Medical Oncologist
Before you start
Vaccines — Before and During Cancer Treatment
Many people going into cancer treatment have not been told which vaccines they should have, which they must avoid, and why timing matters. Getting this right before treatment starts protects you from infections your immune system may not be able to fight as well during treatment.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Live vaccines must be avoided — Any vaccine containing live virus — including some flu sprays and the older shingles injection — cannot be given while treatment is active.
- Non-live vaccines are generally safe — The injectable flu shot, COVID-19, pneumococcal and hepatitis B vaccines can usually be given during treatment, though your response may be lower than usual.
- Timing before treatment matters — Vaccines given before treatment starts tend to produce a stronger response. Your oncologist can plan this into your pre-treatment preparation.
- Household contacts matter too — People who live with you should keep their own vaccinations current — especially the injectable flu shot each year.
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Some vaccines are safe during cancer treatment and some must be avoided. The key distinction is live versus non-live. Live vaccines cannot be given while your immune system is suppressed by treatment. Non-live vaccines — injectable flu, COVID-19, pneumococcal — are generally safe, though your response may be lower. Timing before treatment starts is where the most protection is gained.
How to prepare your vaccinations before and during treatment
Gather your vaccination record
Find your immunisation booklet or ask your GP for a printed summary of what you have received and what is due. If you do not have a record, your GP can check what is on file.
Bring it to your first oncology appointment
Tell your oncologist or nurse which vaccines are due or overdue before your treatment plan is finalised. This conversation needs to happen early, because some vaccines need to be given several weeks before treatment begins in order to work properly.
Schedule any recommended non-live vaccines before treatment starts
Non-live vaccines — the injectable flu shot, pneumococcal, COVID-19, hepatitis B — are generally safe and work best when given before chemotherapy or immunotherapy suppresses your immune response. Your team will advise on the timing.
Avoid all live vaccines while treatment is active
Live vaccines include the nasal-spray flu vaccine, MMR, varicella (chickenpox), yellow fever, oral typhoid, BCG, and the older shingles injection (Zostavax). None of these can be given while your immune system is suppressed. If someone offers you a vaccine you are unsure about, call your team before accepting it.
Ask when you can catch up on vaccines after treatment ends
Non-live vaccines can often be restarted relatively soon after treatment ends. Live vaccines need a longer gap while your immune system rebuilds. Your oncologist will give you a schedule specific to your treatment and recovery.
Your vaccine checklist to bring to your appointment
- Annual influenza vaccine — ask for the injectable version, not the nasal spray, each year of your treatment
- Pneumococcal vaccine — ask if you have not already had it
- COVID-19 vaccine — generally safe; ask your team about timing within your treatment cycle
- Hepatitis B vaccine — ask if you are not already immune, particularly before certain treatments
- Shingrix (non-live shingles vaccine) — ask whether this applies to you; the older Zostavax is not safe during treatment
- Travel vaccines — tell your team about any planned travel so they can advise which vaccines are safe
- Ask household members to get the annual injectable flu shot each year while you are in treatment
- Keep your vaccination record with your treatment documents and bring it to every appointment
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Which vaccines are safe during treatment?
| Vaccine type | Common examples | Safe during active treatment? | What to know |
|---|---|---|---|
| Live attenuated — avoid | Nasal-spray flu, MMR, varicella (chickenpox), yellow fever, oral typhoid, BCG, Zostavax (older shingles) | No — do not give during treatment | Can usually be given before treatment starts if there is time, or after immunity recovers. Your oncologist will advise on the gap needed. |
| Non-live (inactivated, subunit, mRNA, recombinant) — generally safe | Injectable flu, COVID-19, pneumococcal, hepatitis B, HPV, typhoid injection, Shingrix (shingles) | Yes — generally safe | Your immune response may be lower than usual but partial protection is still valuable. Best timed when your blood counts allow. |
Do the people you live with need to think about this too?
Yes, and this is one of the most practical steps your family can take. When household members are vaccinated against flu and COVID-19, the chance of them bringing those infections home is reduced at a time when you may not be able to fight them as well.
For the flu vaccine, household members should specifically use the injectable version, not the nasal spray. The nasal spray contains live virus, and there is a theoretical risk of transferring it to someone whose immune system is suppressed.
If anyone in your household is recommended a live vaccine for any reason — a travel vaccine, for instance — mention it to your oncology team so they can advise on how to manage the short window after that vaccine is given.
Did you know?
ASCO guidance recommends that cancer patients receive the inactivated influenza vaccine every year of treatment — not wait until treatment ends. Even when the immune response is lower than usual, partial protection from flu reduces the risk of a serious complication at a time when the body is already under stress.
Source: ASCO Clinical Practice Guidelines on Vaccination in Patients with Cancer
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Common questions
Frequently asked questions
Is it safe to get vaccinated while on chemotherapy?
Non-live vaccines — the injectable flu shot, COVID-19, pneumococcal, hepatitis B and others — are generally considered safe during chemotherapy, according to ASCO and ESMO guidance. Your immune response may not be as strong as in someone not on treatment, which is why your team may advise on the best timing within your cycle. Live vaccines, including the nasal-spray flu vaccine, must be avoided entirely while treatment is active. Always check with your oncology team before having any vaccine during treatment.
Can I get the flu vaccine during cancer treatment?
Yes — the injectable flu vaccine is recommended during cancer treatment by ASCO and ESMO. Ask specifically for the injection, not the nasal spray. The nasal spray is a live attenuated vaccine and is not safe when your immune system is suppressed. Your team may suggest a specific point in your treatment cycle, when blood counts are more likely to support a reasonable immune response, as the best time to have it.
What vaccines should I avoid during cancer treatment?
Avoid all live attenuated vaccines. These include the nasal-spray flu vaccine, MMR, varicella (chickenpox), yellow fever, oral typhoid, BCG, and the older shingles injection (Zostavax). These vaccines contain a weakened but live organism, which can cause active infection when your immune system is suppressed. If you are offered a vaccine you are unsure about — by a GP, school, employer, or travel clinic — call your oncology team before accepting it. It takes one call and it is always the right call.
When can I catch up on vaccines after chemotherapy ends?
Your oncologist will advise on specific timing, because it depends on your treatment type and how your immune system recovers. As a general principle, non-live vaccines can often be restarted relatively soon after treatment ends. Live vaccines need a longer gap — your immune system needs time to reach a level where it can safely handle a live organism. Do not book a catch-up vaccination without checking with your team first, because the right timing is individual.
Should I get the COVID-19 vaccine during cancer treatment?
ASCO and ESMO guidance supports COVID-19 vaccination for most cancer patients, including those on active treatment. COVID-19 vaccines currently available in India are non-live, so they are not contraindicated during treatment. The timing within your treatment cycle may matter, and your team will advise on the best point. If your immune system is significantly suppressed, an additional dose may be recommended to support your response — your oncologist can assess whether that applies to you.