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*

≥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
 

≥20 mg/day of prednisilone or equivalent for 14 days or longer
  • At least 1 month before treatment starts, or
  • At least 1 month 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, and at least 6 months for people who have received chemotherapy or radiotherapy (based on an individual patient risk assessment)
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

* 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

Last updated: 
11 November 2020
Last reviewed: 
11 November 2020