8/24/2019 Avant Given Six Months To Live
SingerAvant was rumored to have six months to live after a photo surfaced of the 41 year old R&B singer looking slimmer than usually.
This past weekend a false statement was posted to Facebook, claiming that the singer only had six months to live.
I would like to thank all my fans for their tremendous support. I have lived my life to the fullest and I have given my life to God and I do not fear what’s in store for me. My doctors have given me about six months to live and during this time, I plan on making my transition as smooth as possible while spending time with family and friends. I’ve made my time here on the Earth a good one and I hope that my music continues to live on. One love.
Family and friends of Avant denies the rumors. Avant’s family said that the singer does suffer from Lupus, but is not dying. According to his love ones Avant is now Vegan and is new appearance is the result to his healthier lifestyle.
Its not clear who started the rumors, but it definitely caused a Social Media uproar. But, its good to hear that it was just a hoax and Avant is doing just fine.
Paediatr Child Health. 2001 Jul-Aug; 6(6): 379–383.
Mar 15, 2019 We are sad to report that R&B singer, Avant, has been given only six months to live. According to close sources to then singer, he has been battling a terminal illness that the singer wants to keep private. Avant contracted the terminal disease about 8 years ago.
PMID: 20084264
Language: English | French
This article has been cited by other articles in PMC.
Abstract
The paediatrician or family physician usually provides primary care for children diagnosed with cancer. Immunizations are an important facet of this care, but guidelines for the immunization of these immunocom-promised children are difficult to locate and cumbersome to follow. The authors have developed immunization guidelines for children receiving chemotherapy for cancer that will hopefully facilitate the care of this group of children. Before initiating any immunizations in this group of children, communication with a cancer specialist is recommended. There is little evidence-based literature to support immunization guidelines in immunocompromised hosts; thus, the recommendations presented are derived from the available literature, existing guidelines and expert opinion.
Keywords: Cancer, Immunization, Immunocompromised children, Vaccination
RÉSUMÉ :
En général, le pédiatre ou le médecin de famille prodigue les soins de premier recours des enfants cancéreux. La vaccination constitue un aspect important de ces soins, mais les directives relatives à l’immunisation de ces enfants immunocompromis sont difficiles à trouver et à utiliser. Les auteurs ont élaboré des directives de vaccination pour les enfants sous chimiothérapie contre le cancer, lesquelles, ils l’espèrent, faciliteront les soins de ce groupe d’enfants. Avant d’entreprendre l’immunisation d’un enfant cancéreux, il est recommandé de consulter un oncologue. Il existe peu de documentation probante pour soutenir les directives d’immunisation relativement aux hôtes immunocompromis. C’est pourquoi les directives présentées sont dérivées de la documentation médicale, des directives existantes et de l’opinion de spécialistes.
Cancer affects children of all ages who may be at any stage of the childhood immunization schedule recommended in the Canadian Immunization Guide (1) (Table 1). Children who have not completed primary immunizations are particularly susceptible to vaccine-preventable infections. Just as other children, some children with cancer will be underimmunized for age, relative to the current Canadian recommendations (1) (Table 2), for various reasons.
TABLE 1:
Immunization schedule for children with cancer who are undergoing chemotherapy
*Children with cancer will be unable to follow this schedule while on intensive chemotherapy.
†Vaccinations should be continued from the point at which the child was last vaccinated. There is no need to restart vaccinations from the beginning of the schedule, regardless of the interval since the last dose.
‡Measles-mumps-rubella vaccine (MMR) is contraindicated while the patient is receiving active chemotherapy. It should be given at least three months after the completion of chemotherapy, with a booster injection at four to six years of age. Some provinces recommend that the second MMR dose should be given at 18 months of age rather than at four to six years of age. Individual provincial guidelines should be consulted. The vaccine should be withheld for three to 10 months following immunoglobulin replacement therapy or blood product receipt.
