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Home > Services > Rheumatology > Rheumatology Patients > My vaccinations

My vaccinations

Vaccination is a safe and effective way of protecting yourself and others from potentially serious infection. This is especially important if you take medications for your rheumatological disorder, as many of these drugs will suppress your immune system and increase your risk of infection.

We strongly recommend that you are up to date with all vaccines that are offered to everyone in the UK as part of the current national vaccination schedule.

The UK currently offers some vaccinations to all people as they age. This includes the influenza (flu), pneumococcal and shingles vaccines offered to everyone 65 years and older; and the COVID-19 vaccine offered to everyone aged 75 years and older.

If you take medications to suppress your immune system, you are eligible to receive these vaccines at a younger age as follows:

  • Influenza (flu) vaccine – once a year (any age)
  • COVID-19 vaccine – when announced by the Department of Health (any age)
  • Pneumococcal vaccine – once only (any age)
  • Shingles (Shingrix) vaccine – one course only: 2 vaccines given 8-52 weeks apart (over 18 years old)

This applies if you fall into any of the groups:
  1. Rituximab or obinutuzumab infusion within the past 12 months
  2. Cyclophosphamide infusion within the past 6 months
  3. Current (or within past 3 months) treatment with:
    • Prednisolone at doses of at least:
      • 20mg per day for more than 4 weeks, or
      • 10mg per day for more than 4 weeks (* shingles vaccine only)
    • Any biologic treatment (other than denosumab or romososumab) – these are treatments which you either self-inject or attend our day unit for infusions
    • Any JAK inhibitor (which includes tofacitinib, baricitinib, filgotinib and upadacitinib)
    • Mycophenolate, methotrexate, azathioprine, leflunomide (*note: pneumococcal vaccine not required unless used in combination with any of the other treatments listed above)

    Note that sulfasalazine and hydroxychloroquine are not included. Also note that even if you do not meet the criteria above, you may still be eligible for these vaccines at an earlier age if you have another chronic health problem. Visit the NHS website for more information.

    Are there any vaccines I shouldn’t receive?

    Most vaccines used in the UK are non-live vaccines and are safe to use in patients taking immunosuppressive drugs. However, there are a few live vaccines in use which carry a very small risk of causing infection in people with weakened immune systems.

    Live vaccines currently used for adults in the UK include:
    • BCG vaccine
    • chickenpox (varicella vaccine)*
    • measles, mumps and rubella (MMR) vaccine
    • some travel vaccines (including the oral typhoid vaccine and the yellow fever vaccine)

    * (note that the shingles vaccine used to be a live vaccine (Zostavax), but has now been switched over to a non-live vaccine (Shingrix))

    Live vaccines should be avoided only if you fall within any of the groups below:
    • Rituximab or obinutuzumab infusion within the past 12 months
    • Cyclophosphamide infusion within the past 6 months
    • Current (or within past 3 months) treatment with:
      • Prednisolone at doses of at least:
        • 40mg per day for more than 1 week, or
        • 20mg per day for more than 2 weeks
      • Any biologic treatment (other than denosumab or romososumab) – these are treatments which you either self-inject or attend our day unit for infusions
      • Any JAK inhibitor (which includes tofacitinib, baricitinib, filgotinib and upadacitinib)
      • Mycophenolate (any dose)
      • Azathioprine (only at doses more than 3mg per kg per day)

    Live vaccines can be safely used in patients taking methotrexate (up to 25mg per week), leflunomide, sulfasalazine and hydroxychloroquine.

    You may need to avoid live vaccines if a reason other than your rheumatology treatment strongly suppresses your immune system – for example:

    • cancer chemotherapy/radiotherapy
    • organ transplants
    • HIV infection
    • bone marrow transplants
    • congenital defects of the immune system.

    Rituximab and Vaccines

    We recommend that you have any vaccines at least 2 weeks and ideally 4 weeks before your infusion. This increases the chance of a good response to the vaccine. We cannot reschedule your rituximab infusions, so please book your vaccine appointments with this in mind.

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