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Are there any types of vaccination I shouldn't have?

Live vaccines, DMARDs and biological therapies

The small dose of a live organism in live vaccines may be enough to cause symptoms of the disease in people who are immunosuppressed. For this reason, live vaccines aren’t recommended if you’re on certain DMARDs or biological therapies as these are immunosuppressive drugs.

Your doctor or rheumatologist will tell you if it’s safe for you to receive a live vaccine. Normally a live vaccine would only be given if immunosuppressive drugs are stopped at least 3 months before the vaccination.

If you’ve had treatment with leflunomide, you may need to take a drug called cholestyramine to help wash the leflunomide from your system before being given a live vaccine, as it can take many months to completely flush the drug from your body.

Sometimes live vaccines will be given before immunosuppressive drugs are started. Immunosuppressive drugs shouldn’t be started for at least 2 weeks, preferably 4 weeks, after you’ve been given a live vaccine.

Live vaccines and steroid treatment

Live vaccination must not be given if you’ve been taking moderate or high-dose steroids for more than 2 weeks. The guidelines from the British Society for Rheumatology (BSR) suggest that you can have live vaccines while on steroids if:

  • you’ve been on steroid treatment for less than 2 weeks
  • the steroid is only applied to the skin in the form of a cream or given via an inhaler
  • the steroid has been given into or around the joint by injection
  • you’re on replacement therapy (for example hydrocortisone), which is given when your adrenal glands, the small glands above your kidneys, aren’t making enough steroids – this can happen with conditions such as Addison’s disease or if you’ve been on long-term steroids
  • you’re on low-dose steroids, which the BSR defines as 10 mg per day or less.

Moderate or high-dose steroids must be stopped 3 months before a live vaccine can be given.

Oral vaccines

An oral vaccine is given using an inhaler. Previously polio was a live oral vaccine but it’s now usually given by an injection of inactive vaccine. Oral vaccine is usually only used during an outbreak and shouldn’t be used in immunosuppressed patients or anyone who lives with them.


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