§HBV vaccine should be repeated one and six months after the initial dose. It can be initiated at any age, but is routinely given in early adolescence (ages 9 to 12 years, depending on the provincial program).
¶Immunization for pneumococcus during chemotherapy may result in poor serum antibody levels and may not be effective in preventing pneumococcal infection. Children who receive the vaccine during chemotherapy or radiation therapy should be reimmunized three months after the discontinuation of therapy. A booster dose should be given three to five years later to children with an ongoing risk factor for infection such as asplenia.
**Influenza vaccine should be given annually in the fall, starting at six months of age. DTaP Diphtheria and tetanus toxoids and acellular pertussis vaccine; HBV Hepatitis B virus vaccine; Hib Haemophilus influenzae type b vaccine; IPV Inactivated poliovirus vaccine; Pne Pneumococcal polysaccharide vaccine; Td Tetanus and diphtheria toxoids vaccine
TABLE 2:
Immunization recommendations for children with cancer who are undergoing chemotherapy with incomplete immunizations*
*Routine schedule may be resumed after catch-up immunizations.
†For patients with incomplete Haemophilus influenzae type b immunization: if between 12 and 14 months of age, and two doses received before 12 months of age, a single dose should be administered; if between 12 and 14 months of age, and one dose received before 12 months of age, two doses should be given, separated by two months; if between 15 and 59 months of age, a single dose of vaccine should be given; and for unvaccinated children older than 59 months of age, a single dose is recommended because naturally acquired immunity may not be present after chemotherapy.
‡Measles-mumps-rubella vaccine (MMR) should be given as two doses at least one month apart after 12 months of age. It is contraindicated in children receiving active chemotherapy until chemotherapy has been discontinued for at least three months.
§Hepatitis B virus vaccine can be initiated at any age, but is routinely given in early adolescence (ages 9 to 12 years, depending on the provincial program).
¶Influenza vaccination should begin as soon as it is appropriate for children without an egg allergy, after six months of age.
**Pneumococcal polysaccharide vaccine is given to children who are at least two years of age. DTaP Diphtheria and tetanus toxoids and acellular pertussis vaccine; HBV Hepatitis B virus vaccine; Hib Haemophilus influenzae type b vaccine; IPV Inactivated poliovirus vaccine; Td Tetanus and diphtheria toxoids vaccine
Cancer chemotherapy suppresses immune response (). This decrease is most marked during induction and consolidation chemotherapy, and is moderate during maintenance chemotherapy. After the cessation of all therapy, immune function recovers to normal within three months or more. Primary immunization responses are more readily affected by immunosuppression than are booster responses. Immunizations should be withheld during induction and consolidation chemotherapy. Some vaccination options exist during maintenance therapy.
Killed vaccines pose no special risk to immunosup-pressed children, but the children may not respond adequately. Conversely, live viral vaccines are contraindicated in immunosuppressed persons and should be deferred until immune function has returned to normal. Live bacterial vaccines (eg, bacille Calmette-Guérin, oral typhoid) should also be avoided.
The receipt of blood products can interfere with responses to live viral vaccines. A washout period, the length of which depends on the type and dose of product(s) received before vaccination (Table 3), is required (1).
TABLE 3:
Washout period required before administering measles-mumps-rubella (MMR) vaccine after receipt of specific blood products
*Interval refers to the washout period required after receipt of blood products before the administration of MMR. MMR administration within this period may result in an inadequate response. Data reproduced with permission from reference 1
Bone marrow transplantation (BMT) results in severe immunosuppression. Ablation of memory lymphocytes may occur, necessitating repeat primary immunization. As engraftment progresses, immune functions gradually recover, but normalization can take 24 months or longer (3). Autologous transplantation results in less immunosuppression than allogeneic transplantation, with a decreased effect on memory cells.
