Immunosuppressive therapy Safe dose to vaccinate Dose vaccine contraindicated  Acceptable timing of vaccination if dose is contraindicated
    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 12 months after treatment stops
csDMARD      
Azathioprine ≤3mg/kg/day
(if used as a single agent, with or without low-dose corticosteroid)
>3.0 mg/kg/day
 
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
Mercaptopurine

≤1.5mg/kg/day
(if used as a single agent, with or without low-dose corticosteroid)

>1.5 mg/kg/day
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
Methotrexate ≤0.4mg/kg/week
(if used as a single agent, with or without low-dose corticosteroid)
>0.4 mg/kg/week
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops
Sulfasalazine, Hydroxychloroquine Any dose None Not applicable
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 or 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 (eg Tofacitinib), phosphodiesterase-4 inhibition (eg Apremilast) or bDMARDs - monoclonal antibodies, IL inhibitors (eg Anakinra; Tocilizumab), costimulation blockers (eg Abatacept), B-cell depleting agents (eg 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; IL = interleukin; TNF = tumour necrosis factor; ts - target synthetic

a if person is on long-term corticosteriod monotherapy or corticosteriod therapy combined with other disease-modulating or immunosuppressive therapy, consider delaying vaccination and consulting with 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