Can live vaccines be given to patients on biologics?
No. Commonly used live vaccines include measles (MMR, Proquad), varicella (Varivax), oral rotavirus, Zostavax, and Flumist.
Yellow fever, BCG, oral typhoid, and adenovirus (military personnel) are live vaccines given only to high-risk groups, whereas small pox and oral polio are rarely given today.
Patients should be given a live vaccine at least 4 weeks before starting a biologic therapy.
If already on a biologic agent, the patients are recommended to stop the biologic at least 3 months before receiving the live vaccine.
Others recommend that a live vaccine can be given if a patient has stopped the biologic for at least three to five times its half-life (9–15 days after ETN; 4–6 weeks after INF and ADA; 6–10 weeks after golimumab, certolizumab, tocilizumab, or abatacept; 9–15 weeks after RTX).
Vaccinations for patients with autoimmune diseases — specifically patients being treated with biologics — bring with them a variety of issues, including disease-specific, medication-related, and vaccine-associated factors, researchers suggested.
Patients with diseases such as rheumatoid arthritis and systemic lupus erythematosus are at increased risk for infections because of aberrations in their immune system and long-term treatments with conventional immunosuppressive therapies.
The concern has become even more acute with the widespread adoption of biologic therapies, as these agents can further increase patients’ susceptibility to serious infections.
And while published recommendations exist for vaccinations in patients on conventional treatments, no guidelines exist for those on biologics.
The administration of live vaccines to patients receiving biologic medications is a complex issue that requires careful consideration of individual medical conditions, the specific biologic being used, and the type of live vaccine involved. Biologic medications, often used to treat conditions like autoimmune disorders, inflammatory diseases, and cancer, can suppress the immune system to varying degrees.
Live vaccines contain weakened but live forms of viruses and bacteria, and there is a concern that these vaccines could potentially cause infections in individuals with compromised immune systems.
Here are some general points to consider while considering live vaccines be given to patients on biologics:
- Immune Suppression: Biologic medications can suppress the immune system, which may reduce the effectiveness of live vaccines and increase the risk of infections.
- Timing: The timing of vaccine administration relative to biologic treatment matters. In some cases, live vaccines may need to be given before starting biologic therapy or during a temporary pause in treatment.
- Individualized Approach: Decisions about vaccinations should be made on an individual basis. The patient’s specific condition, the biologic being used, and the risk of exposure to the diseases targeted by the vaccines should all be taken into account.
- Vaccine Types: Some live vaccines, like the measles, mumps, and rubella (MMR) vaccine, the varicella (chickenpox) vaccine, and the yellow fever vaccine, are more concerning due to the potential for causing infections in immunocompromised individuals.
- Alternative Vaccines: In cases where live vaccines are not recommended, patients might be offered alternative vaccines that contain inactivated (killed) viruses or bacteria.
- Consultation with Healthcare Provider: Patients on biologic medications should discuss their vaccination status and needs with their healthcare provider. The provider can guide them on when to receive vaccines, which vaccines are safe, and any necessary precautions.
- Weighing Risks and Benefits: The decision to administer live vaccines to individuals on biologics involves weighing the potential benefits of vaccination against the risks of infections or reduced vaccine efficacy.
Ultimately, decisions about administering live vaccines to patients on biologics should be made by a healthcare provider who has a comprehensive understanding of the patient’s medical history, the specific biologic treatment, and the vaccines in question. The provider can offer personalized recommendations and guidance to ensure the best possible outcome for the patient’s health.
