Vaccinations when taking DMARDs or Biologics Print Page

a If patient has received Pneumovax previously, administer Prevnar-13 at least 1 year later, followed by a Pneumovax-23 booster 5 years after the first dose.
b Alberta Health will pay for Prevnar-13 and Pneumovax-23 for patients with inflammatory arthritis taking therapy/therapies beyond HCQ and/or SSZ.
c Despite the monograph statement that Zostavax II should not be administered at the same time as Pneumovax-23 due to potential for reduced immune response, this has not been found to be clinically important. Thus, either Prevnar or Pneumovax may be provided concomitantly with Zostavax II.
d An injected live vaccine (MMR, varicella, zoster, yellow fever) can be given simultaneously (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 or wait >3 half-lives after stopping biologic therapy
2 Administer ≥4 weeks before biologic initiation or wait >3 half-lives and at least 1 month after stopping biologic therapy
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 last dose of RTX & INFL.


4 Under compelling circumstances may be considered; consultation with infectious diseases physician 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: travelers to sub-Saharan Africa, Mecca, Saudi Arabia; laboratory or military personnel; close contact of a case of IMD or outbreak control, high risk medical conditions.

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