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Oxford University Hospitals NHS Foundation Trust

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Vaccinations (also called immunisations) are given to protect children and adults from serious contagious diseases. Diseases such as diphtheria, tetanus, measles, whooping cough and polio are now rare because of this.

In general we advise children to continue with all routine vaccinations unless they are receiving medicls that cause immunosuppression. There is no evidence that vaccinations make JIA or other inflammatory conditions worse.

Important!If an immunosuppressing drug is being taken live vaccines are not commended. Inactived vaccines can be given safely but may not be quite as effective.

Which rheumatology medications affects the immune system?

The following are considered to alter the immune system in a way that may affect the use of vaccines:

  • Prednisolone
  • Methotrexate
  • Biologics (e.g. Etanercept, Adalimumab, Infliximab, tocilizumab)
  • Leflunomide
  • Azathioprine
  • Mycophenolate
  • Cyclosporine
  • Rituximab
  • Abatacept
  • Cyclophosphamide
  • Thalidomide

Which vaccines do the national guidelines say my child can have/not have whilst taking these medications?

Vaccines that can be given

  • cholera
  • diphtheria
  • haemophilus influenza HIB
  • hepatitis A
  • hepatitis B
  • influenza (by inactivated injection only)
  • meningitis C
  • meningitis ACWY
  • pneumovax
  • rabies
  • tetanus
  • typhoid (by inactivated injection only)
  • Polio (by inactivated injection only - SALK)
  • human papilloma virus (HPV)
  • heaf (6 needles)/mantoux (PPX)
    (can be difficult to interpret if immuno-compromised)

Vaccines that cannot be given

  • varilrix (chickenpox)
  • TB (BCG)
  • individual measles
  • individual mumps
  • individual rubella
  • MMR
  • oral polio
  • oral typhoid
  • yellow fever
  • nasal flu spray

In line with new EULAR recommendations we now recognise that live vaccines, including chickenpox and the MMR, can be considered for patients on certain immunosuppressive medications, such as low-dose DMARDs and low-dose steroids. This will be considered on a case-by-case basis by the rheumatology team.

Should my child have the flu vaccine?

Children with a long-term condition, or who are receiving medications that cause immunosuppression are recommended to have the annual flu vaccine. The injectable flu vaccine is not live. This should be arranged at your GP surgery.

NB the nasal flu spray is live and not recommended for patients on medications which affect the immune system.