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Vaccinations and Biologics: Should we vaccinate or not?

Vaccinations and Biologics: Should we vaccinate or not?

We are smack in the middle of Flu season and many of my patients on biologics for Psoriasis, Atopic Dermatitis, and Hidradenitis Suppurativa are asking me whether they should get the Flu shot. The answer is a resounding YES! As always, though, there are caveats:

  • Live attenuated vaccines (e.g., herpes zoster vaccine, aka Zostavax) should be avoided in people who are receiving biologics.
  • Inactivated influenza and pneumococcal vaccines are strongly recommended. The pneumococcal vaccine should be done for any person aged 65 or older. Pneumococcal guidelines for immunocompromised patients (people on biologics, for instance!) include the following recommendations:
  • For pneumococcal vaccine–naive adult patients, administer 13-valent pneumococcal conjugated vaccine (PCV13) first, 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later, and booster PPSV23 doses every 5 years. - For patients who have already received PPSV23, administer PCV13 at least 1 year after the last PPSV23 vaccination, and booster PPSV23 doses every 5 years.
  • Tetanus toxoid should be administered as in the general population.
  • Responses to human papillomavirus (HPV), hepatitis A, hepatitis B, meningococcal, and Haemophilus influenzae b vaccines have not been studied in this population. Your primary care doctor should guide you regarding these vaccines.
  • Most data suggest that adequate response to vaccinations is seen when patients are receiving anti–tumor necrosis factor (TNF) therapies, tocilizumab (Actemra), and probably abatacept (Orencia).

As always, check with your prescribing doctor before doing anything!

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