Immunosuppressive therapy

Treatment regimen

Potential timing of vaccination

High-dose corticosteroid monotherapy (≥20 mg per day of prednisone or equivalent)

Therapy for less than 14 days

  • At least 1 month before treatment starts, or
  • Any time after treatment stops

Therapy for 14 days or longer

  • At least 1 month before treatment starts, or
  • At least 1 month after treatment stops

csDMARD — azathioprine

>3.0 mg per kg per day

  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops

csDMARD — 6-mercaptopurine

>1.5 mg per kg per day

  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops

csDMARD — methotrexate

>0.4 mg per kg per week

  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops

Other csDMARDs (except sulfasalazine, hydroxychloroquine and similar, which are safe at any dose)

All regimens

  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops

T-cell inhibitors (eg tacrolimus, cyclosporine)

All regimens

  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops

Other unspecified immunosuppressants (eg chemotherapy, radiotherapy)

All regimens

  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops, and possibly at least 6 months for people who have received chemotherapy or radiotherapy (based on an individual patient risk assessment)

bDMARDs or tsDMARDs (eg monoclonal antibodies)

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

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

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Table. Recommendations for revaccination after haematopoietic stem cell transplant in children and adults

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Table. Recommendations for vaccination in people with functional or anatomical asplenia

Last updated: 
5 June 2018
Last reviewed: 
5 June 2018