Recommendations for Vaccinations in Adult Inflammatory Arthritis Patients on Immunomodulating Therapy Print Page

^a Evidence supports withholding MTX (only) for 1 week post-influenza vaccination to optimize immunogenicity if the patient’s disease activity allows and using shared decision making. Guidelines recommend continuing other DMARDs around the time of any non-live vaccination, except RTX (delay dose ≥2-4 weeks).

^b Prevnar-20 is a new conjugated vaccine that has replaced Prevnar-13 and Pneumovax-23; it is covered by AB Health for

●        See flow diagram to determine which pneumococcal vaccine(s) is/are recommended.

●        Note: if Prevnar-20 is not covered and a patient has received Pneumovax-23 previously, administer Prevnar-13 at least 1 year later, followed by a Pneumovax-23 booster 5 years after the first dose.

^c Alberta Health covers Prevnar-13 and Pneumovax-23 for patients with inflammatory arthritis taking therapy/therapies beyond HCQ and/or SSZ. Pneumovax-23 is available at community pharmacies, however, publicly funded Prevnar-13 is only available at community health centres.

^d An injected live vaccine (MMR, varicella, zoster, yellow fever) can be given simultaneously (on the SAME day) with a TB skin test, BUT if provided >1 day prior, you must wait 4-6 weeks before placing the skin test, as there is a risk of a false-negative skin test in a person who has a TB infection. Inactive vaccines can be given on the same day or any time after a TB skin test.

¹ Ideally, provide ≥14 days before biologic initiation/next dose

² Administer live vaccines ≥4 weeks before DMARD initiation or at least 1 month after stopping csDMARD, ≥1 week after stopping tsDMARD, and ≥1 dosing interval for bDMARD and IV cyclophosphamide therapies. See further guidance for MMR vaccine.

³ To ensure minimal immunosuppression (reduce risk of infection) and optimal vaccine response: recommend waiting >3 half-lives after stopping biologics to give live vaccines. To ensure safety, guidelines recommend waiting ≥6mo after the last dose of RTX.

⁴ Under compelling circumstances may be considered; consultation with an infectious diseases physician is recommended.

⁵ High-Risk Groups:

●        Hepatitis A: travel to, immigrants from, or residence in endemic countries of HAV; occupational exposure (i.e. health care professionals); infected family member or contacts; illicit drug users; men who have sex with men; chronic liver disease.

●        Hepatitis B: residents, immigrants, travelers, or close contact with individuals from HBV endemic areas; persons with lifestyle risks: illicit drug use (injectable or non-injectable), oral sex, men who have sex with men, other high risk sexual practices; chronic liver disease; chronic kidney disease; occupational exposure (i.e. health care professionals); frequent blood transfusions.

●        HPV: previous STI, number of partners, inconsistent condom use, men who have sex with men (not covered by public health)

●        Meningococcal: travellers to sub-Saharan Africa, Mecca, Saudi Arabia; laboratory or military personnel; close contact of a case of invasive meningococcal disease or outbreak control, high risk medical conditions.

 Developed by Jill Hall, PharmD (Last updated: 2024-06-25)