Yellow Fever

Dear Carlos,

I think that if your consultant- who I presume is expert in CML? - understands the risks of vaccination. From what I

understand, as long as the vaccination is not 'live' and your white cell count is within normal range (approximately 2-11) you should be OK. I understand why your GP is being cautious but she/he might not understand that with TKI therapy people are generally not immuno-compromised, as they are when they are treated with chemotherapy.

Generally, what is meant by being immuno-compromised is that leukocytes- neutrophils, lymphocytes -T and B cells and other kinds of white cells, are at too low a level to effect an effective immune response to combat a bacterial or viral infection. However, if your blood counts show your leukocytes (white cells) are at good to normal levels then I cannot see that there would be a problem. 

Whether having a vaccination would be a risk worth taking (unpleasant side effects such as fever etc.) is another consideration but you can assess what the level of risk is for you contracting Yellow Fever. I assume from what you say you have already thought about this and it seems unlikely given where you are staying and it not being the rainy season? I assume Yellow Fever is contracted from a water borne bacteria? 

Addenbrookes is one of the specialist centres for CML, so you can be pretty trustful of your consultant's advice as she/he would have access to your blood counts- however if you feel your GP has legitimate cause for concern (i.e. he thinks your white cell count is too low to risk side effects from vaccination/ or the yellow fever vaccination is a love one?) then you could take his/her concerns back to your CML consultant and ask for his/her opinion.

I am sure if the GP could ask the consultant ( just a phone call between the two to put your GP's mind at rest) then you will be confident that you have clear advice and can then make an informed decision about the vaccination. 

I hope you can resolve the conflicting advice so that you can take the precautions you feel you need in order to ensure a good and uneventful trip,

Best wishes,

Sandy

I recently had to have a series of vaccinations - all fine, though none were live. Before doing this however, I checked with several sources all of whom said that so long as I was not immuno compromised on Glivec (which I am not - my white cells are all normal), ALL vaccinations even live ones should be OK (I had heard somewhere that we should not receive live vaccines but I was advised that is not so if your white count is OK).  Yellow Fever vaccine is live I understand - and is about the only live one used on adults in the UK. 

Sandy's advice makes sense - your consultant will know much better than your GP and if in doubt ask your GP surgery to speak to your consultant.  As far as I understand, if your immune system is OK the fact you have CML at some level isn't relevant. Your consultant can best advise though.

Something to bear in mind - though I don't know if relevant - is that if you travel to a Yellow Fever country, there are some others who insist that you have Yellow Fever vaccine before you visit them subsequently, if you have not already been vaccinated. 

Richard

If the Hammersmith advised me not to have it, then I certainly wouldn't.  I think though it may vary from patient to patient and I would certainly seek my own consultant's specific advice were I in your position Carlos.  Interestingly, cancerhelp gives advice for glivec which suggests that if your white count is OK, live vaccines are OK and logically that makes sense as it's an immune system issue.  I did ask a consultant (CML) haematologist this question before having any vaccinations and while none of mine were live, I was told that because my white count is normal and has been for many months there was no reason why any vaccine was a problem. 

This is the link to cancerhelp for glivec - which suggests it's OK when white count is stable and normal - but note the advice for dasatinib is less complete (possibly because it's a newer drug) so I would definitely ask my consultant!

http://www.cancerhelp.org.uk/about-cancer/treatment/cancer-drugs/imatinib

Hope this helps - I would ask my consultant again if I were you.