Vaccination-associated adverse effects are not more common in children with cancer compared with healthy children when the above precautions are observed. Patients and their parents should be informed about the risks and benefits of immunizations before vaccines are administered (). General information about immunization is available on the Canadian Paediatric Society Web site <www.cps.ca/english/carekids/vaccination/index.htm>. Patients with cancer may also have allergies to antibiotics or eggs that may pose a contraindication to certain vaccines (eg, influenza vaccine in a child with an egg allergy) ().
Meticulous immunization record keeping is necessary in the setting of specialist-directed care to ensure that all physicians who may immunize a child are aware of what doses are planned and which doses have been given.
The immunization of household members merits special attention as a means of maximizing protection of the cancer patient whose own responses to vaccination may be blunted. Recommendations for the immunization of household members are found below under “Recommendations for household contacts of immunocompromised children”.
The immunization of health care workers who interact with cancer patients similarly requires attention. Recommendations for the immunization of health care workers are presented below under “Recommendations for health care workers attending to immunosuppressed children”.
SPECIFIC GUIDELINES
For children who reach the age of a routinely recommended immunization while they are undergoing chemotherapy, immunizations during or soon after intensive chemotherapy result in a poor response and, thus, should not be given during this period. Primary immunization with four doses of diphtheria and tetanus toxoids and acellular pertussis-inactivated poliovirus vaccine-Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine (Pentacel, Aventis Pasteur, Canada) can be undertaken or completed during maintenance therapy to avoid undue delays. However, the response may be suboptimal, warranting booster immunization once therapy has been completed, even though the routine schedule may not call for a booster dose at that age. Giving an extra booster in this context is generally safe and well tolerated, and need not be based on antibody measurements because they are not readily available. For example, a child who was diagnosed with acute lymphoblastic leukemia at 13 months of age, and who received three doses of DTaP-IPV-Hib but was not given a dose of measles-mumps-rubella (MMR) vaccine, may receive dose 4 of Pentacel while on maintenance chemotherapy, but should be given another dose three months or more after therapy is completed to ensure adequate protection. The MMR vaccine dose should be delayed until at least three months after therapy is completed. Pentacel and MMR vaccine may be given in opposite limbs during the same visit. The child should resume the normal immunization schedule upon school entry. If the child is exposed to measles before MMR vaccine can be safely administered, immunoglobulin prophylaxis may be given.
A tetanus and diphtheria toxoids and acellular pertussis (Td.aP) vaccine (Adacel, Aventis Pasteur, Canada) is licensed in Canada for booster immunization of adolescents (at least 11 years of age) and adults. It may be useful for booster immunizations in older children.
Live virus vaccines should be delayed until at least three months after the completion of chemotherapy or at least 24 months after BMT in the absence of graft-versus-host disease and a need for ongoing immunosuppression (6). At the present time, varicella zoster vaccine is not recommended for children with impaired immune function during or following chemotherapy.
Following autologous BMT, reimmunization may not be necessary if an adequate serum antibody titre is demonstrated against tetanus, diphtheria, measles, mumps, rubella, hepatitis B or polio. The decision to reimmunize a child following BMT should be made in concert with the transplantation team at the treating institution.
Children with cancer are at an increased risk of severe influenza infection. Influenza vaccine is a killed vaccine and can safely be given to immunocompromised children. It should be given annually in the fall, starting at six months of age. Because a poor response is expected at times of severe immunosuppression, it is recommended that vaccination be withheld until three to four weeks after the completion of intensive chemotherapy, and until peripheral granulocyte and lymphocyte counts are greater than 1×109 cells/L (3). Influenza vaccine is contraindicated in children with an egg allergy.
Children with cancer are also at an increased risk of invasive pneumococcal infection. Thus, the 23-valent polysaccharide pneumococcal vaccine should be given to children with cancer who are at least two years of age, after the completion of intensive chemotherapy. This recommendation may be altered when the conjugate pneumococcal vaccine becomes available.
The above guidelines are intended for children with cancer receiving chemotherapy and not for children receiving chemotherapy for other indications.
