July 01, 2019

I have a suppressed immune system. Are vaccines safe?

Q: I take a drug for rheumatoid arthritis that suppresses my immune system. I'm scheduled to receive a vaccine later this year. Is getting a vaccine a safe and wise thing to do?

A: Appropriate and timely vaccines are very important for anyone with a suppressed immune system. That's because a suppressed immune system increases your vulnerability to infections, including those that can be prevented by vaccines. However, vaccine selection for a person with immune suppression is a nuanced topic. It's important to have a detailed discussion with your doctor, as the choices are individualized based on your circumstances.

Many diseases and disease treatments can suppress the immune system. These include cancer and chemotherpy, drugs for autoimmune diseases — such as rheumatoid arthritis, psoriasis or inflammatory bowel disease — drugs given after organ transplant, and corticosteroids, which are used for a variety of problems.

In general, a vaccination assessment includes consideration of:

  • Safety — It's possible that vaccines with live viral or bacterial elements could cause an infection in people with suppressed immune systems. Therefore, these vaccines are avoided for people with severe immune suppression. However, select live vaccines can sometimes be safely used in people with milder immune suppression. Thankfully, several vaccines that are important for older adults — such as the annual flu (influenza) vaccine and the pneumococcal vaccine — aren't live vaccines and have no risk beyond what occurs in those with healthy immune systems.
  • Effectiveness — Depending on the severity of your immune suppression, your immune system might not fully respond to the vaccine, providing only partial or very limited protection against infection. However, so long as the vaccine is considered reasonably safe, partial protection...