Vaccination.

Vaccination has been an important part of antiinfectious prophylaxis in ped iatric oncology comprising immunizations with special indication like varic ella vaccine and followup of routine immunizations after chemotherapy and b one marrow transplantation (BMT). Studies from the last decade demonstrate a loss of long term immunity to immunization preventable disease in most pa tients with chemotherapy and BMT who had received appropriate immunization before. So far routine vaccination programs following intensive chemotherap y have not been studied prospectively. Immunization programs following BMT have shown that immunizations with tetanus toxoid, diphteria toxoid, inacti vated poliovirus vaccine and influenza vaccine - given at least 12 months a fter transplantation - are safe and effective. Vaccination with live attenu ated trivalent vaccine against measles, mumps and rubella in patients witho ut chronic "graft versus host disease" (GVHD) and without ongoing immunosup pressive therapy, performed 24 months after transplantation, proved to be s afe too. Recommendations have been published by 5 different official groups : (1.) "Standige Impfkommission" (STIKO) and (2.) "Deutsche Gesellschaft fu r padiatrische Infektiologie" (DGPI) recommend varicella vaccine for childr en with leukemia in remission for at least 12 months, for children with sol id tumors and for patients getting an organ transplantation. Both societies do not comment on the schedule of booster vaccinations (with live attenuat ed vaccines) after the end of chemotherapy and after BMT. (3.) "Qualitatssi cherungsgruppe" der "Gesellschaft fur padiatrische Onkologie und Hamatologi e" (QS-GPOH) recommends immunization with nonliving vaccines when the patie nt is off therapy for at least 3 months and immunization with live attenuat ed vaccines when he is off therapy for at least 6 months. This group does n ot comment on varicella vaccine which has been controversial among pediatri c oncologists. (4.) The "Infectious disease working party of the European g roup for Blood and Marrow Transplantation" (EBMT) recommends immunization w ith nonliving vaccines when the patient is off transplantation for at least 12 months, without GVHD and without immunosuppressive therapy. (5.) The "G uidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant (HSCT) Recipients" published by the following american inst itutions and societies: "Centers for Disease Control and Prevention", "Infe ctious Diseases Society of America" and "American Society of Blood and Marr ow Transplantation" recommend that patients should be routinely revaccinate d after transplantation if they are off immunosuppressive therapy and do no t suffer from GVHD: beginning of vaccinations with nonliving vaccines in th e second year after HSCT, beginning of vaccinations with live attenuated va ccines in the third year after HSCT. Life-long seasonal influenza vaccinati on is recommended for all HSCT candidates and recipients, beginning during the influenza season before HSCT and resuming > 6 months after HSCT. IT wou ld be appriciated if working groups of these societies could find consensus recommendations on open and controversial questions in the near future.