Live Vaccines and Immunocompromised Host

Immunocompromised Hosts include those caused by active immunosuppression such as medications and those that are caused by a diseases process or immunodeficiency:

Active immune suppression by Medications include:

  1. Steroids such as Prednisone
  2. Chemotherapy Alkylating agents such as cyclophosphamide and Antimetabolites such as Dactinomycin
  3. Biologic Therapy including Anti-TNF drugs such as Enbrel or Remicade, Interferon beta-1a Avonex, Monoclonal antibody anti-CD20 Rituximab,  Abatacept that depletes T cells, and most recent one Janus kinase Inhibitor, Tofacitinib.
  4. Anti-rejection drugs such as Prograf, and Cyclosporine 
  5. Mycophinolate
  6. Opiates
  7. Radiation Therapy
  8. mTOR inhibitors such as Zortress

Immunocompromised Host caused by various congenital diseases such as B cell and T cell defects and acquired conditions such as HIV infection and malnutrition all of which are listed here.

Live vaccines include:

Inactivated vaccines include:

  • Live vaccines listed above should be avoided in patients on biologic therapy such as Enbrel, Humira, Orencia, Rituxan, Cimzia, Simponi, Xeljanz, Stelara, Cosentyx, Actemra, and Remicade.
  • In patients who are to start above therapies, vaccinations should be done before starting their biologic therapy.
  • Inactivated vaccines can be used in patients on biologic therapy.
  • EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases are listed here.
  • EULAR recommendations for vaccination in pediatric patients with rheumatic diseases are listed here.

The 2013 guidelines by Infectious Diseases Society of America are listed here.