Biologics, such as infliximab and adalimumab, are immunosuppressive agents commonly used in the treatment of various autoimmune conditions like rheumatoid arthritis, Crohn’s disease, ulcerative colitis, and psoriasis. Because they suppress or modulate the immune response, there’s an increased risk of infections in patients taking these medications.
Before starting biologic therapies, it’s recommended that patients be up-to-date with their vaccinations. Here’s a general guideline regarding vaccinations for patients considering biologics:
- Live Vaccines: In general, live vaccines should be avoided during treatment with biologics due to the risk of causing disease in immunosuppressed individuals. If necessary, they should be given before starting the biologic therapy:
- Measles, Mumps, Rubella (MMR): Ensure completion according to the recommended schedule, or check for immunity.
- Varicella (chickenpox): Either ensure completion or check for immunity. If non-immune, consider vaccination before starting biologics.
- Yellow Fever: If travel to an endemic area is anticipated, this vaccine should be considered. Consultation with a travel medicine expert might be beneficial.
- Oral Typhoid: If required for travel.
- Zoster (shingles) vaccine: The live zoster vaccine should be given before starting biologics. However, there’s a newer recombinant zoster vaccine (Shingrix) that is not a live vaccine and can be given while on biologic therapy.
- Inactivated Vaccines: These can generally be given before or during treatment with biologics, but they might produce a less robust immune response when given during biologic therapy:
- Influenza (flu) vaccine: Annual vaccination is recommended.
- Pneumococcal vaccines: Both PCV13 (Prevnar 13) and PPSV23 (Pneumovax) should be considered, based on age and underlying conditions.
- Hepatitis A: Especially if at risk or traveling to an endemic area.
- Hepatitis B: Ensure immunity, especially if at risk.
- Human Papillomavirus (HPV): For individuals up to age 26 or those who have not completed the vaccination series.
- Meningococcal vaccines: Especially if at risk.
- Diphtheria, Tetanus, Pertussis (dTpa): Ensure up-to-date, with boosters as recommended.
- Haemophilus influenzae type b (Hib): Based on underlying conditions.
- Polio: Ensure completion of the schedule.
- Other Considerations:
- Tuberculosis (TB): Screen for latent TB infection before starting biologics, typically using a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA). If positive, consider treatment for latent TB before starting the biologic.
- Other infections: Screen for hepatitis B, hepatitis C, and HIV based on risk factors.