title: Guidelines on vaccinations in paediatric haematology and oncology patients.
abstract: OBJECTIVE
  Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children.
  
  
  METHODS
  A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed.
  
  
  CONCLUSIONS
  During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.
authors.affiliation: Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Ospedale Borgo Roma, P.le L.A. Scuro 10, 37134 Verona, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.affiliation: Paediatric Hematology Oncology, Regina Margherita Hospital, P.zza Polonia 94, 10126 Torino, Italy.
authors.forename: Mareva
authors.initials: M
authors.lastname: Giacchino
authors.affiliation: Paediatric Hematology, G. Gaslini Institute, Via Gerolamo Gaslini 5, 16148 Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fioredda
authors.affiliation: Paediatric Hematology Oncology, Azienda Ospedaliera, Via Gramsci 14, 43100 Parma, Italy.
authors.forename: Angelica
authors.initials: A
authors.lastname: Barone
authors.affiliation: Paediatrics, Azienda Ospedaliera, Via Lorenz Böhler 5, 39100 Bolzano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Battisti
authors.affiliation: Paediatric Hematology Oncology, Regina Margherita Hospital, P.zza Polonia 94, 10126 Torino, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bezzio
authors.affiliation: Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Meyer, Viale Pieraccini 24, 50139 Firenze, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Frenos
authors.affiliation: Paediatric Hematology Oncology, Casa Sollievo della Sofferenza Hospital, Viale Cappuccini 2, 71013 San Giovanni Rotondo, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: De Santis
authors.affiliation: Paediatric Immunology and Infectious Diseases, Ospedale Bambin Gesù, Piazza di Sant'Onofrio, 4, 00165 Roma, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Livadiotti
authors.affiliation: Infectious Diseases, Azienda Ospedaliera, Via Giustiniani, 35128 Padova, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Marinello
authors.affiliation: Paediatric Hematology Oncology, Burlo Garofalo Institute, Via dell'Istria 65, 34137 Trieste, Italy.
authors.forename: Andrea Giulio
authors.initials: AG
authors.lastname: Zanazzo
authors.affiliation: Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Meyer, Viale Pieraccini 24, 50139 Firenze, Italy ; Medical Direction, A.O.U. Meyer, Children Hospital, Viale Pieraccini, 24, 50139 Firenze, Italy.
authors.forename: Désirée
authors.initials: D
authors.lastname: Caselli
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D006405:Hematology / Q000592:standards*; D022362:Hepatitis A Vaccines / Q000627:therapeutic use; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006801:Humans; D007107:Immune System; D032521:Immunity, Herd; D017589:Immunization Programs; D008495:Medical Oncology / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D014611:Vaccination / Q000379:methods / Q000592:standards*
chemical_list: D000970:Antineoplastic Agents; D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines