and offering protection seem lower. The current recommendations seem to be based on the idea that vaccines are essentially benign, but I'm not convinced that they are, even in apparently healthy people.

[HAIRBEAR_UK Founder Admin]

Hi poing

Interesting question I’m sure others in the group will have input. The latest UK guidelines do address some of this in the immunization notes ahead of guidelines. This is a very current question as it’s that time again.

This year is the first when my Children now teenagers have been vaccinated along with my partner to provide herd immunity. I believe the level of protection afforded to me as a patient is unknown and I am not sure where to evidence the dangers of vaccination? Knowing the complications infection may cause me as a patient I am happy to believe some protection is better than none. You should discuss this with your consultant.

I have pasted the recommendations below. Professor Terry Hamblin wrote a fair bit on the topic and ways you may be able to improve vaccination efficacy in his blog Mutations of Mortality.

I assume you are referring to the latest British Committee for Standards in Haematology guidelines which were published early view on-line on the 11th October 2012 in the British Journal of Haematology ? Immunisation and rcomendations are towards the end.

Nick

[Myrddin]

I was advised to have the annual flu jab and pneomonia every 5 years. Advice which I have followed. Important that no vaccine is live. Could be they will not be as effective as would be the case for those with good immune system but better than nothing. This subject came up on Facebook group and most seemed to get vaccinated without problem. I did get a very big bruise this year. I have seen it recommended that a few months after the pneumonia jab you have your blood checked to see if the vaccine has worked or not. My GP was surprised at this. My penny worth.

[HAIRBEAR_UK Founder Admin]

This is the link to the the latest British Committee for Standards in Haematology guidelines which were published early view on-line on the 11th October 2012 in the British Journal of Haematology ? Immunisation and rcomendations are towards the end.

onlinelibrary.wiley.com/doi...

[Hidden]

I have just today had my first ever flu jab and am having pneumonia jab next week after recommendation by my consultant.

I think even though it doesn't work as effectively for us as for non cllers it still affords us some protection.

I feel fine at moment but am nervous in case it starts to make me feel ill.

Agree with Nick that catching flu or pneumonia would hit us quite badly so think any risks from side effects from jabs are worth it.

[Gartshore in reply to Hidden]

I had my first flu jag two weeks ago and one for pneumonia yesterday - both without any adverse reactions. I do wonder about 'exciting' the bad b lymphocites but, nevertheless, I think that being vaccinated is the correct decision

[David39]

I echo your comments, welshswan. It's unlikely that we'll get the same benefit of the flu and pneumonia jabs as non CLL sufferers, but we'd almost certainly be hit harder and for longer by the real thing if we were unlucky enough to catch either of them. All the medics I've ever had dealings with have urged me to have both. I've had the flu vaccine before, during and after treatment for CLL and have never suffered from anything other than a mild reaction - no more than the sniffles for a couple of days and a sore arm. I'd encourage anybody to go for it.

[louise66]

I was advised to have an anual flu jab and have also had a pneumonia jab too, my doctors also give flu jabs to the other members of my family. After taking 5-6 weeks to get over a slight cold i'd rather not risk flu. The only reaction to the jabs I've ever had is a sore arm for a day or two.

[Hidden]

I have just had my first flu jab, and so have my family.

As someone with a suppressed immune system (CLL) the benefits of the jab for me are certainly less significant than the benefits of having my family being inoculated and, therefore, being less likely to give me the flu.

As for the intrinsic and quantifiable merits of the flu jab for we with CLL, best ask the others.

[sparkler]

I have had my annual Flu jab for a number of years, because I also have Rheumatoid Arthritis. Last year I had the Pneumonia jab too and my GP recommended that my husband now has the Flu jab each year; we both had them last month.

I will accept any extra protection I am offered, against possible infections....obviously if safe for CLLers

sparkler x

[dinkywoman13]

both me and my hubby have had the flu jab this year, as well as last. no problems either time

[Cllcanada Top Poster CURE Hero]

CLL patients should be careful of contact with children who have had nasal spray type live vaccines... get guidance from your physician.

'FluMist® recipients (often children) should not associate with people who are immunocompromised (Cll patients) for at least 2 weeks following vaccination. If contact with severely immunocompromised individuals (after treatment or transplant) is unavoidable, the potential risk of transmission of the influenza vaccine virus should be weighed against the risk of acquiring and transmitting wild-type influenza virus.' , from the FluMist website.

[HAIRBEAR_UK Founder Admin]

Thanks for the post Chris. Live viruses are to be avoided including association with those following vaccination with the nasal spray is important news.

I am guessing that the majority in the UK don’t come into contact with the live virus but that is probably about to change. Many will have seen the news this year of the extension to the UK flu immunisation programme given the go ahead for 2014, which is aimed at reducing complications of spread of infection to the vulnerable. For example the older population, immune compromised (us), etc.

However the vaccination on offer to the main population for vaccination is Fluenz a live attenuated - weakened - intranasal vaccine, which has been used for several years in the United States under the brand name FluMist. It is offered as the mode of delivery as it may be more widely accepted by parents and children because it is given as a nasal spray..

So I guess we may soon have to make sure our kids living under the same roof get the jab not the spray when the project goes live!!.

Of course on a much wider scale the encouragement of “HERD” immunity in the general population is good news to us CLL patients, perhaps we may fear the winter a little less??

This was the news broadcast announcing the future programme.

. bbc.co.uk/news/health-18969338

“All two to 17-year-olds in the UK are to be offered annual flu vaccinations.

[arthur123]

All I know is that my consultant at the hospital advised me that it would be a waste of time for me to have the flu jab as my immune system will not form antibodies against it so it would be ineffective. So I haven't had it for the last three years although my wife was advised to have it to avoid passing it onto me. I did, however, have the pneumonia jab when I was first diagnosed with CLL as I was told it would protect me for life.

[HAIRBEAR_UK Founder Admin]

This may be of interest, can anyone explain this further?

Professor Hamblin wrote about this frequently and published several papers on the topic.

This is an exceprt from an article he wrote in Professor’s posts in ACOR .

“All patients with CLL have a diminished immune response which means that they have difficulty making antibodies to bacteria, even after vaccination. This is particularly so against bacteria with polysaccharide cell walls where the re- sponse is "T-independent". Examples of such bacteria are Pnemococcus and Haemophilus, so vaccines such as pneumovax don't work. Vaccines that contain protein are a bit better with an average response rate of about 40%. There are so-called "conjugated vaccines" where protein is conjugated to the polysaccharide, and response to these is better.

There is a further trick to help the immune response, which involves raising the level of blood histamine, which in turn enhances the response to IL-2, one of the "cytokines" that stimulates T

cells in the immune response. This is done by blocking the H2 receptors for histamine so there is a compensatory increased secretion of histamine. The way this is done is to take ranitidine 300 mg twice daily with the first vaccination, to have a boost of vaccine at 45 days and to continue the ranitidine for 90 days. This increases the response rate to 90%.”

Can someone explain if this is relevant today and which vaccinations it may improve response to?

The immunodeficiency of chronic lymphocytic leukaemia

A. D. Hamblin and T. J. Hamblin 2008

“Vaccination against infections is generally ineffective, but various manoeuvres can improve performance.”

[poing]

Thanks to everyone who's answered my question so far. Interesting variety of responses, and it sounds like people are getting different advice.

I'm particularly concerned about the flu vaccine as it's the one people get annually. And today I saw an article reporting yet another study that says flu vaccine isn't very effective, even in healthy people:

drbriffa.com/2012/11/22/flu...