However, there are a number of live and attenuated vaccines that rheumatologists should approach with extreme caution. In fact, “many of these are largely contraindicated in most immunosuppressed individuals,” Dr. Bingham said. These include varicella/zoster, the H1N1 flu mist, yellow fever, oral polio, the oral form of typhoid vaccines (Ty21a oral), vaccinia (smallpox), BCG (a vaccine for tuberculosis), rotavirus, and measles, mumps, and rubella.
“What is normally an attenuated form of the virus can become pathogenic in patients with immunosuppression,” Dr. Bingham said. Because studies have shown that patients who receive a live virus may shed live virus for up to three weeks, those who receive a live virus and live with patients with autoimmune disease should avoid close household contact after vaccinations, even though the risk is relatively low, he explained.
Role of Medications and Vaccine Administration
Dr. Bingham’s presentation addressed how common medications that patients with autoimmune disease use may affect vaccinations.