There are some general, day-to-day things you can do to reduce your risk of picking up an infection, including:
- washing your hands frequently
- being careful with the food you eat and water you drink, especially when you’re abroad
- avoiding unpasteurised foods (e.g. Brie, feta and blue cheeses) if you’re on immunosuppressive drugs
- contacting your GP or the hospital early if you get a fever (temperature).
As well as simple measures like these, there are some specific ways in which certain infections can be avoided.
How can the risk of infection be reduced if I’m taking DMARDs?
Even if you do have vaccinations, if you’re on treatment with DMARDs your blood count should be checked to make sure that your body is producing enough white blood cells. This is because a low white blood cell count will decrease your body’s ability to fight infection. If your white blood cells are low, this can normally be reversed by stopping the drug and in some cases taking other drugs to improve the production of white blood cells. Examples include folic acid if you’re on methotrexate or use of a cholestyramine washout if you’re on leflunomide. This will increase your body’s ability to fight infection.
What can be done if I’m exposed to an infection?
You can be given immunoglobulins to stop certain types of infection developing. Immunoglobulins act like your body’s antibodies. They can be used straight away if you think you’ve been exposed to:
- tetanus (your GP or an A&E department can advise if an injury is high risk for tetanus)
- hepatitis B (for example, treatment would be considered after stabbing yourself with a needle from someone who may be carrying hepatitis B)
- rabies (for example, if you get bitten by an animal in a country which still has rabies)
- chickenpox or shingles.
Chickenpox and shingles
Chickenpox vaccination is normally given in childhood. Because it’s a live vaccination, it’s not currently recommended for people who are immunosuppressed, but most adults will have been exposed to the virus and will be immune to it.
Immunoglobulin treatment would be considered for if you’ve never had chickenpox or if you’re on immunosuppressive drugs and have had close contact (in the same room for 15 minutes or more or face-to-face contact) with someone with chickenpox. Your doctor will check your immunity (the level of antibodies in your body) and if it's low may recommend immunoglobulin treatment or aciclovir (an antiviral drug) to stop the infection developing.
Shingles can develop if you've previously had chickenpox. The shingles vaccine is currently recommended only for some people on immunosuppressive drugs. If others within the same household as someone with shingles haven’t previously had chickenpox or been vaccinated against it, it may be worth suggesting that they also have the vaccination.
You should tell your rheumatologist whether or not you've previously had chickenpox, as this is useful to know if you're exposed to the virus..
What should I look out for if I have a vaccination?
The flu vaccine should provide enough protection, but if you do develop flu-like symptoms, especially if you had the vaccine while on rituximab, please speak to your GP about antiviral treatment, which should be started within the first 48 hours of symptoms.
Pneumococcal vaccination will only provide protection against pneumococcal pneumonia. If you develop a high fever, breathlessness, and a cough with green spit, seek medical help immediately as it’s likely that you’ll need antibiotics to stop the infection developing.