Varicella Vaccine is Contraindicated in Children with Leukemia
Both varicella vaccine and oral poliovirus vaccine (OPV) are contraindicated in children with leukemia, but among the options provided, varicella vaccine (Option A) is the most definitively contraindicated live vaccine that remains clinically relevant, as OPV has been discontinued in most countries. 1, 2
Live Vaccines Are Absolutely Contraindicated
The varicella vaccine should not be administered routinely to children with leukemia, lymphoma, and other malignant neoplasms affecting the bone marrow or lymphatic systems due to T-lymphocyte immunodeficiency. 1, 2
The CDC explicitly states that varicella vaccine is contraindicated in individuals with malignant conditions affecting bone marrow or lymphatic systems, including blood dyscrasias, leukemia, and lymphomas. 2
OPV (oral poliovirus vaccine) is also a live attenuated vaccine and would be contraindicated in immunocompromised children with leukemia. 1 However, OPV has been replaced by IPV in most vaccination schedules worldwide, making this option less clinically relevant.
Inactivated Vaccines Are Safe
PCV (pneumococcal conjugate vaccine) is an inactivated vaccine and is NOT contraindicated—in fact, it is specifically recommended for children with leukemia before or during treatment. 1
IPV (inactivated poliovirus vaccine) is also NOT contraindicated and can be safely administered to immunocompromised children. 1
Inactivated vaccines such as influenza, hepatitis B, and pneumococcal vaccines can be safely administered to children with leukemia, though immune response may be reduced. 1
Special Circumstances for Varicella Vaccination in Leukemia
While varicella vaccine is generally contraindicated, immunization of varicella-susceptible leukemic children in remission should be undertaken only with expert guidance and with the availability of antiviral therapy. 1
Historical research protocols demonstrated that varicella vaccine could be given to children with acute lymphoblastic leukemia in remission with acceptable safety profiles, but these protocols have been terminated. 1
Given the variability of chemotherapy regimens and decreasing incidence of varicella, these high-risk children should not be routinely immunized. 1
Critical Clinical Pitfalls to Avoid
Do not confuse "contraindicated" with "never possible under any circumstances"—varicella vaccine may be considered in select leukemic children in stable remission with expert consultation, but this is the exception, not the rule. 1
Do not assume all vaccines are contraindicated in leukemia—only live attenuated vaccines pose significant risk. 1
The presence of an immunodeficient family member does not contraindicate vaccine use in other family members, but special precautions are needed if the immunocompromised child is exposed to recently vaccinated household contacts. 1
Answer to the Question
Among the options provided:
- A. Varicella (CONTRAINDICATED) - Live attenuated vaccine 1, 2
- B. PCV (NOT contraindicated) - Inactivated vaccine, actually recommended 1
- C. OPV (CONTRAINDICATED) - Live attenuated vaccine, but largely discontinued 1
- D. IPV (NOT contraindicated) - Inactivated vaccine, safe to use 1
The correct answer is A (Varicella), as it is the most clinically relevant live vaccine that remains contraindicated in children with leukemia. 1, 2