Immunizations in Autoimmune

Inflammatory Rheumatic Disease in Adults

Ahmed A. Alanazi, PharmD
Teaching Assistant
College of Clinical Pharmacy
aasalanazi@iau.edu.sa
Office #1021
Immunizations in Autoimmune Inflammatory Rheumatic Disease
in Adults
• Patients with autoimmune inflammatory rheumatic disease (AIIRD) are at higher risk for serious
infections
o Likely due to both disease-related immune dysfunction and immunosuppressive medication use

• As a general rule of thumb, vaccinations should be given several weeks prior to the start of
immunosuppressive therapy for maximum protection
o Non-live vaccines: Complete any needed series ≥2 weeks before immunosuppressive medications are given
 Pneumococcal, influenza, Td, RZV, meningococcal, RSV vaccines

o Live vaccines: Contraindicated for those receiving moderate to high immunosuppressive medications. Should be given
at least ≥2 weeks prior to the start of immunosuppression. However, this window is extended to ≥4 weeks for patients
who will be receiving more potent immunosuppressive medications
 Measles, mumps, rubella, and varicella vaccines
Non-Live Vaccines: Pneumococcal Vaccines

• Patients should receive either the 20-valent pneumococcal vaccine (PCV20) alone or the 15-valent
pneumococcal vaccine (PCV15) followed by the 23-valent polysaccharide vaccine (PPSV23) at least
eight weeks later
o When vaccination cannot be given prior to immunosuppression, these vaccines should be given as soon as possible
and ideally during a period when immunosuppression is low
Non-Live Vaccines: Seasonal Influenza Vaccine

• All patients should receive a seasonal influenza vaccine annually, unless contraindications are
present

• When possible, give seasonal influenza vaccines prior to the start of immunosuppression
o For patients who are receiving immunosuppressive medications, try to vaccinate during periods when
immunosuppression and inflammatory disease activity is low
o For patients receiving methotrexate and inflammatory disease activity is low, hold methotrexate for one to two weeks
starting from the time of influenza vaccine administration
Non-Live Vaccines: COVID-19 Vaccines and Respiratory
Syncytial Virus (RSV) Vaccine
• COVID-19 vaccination is recommended in all patients with AIIRD who are receiving or planning to
receive immunosuppressive therapy

• RSV disease can be a serious infection associated with morbidity and mortality
o RSV vaccine should be offered to immunosuppressed patients with AIIRD who are over the age of 60 years
o RSV vaccine is preferred to be administered alone (without other concomitant vaccines) to optimize immunogenicity
and minimize adverse effects.
Non-Live Vaccines: Other Vaccines

• Tetanus, Diphtheria, Pertussis and Meningococcal Vaccines

o Should be given per the same indications and schedules as the general adult population

• Zoster vaccine
o Patients with AIIRD who are ≥19 years of age receiving or planning to start immunosuppressive therapy should be
given ecombinant (nonlive) herpes zoster vaccine (RZV)

o RZV is administered in two doses spaced at least four weeks apart

• Hepatitis vaccines
o Hepatitis A virus vaccine should be given to at-risk adult patients who have not been previously vaccinated

o All patients <60 years old regardless of risk and those ≥60 years old with risk factors (eg, chronic liver disease,
injection drug use, household contacts with hepatitis B, occupational risk) should be vaccinated against hepatitis B
 Following completion of the vaccine series, check for antibody titer to ensure that hepatitis B surface antibody seroconversion has been
achieved