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Vaccination advice

Vaccinations and medication

Patients with JIA or other rheumatology conditions receiving steroids, DMARDs or biologics should receive all routine non-live vaccinations, although potentially these may not be quite as effective. The Green Book states that live vaccines are safe for patients receiving low-dose DMARDs and low dose oral corticosteroids. Those on biologic medications should not receive live vaccines. You should contact us for advice if you are unsure whether a patient should receive a live vaccine.

Specific advice for patients on Rituximab can be found below.

Flu vaccine

It is a national recommendation that children with a long term illness or who are taking drugs that may cause immunosuppression receive the flu vaccine each year. Current advice is not to give the live nasal spray to patients receiving biologic medication or high-dose corticosteroids.

Chicken-pox vaccine

Prior to commencing immune modifying drugs, children should have their chicken-pox (VZV IgG) status and vaccination history checked. If the patient is not immune to chicken-pox, the chicken-pox vaccine is usually recommended. This should be given at the GP surgery and then a booster given 4 weeks later.

VZV IgG should be checked again at least three weeks after the 2nd vaccine to check vaccine up-take.

If children are not immune to chicken pox and are not able to receive a chicken-pox vaccine, please consider giving the vaccine to non-immune family members or discuss with the paediatric rheumatology team.

Please refer to our guidelines for advice if a child on immune modifying drugs has been in contact with or contracts chicken-pox.


Prior to commencing biologic medications, the child's vaccination history will be checked. If children have not received the MMR or the pre-school booster of the MMR, this can be given early from 2 years of age. Alternatively titres can be checked to determine immunity status.


Patients on Rituximab should not be given live vaccines. Should non-live vaccinations be required, these should be completed at least 4 weeks prior to commencing the next course of Rituximab. Annual flu vaccines are recommended.

It is not known whether patients may need re-immunisation of previous non-live vaccines following rituximab. Once immunoglobulins are back to normal, check specific antibodies (Tetanus, Hib, Polio etc.) from previous immunisations and if low, re-immunise and recheck levels.

If a patient has a contaminated wound (and has received rituximab within the last 6 months) and there is any doubt about the patient’s tetanus status, then a tetanus immunoglobulin should be administered.

Reference list

Heijstek, M et al (2011) EULAR recommendations for vaccination in paediatric patients with rheumatic diseases. BMJ (online) Available at (Accessed August 5th 2011)

The Green Book (2017) Chapter 6: Contraindications and special considerations. Available at (Accessed December 4th 2017)