The Vaccine Working Group is a collaboration between St. Jude and SIOP.
COVID-19 Vaccine
In less than one year since the announcement of the SARS-CoV-2 pandemic, hundreds of vaccines have been developed, several of them reaching approval and usage around the world, including U.S. FDA emergency use authorization of the Pfizer/BioNTech vaccine for those age 12 and older.
The similarity of these vaccines is to produce antibodies to protect against COVID-19 infection, but each of these vaccines have different designs, compositions, number of doses, time intervals between dose administration, and efficacy.
An avalanche of information has been generated surrounding these vaccines. And to make it more challenging, a horde of misinformation disseminated with similar speed. Therefore, it is natural that caregivers and health care providers face the difficult task to make the decision whether or not to vaccinate these at-risk children.
Is the vaccine safe for pediatric patients with cancer and those with other underlying conditions that compromise the immune system?
Yes, the vaccine is safe for these patients based on data from both adult and childhood patients with immunocompromised systems. None of the current COVID-19 vaccines that are used worldwide contain agents that actively replicate the virus in the recipient, which immunocompromised individuals should avoid.
Should individuals with cancer receive a COVID-19 vaccine?
Children with cancer or other types of hematologic malignancies have a higher risk of severe COVID-19 disease and its complications. Though they may have a lower immune response to the vaccine, it can still prevent or decrease serious complications from the infection. International cancer groups and health centers recommend that all children with cancer, including those receiving hematopoietic cell transplantation (HCT)/cellular therapy, are vaccinated with one of the available COVID-19 vaccines.
Patients with solid tumors in remission, with myeloproliferative neoplasia, with myelodysplastic syndromes without treatment, and patients receiving endocrine treatment or noncytotoxic agents can receive the COVID-19 vaccine at any time.
Patients with lymphoid malignancies who will receive B-cell depleting agents and those with solid tumors who will receive cytotoxic agents should be given the COVID-19 vaccines before anticancer treatment begins, where possible. If treatment has already been started, then vaccination should be timed around expected periods of treatment-induced cytopenia.
Patients who have undergone HCT or chimeric antigen receptor (CAR) T-cell therapy should wait to vaccinate against COVID-19 until 100 days after completing treatment.
Importantly, close contacts and caregivers of those with cancer as well as those who live in the same household should receive a COVID-19 vaccine.
What is the recommendation for COVID-19 vaccination for children younger than 16 years of age, including infants?
All children older than 6 months, including those with cancer and receiving anticancer treatment or who recently completed anticancer treatment, should receive a COVID-19 vaccination according to the approved dosage for the age group.
All childhood cancer survivors who are older than 6 months should receive a vaccine.
Does receiving the COVID-19 vaccine require altering anticancer treatment?
If possible, vaccination should be completed at least 14 days before starting cancer-directed therapy. Otherwise, there is no indication for altering anticancer treatment after a patient has received COVID-19 vaccination.
If vaccinating while treating a patient for cancer, COVID-19 vaccination should be given outside of the anticipated period of therapy–induced cytopenia.
If a cancer patient received a COVID-19 vaccination while immunosuppressed, is an additional dose recommended after completion of anticancer treatment?
Yes, an additional booster dose is recommended to enhance or re-establish the protection of the primary series of COVID-19 vaccine doses. Patients with cancer can have lower response rates to vaccines than individuals with competent immune systems. Additional vaccine doses are frequently used when immunizing oncology patients, for example when vaccinating against influenza, especially if the patient was vaccinated while immunosuppressed.
For a child who has received bone marrow transplantation, when should he/she receive a COVID-19 vaccine?
Current recommendations support vaccinating patients as early as 100 days after HCT and CAR T-cell therapy. Patients who received COVID-19 vaccination prior to HCT should receive a complete COVID-19 vaccine series at least 100 days after HCT and CAR T-cell therapy.
Which COVID-19 vaccines are approved for use in immunocompromised patients?
Individuals, including children, who are immunocompromised, should receive the COVID-19 vaccine for which they are eligible and to which they have access. However, live-attenuated virus vaccines and replicating viral-vectored vaccines are not recommended for patients with immunosuppression.
Working Group Membership
The COVID-19 Vaccine Working Group on Pediatric Oncology convened in early March 2021 to answer vaccine questions. Members are a multidisciplinary group of oncologists, infectious disease physicians and nurses representing all major regions of the world and several countries.
Arpita Bhattacharyya, India, Pediatric Oncologist
Gita Naidu, South Africa, Pediatric Oncologist
Ivan Gutierrez, Colombia, Pediatric Infectious Disease
Jessica Bate, United Kingdom, Pediatric Oncologist
Jose Luis Copado, Mexico, Pediatric Infectious Disease
Lisa Morrissey, United States, Nursing
Nita Radhakrishnan, India, Pediatric Oncologist
Riyadi Adrizain, Indonesia, Pediatric Infectious Disease
Sarah Alexander,Canada, Pediatric Oncologist
Tarek Ahmed, Egypt, Pediatric Oncologist
Vivian Paintsil, Ghana, Pediatric Oncologist
Yan Yin Lim, Singapore, Nursing
The COVID-19 Vaccine Working Group on Pediatric Oncology is led by Dr. Miguela A. Caniza (Pediatric Infectious Disease Specialist, St. Jude), Dr. Jessica Bate (Pediatric Oncologist, University Hospital Southampton, United Kingdom) and Maysam R. Homsi (Project Coordinator, St. Jude). Consultants to the working group are Dr. Kenneth Alexander (Vaccinologist and Pediatric Infectious Disease Specialist, Nemours Children’s Hospital, Orlando, Florida), Dr. Sheena Mukkada (Pediatric Infectious Disease Specialist, St. Jude) and Dr. Robert Phillips (Pediatric Oncologist, Senior Clinical Academic and NIHR Post-Doctoral Fellow Honorary Consultant in Paediatric Oncology, CRD, University of York, York, United Kingdom).
Parent/Carer Advisory Group Membership
The COVID-19 Vaccine Parent/Carer Advisory Group is made up of individuals who represent cancer patients and their families from around the world. Their questions and concerns about vaccines are addressed by the working group below.
Julia Gumy, United Kingdom, Children’s Cancer and Leukaemia Group
Brian Regan, United States, Dana Farber/Boston Children’s Pediatric Patient/Family Advisory Committee
Meghan Shea, United States, Dana Farber/Boston Children’s Pediatric Patient/Family Advisory Committee
Julie Chessell, Canada, AC20RN
Kim Buff, United States, Momcology
Carmen Auste, Philippines, Childhood Cancer International
Pinta Manullang-Panggabean, Indonesia, Yayasan Anyo Indonesia
