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

  • At least 1 month before treatment starts, or
  • Any time after treatment stops
Anti-TNF — (Etanercept Infliximab Adalimumab) None All regimens
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
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
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
Sulfasalazine, Hydroxychloroquine Any dose NA NA
Mycophenolate None All regimens
  • At least 1 month before treatment starts, or
  • At least 12 months after treatment stops
Other csDMARDs None All regimens
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
T-cell inhibitors/activators (eg tacrolimus, cyclosporine except denosumab for which there is no evidence of significant immunosuppression) None All regimens
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
Other unspecified immunosuppressants (eg chemotherapy, radiotherapy) None All regimens
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
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
  • 1 month before treatment starts, or
  • At least 12 months after treatment stops — this must be discussed with the treating physician
Haematopoietic stem cell transplant None All regimens
  • At least 1 month before transplant, or
  • At least 24 months after transplant

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