Identifying Care Gaps in Revaccination of the Non-Hematopoietic Stem Cell Transplant (Non-HSCT) Childhood Cancer Survivor Population at Helen Devos Children's Hospital

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

National childhood vaccination rates are declining. For children entering kindergarten in 2016-2017 compared to 2024-2025, national vaccination rates fell from 95.2% to 92.1% for DTaP, 95.2% to 92.5% for Polio, 95% to 92.5% for MMR and 94.2% to 92.1% for 2 dose varicella. Additionally, data overall suggest childhood cancer survivors are inadequately protected against vaccine preventable disease. In one study only 26.7% of survivors had positive measles and mumps titers following treatment despite previous vaccination. There is no national standard for revaccination for non-hematopoietic stem cell transplant (non-HSCT) childhood cancer survivors. This survey goal was to ascertain the current practice regarding revaccination protocol for non-HSCT childhood cancer survivors at Helen Devos Children's Hospital (HDVCH) to identify gaps in care and potential benefit of practice standardization.

Ten question, single answer choice survey completed by the ten HDVCH pediatric hematology/oncology physicians. Each question included a text box for further clarification and detailed responses.

1/10 HDVCH providers routinely revaccinate non-HSCT patients, 3/10 elect to sometimes, depending on diagnosis, treatment or titers, and for 6/10 it is not their standard practice. The one provider who routinely revaccinates does so after assessing titers, most often giving Pneumovax, while only one additional provider routinely checks titers and 1/10 sometimes check titers depending on therapy received or delayed lymphocyte recovery. 7/10 do not routinely assess childhood vaccines titers. 4/10 providers routinely assess for immune reconstitution, primarily via absolute lymphocyte count or immunoglobulins. For management of routine childhood vaccines post therapy 4/10 rely on PCP, 4/10 co-manage with the PCP and 2/10 managed themselves. 7/10 providers felt specific attention and specialized protocol would be necessary for revaccinating post-immunotherapy (ex. Blinatumomab and Rituximab). 10/10 providers agree that a standardized post chemotherapy vaccine protocol would potentially benefit their practice.

There is no consensus or standard for revaccinating non-HSCT childhood cancer survivors at HDVCH, a population particularly at risk given inadequate protection against vaccine preventable disease and the growing threat to heard immunity. The rise in immune modulators as primary therapy requires further research on the impact of these treatments to vaccine titers and post therapy vaccine efficacy and timing. Identifying these inconsistencies highlights a significant gap in care and provides the basis on which to develop a practice wide standardization for revaccination.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2125

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