Date of publication: February 2026
Date for review: February 2028
Updates to vaccine schedule
Changes in the epidemiology of infectious diseases and the introduction of new vaccines and/ or availability of vaccines mean that adjustments need to be made to the routine childhood vaccination schedule, and hence to the vaccination schedule for people treated for cancer.
July 2025
From July 2025, discontinuation of the manufacture of the Menitorix (Hib/ MenC) vaccine has resulted in changes to the national vaccination schedule. Whilst vaccination against Meningococcus group C (Men C) in early childhood is no longer considered necessary, vaccination against Haemophilus influenzae type b (Hib) in the second year of life needs to continue. For the national childhood vaccination schedule, the Joint Committee on Vaccination and Immunisation (JCVI) recommend an additional dose of a Hib-containing vaccine, the hexavalent combination (DTaP/IPV/Hib/HepB) vaccine which should be administered at age 18 months.
Patients treated with standard-dose chemotherapy: Should be offered the DTaP/IPV/Hib/HepB vaccine. With regards to children above 10 years of age that have completed treatment with standard dose chemotherapy, they can have a booster dose with DTaP/IPV/Hib/HepB; we have balanced the potential risk of reactogenicity in older children to the higher dose diphtheria toxoid in this vaccine with the need for Hib-conjugate vaccine as the risk of invasive Hib remains in older children and adults (UKHSA data, June 2025).
HSCT recipients: Are considered ‘never vaccinated’ as their immune system reconstitutes and they need a full re-vaccination programme; the higher diphtheria toxoid dose should not be an issue irrespective of recipient age.
January 2026
Measles/ Mumps/ Rubella/ Varicella (MMRV) vaccine
Measles/ Mumps/ Rubella (MMR) vaccine replaced with MMR/ Varicella vaccine (MMRV) in the national childhood vaccination schedule. Varicella zoster virus (VZV) is responsible for primary disease as varicella (chickenpox) and reactivation as Herpes zoster (shingles). The immune response to the MMRV vaccine after one dose demonstrates high seroconversion rates, with approximately 87% of children developing antibodies against varicella, and more than 90% developing antibodies against measles, mumps, and rubella. Following the second dose, seroconversion improves further, reaching approximately 99% for all four.
Licensed MMRV vaccines are ProQuad® or Priorix-Tetra®.
The titre of VZV (vOka strain of live attenuated virus) is approx. 7 x higher in MMRV vaccine than in the monovalent varicella vaccine (V titre is higher in MMRV because the MMR components interfere with V antigenicity). The MMRV vaccine has been proven safe. There is a small increase in febrile seizures in infants receiving their first dose of MMRV. There are no published studies that have examined the immunogenicity or safety of MMRV vaccine in individuals treated for cancer. Patients treated for cancer are at increased risk of skin rash after the first dose and in some they may also have a more typical varicella-like infection. MMRV is a live vaccine, hence should not be given during immunosuppressive treatment. Vaccination after completion of standard dose chemotherapy and HSCT should be undertaken as detailed below.
We do not know how long the monovalent varicella vaccine will be available in the UK; hence, we recommend MMRV vaccine. However, whilst the monovalent varicella vaccine is available consideration can be given to using combination of MMR and monovalent Varicella vaccines on a case-by-case basis.
After completion of standard dose chemotherapy:
- If no MMR vaccine prior to diagnosis, then give two doses of MMRV vaccine
- If received one dose of MMR vaccine prior to diagnosis, then give two doses of MMRV vaccine
- If completed two dose MMR schedule prior to diagnosis, then 1 x MMR and 2 x V components required so give two doses MMRV vaccine
With time, as most children will have received two doses of MMRV vaccine prior to diagnosis, the recommendation after treatment will be adjusted accordingly.
Two doses MMRV vaccine recommended. If Varicella IgG positive (or Herpes zoster (shingles) as clinical indicator of varicella immunity) after HSCT, either two doses MMR or two doses MMRV vaccine the varicella component of MMRV may boost varicella immunity akin to HSCT recipients aged above 18 years receiving the recombinant zoster vaccine) and prevent/ reduce reactivation (Herpes zoster).
MMRV vaccine should be given to household members/ close contacts as per the national vaccination schedule. Transmission of attenuated varicella vaccine virus from vaccinee to immunocompromised close contact has been documented, but the risk is low. Should the vaccinee develop a varicella like rash (usually within one month of vaccination), the rash should be covered and as a precautionary measure, the patient should avoid direct contact with the vaccinee/ their rash until the rash is dry and crusted. If the rash is disseminated, the risk of transmission is higher, and varicella prophylaxis should be provided for the immunocompromised contact as per the national guideline on post-exposure prophylaxis (PEP) for varicella or shingles, July 2025 (https://www.gov.uk/government/publications/post-exposure-prophylaxis-for-chickenpox-and-shingles/guidelines-on-post-exposure-prophylaxis-pep-for-varicella-or-shingles-january-2023#sectiond).
Pneumococcal conjugate vaccine
The 13-valent pneumococcal conjugate (PCV13) replaced with 20-valent pneumococcal conjugate (PCV20) for clinical risk groups (The Green Book: Immunisation against infectious disease). This would include patients treated for cancer, particularly HSCT recipients. PCV20 is recommended, if it is not available then PCV13 should be offered.