Immunisation practices of paediatric oncology and shared care oncology consultants: A United Kingdom survey

Abstract

In March 2002, the Royal College of Paediatrics and Child Health (RCPCH) introduced guidelines for re-immunisation of children after completion of standard-dose chemotherapy and after haematopoietic stem cell transplant (HSCT). To ascertain whether these guidelines form standard unit policy by undertaking a survey of UK paediatric principal treatment centre (PTC) consultants and shared care (SC) consultants. In October 2008, a link to an on-line anonymised survey was sent by e-mail to all UK PTC consultants in Children's Cancer and Leukaemia Group (CCLG) centres and to SC consultants linked to eight of these centres. Responses were received from 55 PTC consultants (representing all 21 CCLG centres) and 54 SC consultants. In accordance with the RCPCH guidelines, most PTC and SC consultants recommend initiating re-immunisation at 6 months after completion of standard-dose chemotherapy (99/105, 94.3%). Re-immunisation at the recommended time after HSCT for each transplant type was reported by 93-100% of respondents. Pneumococcal conjugate vaccine (PCV) was recommended after chemotherapy by 58.3% (35/60) of respondents and by 51.7% (30/58) after HSCT. There were distinct differences between PTC and SC consultants in their choice of varicella (VZV) post-exposure prophylaxis. There is a high level of stated compliance with RCPCH guidelines. Recommendations for PCV after chemotherapy and HSCT were lower than expected. This may reflect the absence of specific guidelines after chemotherapy but not in HSCT patients where guidelines do exist. Variation in VZV post-exposure prophylaxis suggests further studies are required.