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Patient Information Leaflet
Immunisation Recommendations for Adult Patients Treated with Immune-Suppressing Medicines or Immunoglobulins
What are the aims of this leaflet?
This leaflet has been written to help you understand what immunisations and vaccinations are recommended, and those to avoid, while you are taking medicines that can suppress your immune system.
It also includes a paragraph about immunisations if you are being treated with immunoglobulins.
What medicines can suppress the immune system?
There are plenty of examples of such medicines, including high dose prednisolone, ciclosporin, methotrexate, mycophenolate mofetil, azathioprine, hydroxycarbamide and new targeted treatments known as ’biological ‘agents e.g. etanercept, infliximab etc.
Should I have the influenza vaccination (Flu Jab)?
Ideally you should have the influenza vaccine (Flu Jab) before you start the treatment and then have further influenza vaccinations every year while you are on the immunosuppressant therapy.
You should not have the influenza vaccine if you have known anaphylactic hypersensitivity (severe allergy) to egg products.
Should I have the Pneumococcal Vaccination?
If you are at increased risk* of getting a pneumococcal infection then before you start the treatment you should ideally have immunisation with pneumococcal vaccine just once. In certain cases you might need a five-yearly booster immunisation.
*(www.nhs.uk/Conditions/Pneumococcal-immunisation/Pages/When-should-it-be-done.aspx)
Do not worry if you have not had the immunisation before starting treatment; there are several possible reasons for this:
- The doctor may feel that your condition is severe enough not to want to delay starting the medicine by waiting for a stock of vaccine to be available at your General Practitioners (GP) surgery.
- It is not always possible for the doctor to be sure in advance that you are going to stay on the medicine long-term, so vaccination may not be considered necessary.
If you did not have the vaccine before starting the immunosuppressive treatment it will not have been thought necessary by your dermatologist, at that time; if it becomes the case that the vaccine is thought advisable, it can be administered by your GP on the advice of your dermatologist.
Is it important to know whether I have had chickenpox in the past?
Yes. Discuss with your doctor/GP whether you are sure that you have had chickenpox in the past. If you are unsure then a blood test can be done to check whether you have got antibodies to Varicella (chickenpox). If you are not immune (i.e. no antibodies are detected) you may be offered vaccination prior to starting treatment.
However, the vaccination in adults involves having 2 separate injections 4 to 8 weeks apart. As this may delay starting your treatment for up to 3 months it may be considered unacceptable.
If you do not have protective antibodies in your blood then it is important that you report any suspected contact with chickenpox to your doctor/GP, as they can then decide whether you require the cover of a pre-prepared injection of chickenpox antibodies called Varicella Zoster Immune-Globulin (VZIG).
What should I do if I am planning to travel?
If you are planning to travel while on treatment then you should let your doctor know. There are certain vaccinations, called ‘live vaccines’, that you should not have once the treatment has started, so it is best to have them before you start the medicine. Your GP or practice nurse will be able to provide you with up to date information on which vaccinations are required when travelling to different locations.
Which vaccines are ‘live’, and should be avoided when on immune- suppressing medicine, and which are safe?
Inactivated Vaccines (safe) Live Vaccines (avoid)
Influenza Measles
Pneumococcal Mumps
Diphtheria Rubella
Tetanus Oral poliomyelitis (OPV)
Pertussis BCG
Haemophilus Influenzae Oral Typhoid
Type b (Hib) Varicella
Hepatitis A Yellow Fever
Hepatitis B
Japanese Encephalitis
Meningococcal
Inactivated Poliomyelitis (IPV)
Rabies
Tick borne encephalitis
Monovalent whole cell typhoid
Typhoid Vi polysaccharide antigen
Does it make any difference to the vaccinations my family members are given?
It is important that other members of your family should not be given live oral polio vaccination while you share the same bathroom/toilet facilities. If the live vaccine is accidentally given to them, then you should avoid close personal contact with the person given the live polio vaccine for 4 to 6 weeks.
An alternative polio vaccine (IPV) is now routinely given in the UK for babies having their primary course of immunisations, and this will not cause a problem.
A special mention about Immunoglobulins
If your doctor is treating you with immunoglobulins into your muscle/ veins you should be given live vaccines at least 3 weeks before the infusion, or wait until 3 months afterwards. This is because the infusion may interfere with the immune system’s response to the vaccination, as it already contains some antibodies to Measles and Varicella.
This does not apply to yellow fever, as immunoglobulin used in the UK is unlikely to contain high levels of antibody to this virus.
Where can I find out more about immunisation?
Links to other Internet sites:
www.immunisation.org.uk
www.wales.nhs.uk/sites3/page.cfm?orgid=719&pid=22646
www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook/DH_4097254
The British Skin Foundation fund vital research into all skin diseases. To find out how you can help, please visit the British Skin Foundation website here.
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED OCTOBER 2010
UPDATED DECEMBER 2010