Table. Recommendations for vaccination in people who have received chemotherapy

These recommendations are based on the principle that, where possible, children and adults have completed an age-appropriate routine vaccination schedule prior to chemotherapy. Generally, people who have completed chemotherapy are recommended to receive additional doses of certain vaccines when the malignancy is in remission, and chemotherapy was completed at least 3 months previously.

These recommendations should be interpreted in conjunction with the guidance in Secondary (acquired) immunodeficiency due to medical conditions. The recommended vaccination schedule after chemotherapy may vary by person, depending on their age, vaccination history, the type of cancer, other immunosuppressive treatments received and other comorbidities. Consult the treating oncologist if uncertain.

Vaccine category	Vaccine	Recommendation	Comments
Non-live vaccines	COVID-19	2-dose primary schedule and can consider a 3rd dose 1 additional dose or ongoing doses every 6–12 months, based on individual risk benefit assessment (see comments)	Number of primary and additional doses are based on the person’s age and presence of other risk factors for severe illness from COVID-19.
	Diphtheria-tetanus-pertussis- and polio-containing vaccines^a,b	Aged <10 years: 1 additional dose of DTPa and 1 dose of polio vaccine (eg Infanrix-IPV) Aged ≥10 years: 1 dose of either dT or reduced antigen content dTpa, and a 1 dose of polio vaccine (eg Boostrix-IPV or Adacel Polio)	–
	Haemophilus influenzae type b^a,b	Aged <5 years: 1 booster dose	–
	Hepatitis A	Use if indicated	–
	Hepatitis B^a,b	1 booster dose for seronegative people with specific at risk conditions	Check serology 4–8 weeks after vaccination.
	Human papillomavirus^a	Aged ≥9 years: 3-dose primary schedule	Gardasil 9 is registered for people aged 9–45 years. Assess the need for, and potential benefits of, vaccination in older adults. Consult a specialist if required.
	Influenza (non-live)	1 dose annually	Use age-appropriate vaccine option Children aged 6 months to 9 years should receive 2 doses (4 weeks apart) if receiving influenza vaccine for the first time, then 1 dose every year after that.
	Japanese encephalitis (inactivated)	Use if indicated	See also Vaccination for international travellers.
	Meningococcal (MenACWY and MenB)^a	1 booster dose of both MenACWY and MenB vaccines	Priority should be given to children (aged <2 years) and adolescents (aged 15–19 years).
	Mpox (live, non-replicating)	Use if indicated or seek specialist advice on individual risks and benefits of vaccination	–
	Pneumococcal (conjugate and polysaccharide vaccines)^a	Aged <18 years: 1 dose of 20vPCV at least 2 months after any previous dose of PCV. Aged ≥18 years: 1 additional dose of PCV at least 2 months after any previous doses of PCV 1 additional dose of PPV 2–12 months after the last dose of PCV, and a 2nd dose of PPV 5 years later	Children who have received either a routine course of 3 doses of any PCV, or 4 doses of 13vPCV or 15vPCV, or 4 doses of any PCV plus 1 dose of PPV, are recommended to receive 1 dose of 20vPCV at least 8 weeks after any previous doses of PCV. Children who received either a routine course of 4 doses of 20vPCV or 4 doses of any PCV plus 2 doses of PPV (i.e. Aboriginal and Torres Strait Islander children) have already received the recommended number of doses of pneumococcal vaccine and do not require any additional doses. If the person has previously received a dose of PPV, the PCV dose should be given at least 12 months after the last PPV dose. For children who have not received a full routine infant course of pneumococcal vaccination, see Table. Catch-up schedule for 20vPCV for children aged <5 years who are either Aboriginal and Torres Strait Islander (including those living in ACT, NSW, Tas or Vic born on or after 1 March 2025), or have a risk condition(s) for pneumococcal disease..
	Rabies	Use if indicated	See also Travellers who are immunocompromised.
	Immunisation against respiratory syncytial virus^a	Aged ≥60 years: 1 primary dose of RSV vaccine At-risk neonates and infants <24 months with significant immunosuppression: 1 primary dose of RSV-specific monoclonal antibody	–
	Zoster (herpes zoster, recombinant)	Aged ≥18 years if immunocompromised: a 2-dose primary schedule	–
Live vaccines	BCG	If benefit outweighs risk, give ≥4 weeks before chemotherapy	See also Travellers who are immunocompromised.
	Cholera (live)	Choose non-live vaccine option if indicated	See also Travellers who are immunocompromised.
	Influenza (live)	Contraindicated, choose non-live vaccine option	-
	Measles-mumps-rubella (MMR)^a	A single dose of MMR-containing vaccine, and a 2nd dose for those not seroconverted (MMRV vaccine can be used as the 2nd dose in children aged <14 years)	Check measles and rubella serology 6–8 weeks after vaccination.
	Q fever	Contraindicated or consult a specialist	Serological and skin tests are needed before vaccination.
	Rotavirus	Complete routine schedule (≥4 weeks before chemotherapy, if possible)	Only indicated in infants within age limit (1st dose <15 weeks of age, 2nd dose <25 weeks of age)
	Typhoid (live)	Choose non-live vaccine option if indicated	–
	Varicella (monovalent)^a	Complete a 2-dose schedule, give ≥4 weeks before chemotherapy if seronegative (MMRV vaccine can be used as the 2nd dose in children aged <14 years)	Check varicella serology before vaccination if unvaccinated or unsure.
	Yellow fever	If benefit outweighs risk, give ≥4 weeks before chemotherapy	See also Travellers who are immunocompromised.
Acronyms used: – = none BCG = bacille Calmette–Guérin dT = diphtheria-tetanus DTP/dTpa = diphtheria-tetanus-pertussis IPV = inactivated poliovirus MenACWY = meningococcal ACWY MenB = meningococcal B MMRV = measles-mumps-rubella-varicella PCV = pneumococcal conjugate vaccine PPV = pneumococcal polysaccharide vaccine RSV = respiratory syncytial virus Footnotes: ^a Recommended but not funded under the National Immunisation Program ^b May be given as combined vaccines