Table. Recommendations for use of zoster vaccine in people on immunosuppressive therapy
Immunosuppressive therapy | Safe dose to vaccinate | Dose vaccine contraindicated and acceptable timing to vaccinate | |
Dose | Timing of vaccination | ||
corticosteroid monotherapy |
≤20 mg per day of prednisilone or equivalent a |
≥20 mg/day of prednisilone or equivalent for less than 14 days |
|
Anti-TNF — (Etanercept Infliximab Adalimumab) | None | All regimens |
|
csDMARD | |||
Azathioprine Mercaptopurine Methotrexate | ≤3mg/kg/day ≤1.5mg/kg/day ≤0.4mg/kg/week (if used as a single agent, with or without low-dose corticosteroid) |
>3.0 mg/kg/day >1.5 mg/kg/day >0.4 mg/kg/week |
|
Sulfasalazine, Hydroxychloroquine | Any dose | NA | NA |
Mycophenolate | None | All regimens |
|
Other csDMARDs | None | All regimens |
|
T-cell inhibitors/activators (eg tacrolimus, cyclosporine except denosumab for which there is no evidence of significant immunosuppression) | None | All regimens |
|
Other unspecified immunosuppressants (eg chemotherapy, radiotherapy) | None | All regimens |
|
tsDMARDs - Janus kinase inhibitors (Tofacitinib), phosphodiesterase-4 inhibition (Apremilast) or bDMARDs - eg monoclonal antibodies, IL inhibitors (Anakinra; Tocilizumab), Costimulation blockers (Abatacept), B-cell depleting agents (Rituximab) | None | All regimens |
|
Haematopoietic stem cell transplant | None | All regimens |
|
b - biologic; cs - conventional synthetic; DMARD - disease-modifying anti-rheumatic drug; ts - target synthetic
a if on long term monotherapy or combined with other disease modulating/immunosuppressive therapy consider delaying and referring to both the treating doctor and an immunisation specialist.
For more information, please refer to the Zostavax screening tool.
Last updated:
13 January 2021
Last reviewed:
13 January 2021
Printed content may be out of date. For up to date information, always refer to the digital version: https://immunisationhandbook.health.gov.au/resources/handbook-tables/table-recommendations-for-use-of-zoster-vaccine-in-people-on.