VACCINES
Vaccines are designed to protect you against infection. With autoimmune disease, you may have a slightly increased risk of infection. For people with mild disease, this is probably not significant. At present, it is unclear whether these people would benefit from additional vaccines. However, if you have mild autoimmune disease but are over 65 years old or you have other condition(s) which may suppress your immune responses (e.g. diabetes), you may wish to discuss vaccination with your GP or Rheumatologist. If you have moderate or severe disease AND you are being treated with drugs which suppress your immune system, e.g. steroids, azathioprine, mycophenolate mofetil, methotrexate, you should talk to your GP (or your Rheumatologist) about having some extra vaccines. Generally, we would advise the following vaccines:
Pneumococcus (pneumovax)
Meningococcus (meningovax)
Influenza (fluvax)
Haemophilus influenzae (HiBvax)
These vaccines are designed to protect you against flu and certain kinds of pneumonia and meningitis.
Note that your immune response to the vaccine may not work quite as well as in someone without autoimmune disease and it may be necessary to check your blood 3 months after the vaccines, to assess how well it has worked. In some people, it is necessary to give an extra booster dose, to get a good response.
Am I at greater risk from vaccination because I have autoimmune disease?
In some cases, yes you are! It is important that you understand which kinds of vaccines pose a hazard to you.
If you have mild disease and you are on no immunosuppressive drugs, the current evidence indicates that you are safe to have any kind of vaccine.
If you have moderate or severe autoimmune disease and you are taking immunosuppressive medicine (e.g. steroids (more than 10mg daily in an adult), azathioprine, mycophenolate mofetil, methotrexate), you should AVOID LIVE VACCINES.
The table lists LIVE and NOT LIVE vaccines, with the commonly-encountered vaccines at the top of the table. Note that vaccines which are “inactivated” or “subunit” vaccines are included in the “not live” column.
| LIVE | NOT LIVE |
| Polio (Sabin) | Polio (Salk) |
| Rubella | Tetanus |
| Measles | Diphtheria |
| Mumps | Pertussis (whooping cough) |
| MMR | Pneumococcal |
| BCG | Meningococcal C |
| Yellow Fever | Haemophilus influenzae B |
| Typhoid | Hepatitis B |
| Varicella | Cholera |
| Smallpox | Rabies |
| Anthrax | |
| Plague |
If you are taking immunosuppressive medicines (e.g. more than 10mg daily of steroid, azathioprine, methotrexate, mycophenolate mofetil), always ask your doctor or nurse whether a vaccine you are going to have is LIVE. Refer to the table to check whether the vaccine you are having is LIVE or not.
The most common problem is with the POLIO vaccine.
The most usual form of Polio vaccine used is LIVE. This is sometimes called Polo Sabine and it may be given on a sugar lump. This is NOT safe to have if you are immunosuppressed.
An alternative is the inactivated Salk Polio vaccine. Your GP or Rheumatologist will have to order this specially for you, so you must give plenty of notice if you need it. Note that other members of the family, particularly young children, may be given the live (Sabin) polio vaccine. They will shed live (attenuated) polio virus in their stools for a few weeks after their vaccination. While this is not a risk to most people, people who are immunosuppressed may pick up an infection with this. This is an important issue to be aware of if you have immunosuppressed and are caring for a baby or young child/children.
Although there are reports that any kind of vaccination can cause a flare of autoimmune disease, the benefits often outweigh the risks, providing that the vaccine is NOT LIVE. You may wish to discuss the pros and cons of a particular vaccine with your Rheumatologist.
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