For patients with compromised immune systems, getting vaccinated often involves making complex decisions. The protection a vaccine provides is especially important to prevent illness, but do vaccines come with added risks?
Whether your system is weakened by conditions such as rheumatoid arthritis or HIV or compromised by medications such as biologics, check with your healthcare provider before receiving a vaccine.
Elizabeth Kirchner, CNP, who specializes in rheumatologic and immunologic disease, explains what risks and options patients should consider. She adds that research is underway to evaluate the safety of certain types of vaccines.
Who qualifies as “immunocompromised”?
Your immune system can be compromised in several different ways. One example is an immunodeficiency, such as an acquired disease like HIV or congenital condition such as common variable immunodeficiency.
But common autoimmune inflammatory diseases can leave your immune system weakened, too. These include rheumatoid arthritis, Crohn’s disease and others.
Medications play a part, too, such as biologic drugs used to treat rheumatoid arthritis and similar conditions. These drugs are designed to stop the immune system from malfunctioning, Kirchner says.
Which vaccines pose a risk?
So-called “live” vaccines carry the biggest risk for immunocompromised patients. Examples of live vaccines include herpes zoster (shingles); the measles, mumps and rubella (MMR) vaccine; and yellow fever. The FluMist version of the flu vaccine is live, too.
Timing is everything in some cases. Patients whose disease may progress to the point of needing biologic drugs in a few years might want to get vaccinated sooner rather than later.
Instead of gently “poking” the immune system to create antibodies as it would for typical patients, a live vaccine might make someone with a compromised system ill because of underlying problems with their immune response, Kirchner notes.
She offers an example: “If you have HIV, and you have less than 350 T-cells, then we don’t like to give the shingles vaccine.”
She adds that in most cases, even patients with low T-cells who mistakenly receive the shingles vaccine don’t suffer ill effects. But general guidance suggests against it.
In addition, patients who take certain biologic drugs for rheumatoid arthritis or similar conditions face a higher risk of developing “disseminated shingles.” In these cases, patients may actually get the virus from the immunization.
These cases are rare but serious. The patient’s immune system becomes so suppressed that instead of just presenting in one area, the virus shows up everywhere in the body, including the inside of the eyes, Kirchner says. “It can cause not only pain, itching, burning, but blindness — and in rare cases it could be fatal.”
Are vaccines always off limits?
Not necessarily. If you have a compromised system, talk to your doctor about risks and benefits specific to your condition. Then weigh your options carefully, Kirchner advises.
Timing is everything in some cases. Patients whose disease may progress to the point of needing biologic drugs in a few years might want to get vaccinated sooner rather than later, for example, before the opportunity closes to receive that vaccine and get critical protection from shingles.
“Anybody who’s a candidate should get the herpes zoster vaccine while they’re still a candidate,” Kirchner says.
Current thinking and future research
If you’re a patient taking a biologic drug, current thinking says the shingles vaccine may be too risky. Yet some studies do suggest the vaccine may be safe for patients taking these drugs.
Studies such as the VERVE clinical trial are underway to confirm whether that’s the case. This trial will evaluate the shingles vaccine in about 1,000 patients who are taking biologics known as anti-tumor necrosis factor drugs (anti-TNFs).
“The expectation is we’re going to find out it’s safer for people than we’ve thought, that we can offer the vaccine to more people who have been on this particular class of drug,” Kirchner says. Final data from the trial should be available this fall.