Vaccines and Your Medications
General Information About Vaccines:
Vaccines are meant to DECREASE (not completely eliminate) a patients potential to acquire the infection in which they are being vaccinated against. There are MANY TYPES of vaccines. These include but are not limited to LIVE and DEAD virus vaccinations.
A LIVE VIRUS VACCINATION is often a shot (or nasal spray) given to a patient in effort to decrease their chance of acquiring the virus or to decrease the severity of infection if they do acquire the virus. Unfortunately when given a LIVE VIRUS VACCINATION, the patient is injected with a low dose, WEAK STRAIN of the virus. This induces the patient’s immune system to recognize the virus and mount a DEFENCE response to the injected virus. If after vaccination, the patient gets exposed to the virus; their immune system will hopefully be able to fight off the stronger strain of the virus and therefore prevent illness or decrease the severity and time of the illness to which they were exposed.
Ex: Chickenpox Vaccine: A patient gets the chickenpox vaccine and therefore their body mounts a defense against the virus, chickenpox. 6 months later the patient is exposed to their child who has chickenpox. The patient’s body already has a defense system present to fight off the chickenpox virus and they hopefully will not come down with any infection at all.
Vaccines depend on a patient’s intact immune system to induce protection. LIVE VIRUS VACCINES also rely on the patient’s intact immune system to NOT ALLOW the low dose, WEAK virus in the vaccine to ACTUALLY CAUSE an infection. For DEAD vaccines and vaccines make of protein components, having a reduced immune system can decrease the body’s ability to respond to the vaccine and therefore decrease the body’s ability to form a defense against the vaccinated agent. Basically in an immunosuppressed patient, vaccines may not work as well to stimulate the body’s defense responses.
Vaccines and YOUR RHEUMATOLOGIC MEDICATIONS:
Research is still being conducted regarding the safety of live virus vaccinations in patients on biologic medications (Humira, Enbrel, Simponi, Remicade, Cimzia, Orencia, Actemra, Rituxan) Given the current data, we recommend that any patient on biologic medications DOES NOT RECEIVE ANY LIVE VIRUS VACCINATIONS. Please see the list of VACCINES THAT YOU SHOULD NOT RECIEVE below. If this vaccination is considered necessary, please discuss this issue further with your Rheumatologist. According to recent literature if a live virus vaccination needs to be given, the patient should be taken off of the biologic medication for 1 to 3 months BEFORE and AFTER vaccination.
DMARDS (plaquenil/hydroxychloroquine, sulfasalazine, methotrexate, Imuran/Azathioprine) and other oral (by mouth) immunosuppressants MAY ALSO BE A REASON TO DEFER LIVE VIRUS VACCINATIONS. We recommend DISCUSSING THIS FURTHER with your Rheumatologist before proceeding with LIVE VIRUS VACCINATION.
If you are on HIGH DOSE PREDNISONE (that is a prednisone dose greater than 20mg for more than 2 weeks) within the preceding 2-4 weeks of desired vaccination, the Center for Disease Control (CDC) also recommends that you DO NOT RECEIVE THE LIVE VIRUS VACCINES.
Studies about the safety and efficacy of LIVE VIRUS VACCINATIONS and all other types of vaccinations are still being conducted and the American College of Rheumatology and the Center for Disease Control hope to announce updated guidelines in the future.
LIVE VIRUS VACCINES that are generally NOT recommended for any patient on immunosuppression.
You need to check with your Rheumatologist before you consider ANY LIVE VIRUS vaccinations such as:
--Oral Adenovirus type 4, 7
This posting is not meant as a substitute for any discussion with your Rheumatologist. It is meant for informational purposes only. Every patient is different and individual risks and benefits of vaccination and forgoing vaccinations should be discussed with your physician.
The button link above is to the CDC Guidelines on Adult Vaccinations for Normal Persons (Immunocompetent) and Immunosuppressed Persons. Note: all patients on drugs for treatment of an autoimmune disease are considered immunosuppressed.