COVID-19 guidance for children and young people with cancer undergoing treatment

Guidance updated 10 November 2022 

This guidance was first introduced in March 2020 to provide information on COVID-19 for families and children and young people on active cancer treatment up to the age of 18 and for those who have received a bone marrow transplant (BMT), also called a stem cell transplant (SCT).

Our guidance remains the same: children with cancer in the UK remain at low risk of severe SARS-CoV-2 infection, standard infection precautions should continue for children with cancer and vaccination with the Autumn booster is recommended for children > 5 years old.  It is important that children with cancer also receive their seasonal influenza (flu) vaccine.

This information is based on the UK Government and Public Health England advice and may differ from guidance issued from other countries. It will be regularly updated as and when new information is available. It has been written by experts in childhood and teenage cancer to reflect the particular needs of our patients. This guidance is consistent with the advice from the Royal College of Paediatrics and Child Health and has been developed with them.

We acknowledge there is a huge amount of information online and this can be overwhelming and sometimes conflicting, causing even more worry and stress. It is important that families make sure that information is filtered and gathered from reliable, easy to understand sources. Our booklet 'Searching for information and support online' has further information. 

Any Covid-19 questions? You can join our closed Parents and Carers Facebook Group to get the latest advice from experts at www.cclg.uk/parentgroup

Guidance on this page now focuses on vaccination. You can download previous versions of the guidance at the bottom of this page.

Update 10 November 2022

• Update on Autumn Booster 2022 for children and families

What are the current 2022 recommendations for the Autumn booster COVID-19 vaccination in children over 5 years who are undergoing treatment for cancer?

This winter (2022/23), it is expected that many respiratory infections, including COVID-19 and flu may be circulating at high levels. Therefore children who are 5 years and older in clinical risk groups are recommended to receive an autumn booster of the COVID-19 vaccine. This should be given at least 3 months after your child’s last dose of vaccine and given between September and December 2022. More information can be found here.

Children in high risk groups who turned five years of age after August 2022 are eligible for primary vaccination and can also receive a booster during the autumn programme, provided there is at least three months since their second (or third) primary dose.

Children with cancer between 5 and 15 years currently eligible to receive the COVID-19 vaccine and the Autumn 2022 booster include those who are:

Immunosuppressed due to disease or treatment, including:

• those undergoing chemotherapy or radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients
• those with haematological malignancy, including leukaemia and lymphoma
• those receiving immunosuppressive or immunomodulating biological therapy (usually end with –mab such as rituximab)
• those treated with or likely to be treated with high or moderate dose corticosteroids
• those receiving any dose of non-biological oral immune modulating drugs e.g. methotrexate, azathioprine, 6-mercaptopurine or mycophenolate
• those with auto-immune diseases who may require long term immunosuppressive treatments

As with other vaccinations, we know that giving a COVID-19 vaccine during chemotherapy is likely to produce a small protective response. The timing of vaccination should fit with chemotherapy cycles as we do with seasonal influenza vaccines.

We advise you to speak with your treating team who will be able to offer advice as to the best timing for your child to receive the vaccine depending on their treatment plan.

Which vaccine will my child be offered as part of the Autumn booster?

The JCVI have advised the following vaccines are suitable for boosting irrespective of the vaccine used for the primary course.

For children and young adults aged 12-17 years: a full 0.3ml dose (30 micrograms) of adult/adolescent Pfizer BioNTech vaccine (Comirnaty®) or a full 0.3ml booster dose of bivalent (15/15 micrograms) Pfizer BioNTech vaccine (Comirnaty® Original/Omicron BA.1)

For children aged 5-11 years: a full 0.2ml dose (10 micrograms) of paediatric Pfizer-BioNTech vaccine (Comirnaty®10) – off label indication

What if my child or young person undergoing treatment for cancer has a healthy sibling over 5 years old? Should the sibling receive the Autumn 2022 booster vaccine?

Yes. To reduce the risk of exposure, household contacts (if aged 5 years and over) of individuals with immunosuppression are also eligible for primary vaccination and boosting in the 2022 autumn campaign.

Should adult household contacts of immunosuppressed children and young people receive an Autumn 2022 booster vaccine?

Yes. All persons aged 5 to 49 years who are household contacts of people with immunosuppression are eligible for a COVID-19 booster vaccine in Autumn 2022. All adults over 50 years old are offered a booster vaccine too.

What if I have some more questions?

Please speak to your child’s consultant or any member of the team in your treating centre.

Original version written by Dr Jessica Bate, Consultant Paediatric Oncologist, Southampton Children's Hospital and Chair, CCLG Supportive Care Group
on behalf of the CCLG Executive. 

Updated version 17 March revised by Dr Jessica Bate with Dr Bob Phillips, Honorary Consultant in Paediatric Oncology, Leeds Teaching Hospitals, Prof Richard Grundy, CCLG Chairman and Ashley Gamble, CCLG CEO. This information was discussed and reviewed by a national group comprising medical representatives from all UK paediatric oncology Principal Treatment Centres, with representation from CLIC Sargent and Bloodwise. 

Updated version 23 March and 24 March revised by Dr Jessica Bate with Dr Bob Phillips, Prof Richard Grundy, Ashley Gamble, Dr Geoff Shenton, Consultant Paediatric Haematologist, Newcastle and Dr John Moppett, Consultant Paediatric Haematologist, Bristol.

Subsequent updates revised by Dr Jessica Bate with Dr Bob Phillips, Prof Richard Grundy, Ashley Gamble, Dr Geoff Shenton and Dr John Moppett

Other useful information

UK data on childhood cancer patients with COVID-19  

Information for survivors - produced by our Late Effects Group

Previous versions of guidance

11 January 2022 

13 December 2021 

August/September 2021 

21 July 2021 

23 June 2021 

2 February 2021 

5 January 2021 

17/03/20 24/03/20 06/04/20 22/05/20 17/06/20 30/09/20 14/10/20 05/11/20  02/12/20  22/12/20