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Recommended Vaccinations for People with Rheumatoid Arthritis

Feb 17, 2017
Drugs used to manage rheumatoid arthritis work by suppressing the immune system, which in turn increases your risk of infection. Your Riverside rheumatologist will recommend that you receive all clinically indicated vaccinations, including an annual flu shot and the pneumonia vaccine.

However, care should be taken when administering live vaccines, which are generally not recommended for patients with weakened immune systems or those using certain medications.

Types of vaccination
There are different types of vaccinations, some of which are not safe for people diagnosed with RA:

Killed or inactivated vaccines - include influenza injection, anthrax, hepatitis A, cholera, rabies, plague, and poliomyelitis

Live attenuated - a weakened version of live bacteria or virus. These include influenza nasal spray, tuberculosis, oral typhoid, smallpox, shingles, yellow fever, and chickenpox. Attenuated vaccines include mumps, measles, and rubella

Subunit - sugar or protein extracted from bacteria or virus, or manufactured in the lab. Sugar subunit vaccines include typhoid injection, haemophilus influenza B, pneumococcus, and meningococcus; protein subunit vaccines include hepatitis V, pertussis, and diphtheria

Which vaccines should RA patients avoid?
Riverside rheumatologists recommend that RA patients taking immunosuppressant drugs avoid live vaccines because they can cause an infection, or stay in the body only to re-emerge later and cause illness. This means that RA patients may have a flu shot, but not the flu nasal spray. Cancer patients who have had radiotherapy or chemotherapy treatment should also avoid live vaccines.

That said, live vaccines are considered safe if given at least six months after the cancer treatment has stopped, or six months after the use of the biologic medication has stopped. Killed and subunit vaccines, on the other hand, are considered safe for all rheumatoid arthritis patients, including those taking immunosuppressant drugs.

What to do if you cannot have a live vaccine
In the unfortunate event that an RA patient being treated with immunosuppressant comes in contact with measles, your Riverside rheumatologist may suggest treatment with human normal immunoglobulin. Patients in contact with chickenpox or shingles, on the other hand, can be treated with varicella zoster immunoglobulin. An alternative treatment for patients exposed to chickenpox is acyclovir - an antiviral drug.

RA patients looking to travel to a country that requires yellow fever immunization may request a certificate of exemption explaining to the immigration authorities of some countries why you have not been immunized. This, however, leaves you at risk of catching yellow fever.

Final note
Although the protective action of some immunizations may not be as strong for RA patients taking biologic medication, most people generate a sufficient protective response that helps to minimize the severity of any subsequent infection. Ideally, the necessary immunizations should be administered before beginning your RA treatment. So, discuss with your Riverside rheumatologist about what vaccinations are essential for you, and best time during the course of your treatment to receive them.
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