IMMUNIZATION SCHEDULES
Immunization schedules are presented in Tables 1, ,22 and and44 as follows: immunizations for children with cancer who are undergoing chemotherapy (Table 1); immunizations for children with cancer undergoing chemotherapy with incomplete immunizations (Table 2); and immunizations for children who have undergone autologous or allogenic BMT or stem cell transplantation (Table 4).
TABLE 4:
Immunization schedule for children who have undergone autologous or allogenic bone marrow transplantation (BMT) or stem cell transplantation
*At least one year should separate the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP)-inactivated poliovirus vaccine (IPV) dose given 24 months after BMT and the school entry dose (age four to six years).
†Primary immunization with DTaP vaccine is currently not recommended for children who are seven years of age and older.
‡MMR is given 24 months after BMT, unless the patient has chronic graft-versus-host disease and continued immunosuppression. A second dose of MMR should be given one month later, unless a serological response to measles is demonstrated after the first dose (6). Another dose at four to six years of age should not be necessary. Vaccination should be delayed for three to 10 months following immunoglobulin replacement therapy or blood product receipt.
¶Influenza vaccine should be given annually in the fall for children more than six months after transplantation.
**Hepatitis B response (anti-hepatitis B surface antigen) should be measured at least one month after completion of the three-dose schedule (). Up to three additional doses may be given if seroconversion has not occurred. HBV Hepatitis B virus vaccine; Hib Haemophilus influenzae type b; Pne Pneumococcal polysaccharide vaccine; Td Tetanus and diphtheria toxoids vaccine
RECOMMENDATIONS FOR HOUSEHOLD CONTACTS OF IMMUNOSUPPRESSED CHILDREN
Recommendations for household contacts of immunosuppressed children are based on the 2000 Red Book: Report of the Committee on Infectious Diseases (6).
Contraindicated vaccines
Oral polio vaccine is contraindicated in household contacts because viral shedding may occur for eight to 12 weeks and may lead to paralytic poliomyelitis in an immunocompromised patient. Inactivated poliovirus vaccine should be given instead.
Recommended vaccines
All routine, age-appropriate vaccines should be administered, including DTaP-IPV-Hib, MMR, Td or TDaP (when available). No special precautions are necessary because transmission of disease from these vaccines does not occur.
Varicella vaccine is recommended in all household contacts with a negative history of varicella zoster virus (VZV) infection. In the event of a vaccine-associated vesicular rash, the transmission risk is low and the consequences of infection are limited by the attenuated nature of the vaccine virus. Protecting an exposed immunocompromised child with varicella zoster immunoglobulin or antiviral drugs is not routinely recommended (7). However, when the vaccinee may be experiencing wild-type varicella infection, prophylactic measures should be considered.
An annual influenza vaccine should be given to all household contacts of immunocompromised children.
RECOMMENDATIONS FOR HEALTH CARE WORKERS ATTENDING TO IMMUNOSUPPRESSED CHILDREN
Recommendations for health care workers attending to immunosuppressed children are based on the 2000 Red Book: Report of the Committee on Infectious Diseases (6).
Td vaccine is recommended every 10 years for all health care workers.
MMR vaccine is recommended for health care workers with negative serology. No special precautions are necessary because transmission of measles, mumps or rubella does not occur.
Hepatitis B virus vaccine is recommended for health care workers.
Varicella vaccine is recommended for all health care workers with a negative history of VZV infection and negative VZV antibody levels. No special precautions are required unless the vaccinee develops a vesicular rash. In the event of a vaccine-associated vesicular rash, the transmission risk is low and the consequences of infection are limited by the attenuated nature of the vaccine virus. Protecting an exposed immunocompromised child with varicella zoster immunoglobulin or antiviral drugs is not routinely recommended (7). However, when the vaccinee may be experiencing wild-type varicella infection, prophylactic measures should be considered.
Annual influenza vaccination is recommended for all health care workers.
Mantoux testing should be performed according to the recommendations of the specific health care facility ().
REFERENCES
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