Vaccines and Immunosuppression

• Patients and families need to know to avoid live vaccines when on DMARDS, biologics or other immunosuppressives; especially if also taking systemic corticosteroids.
• Annual influenza vaccines are recommended for patients who are immunosuppressed. 
• Before starting immunosuppression then serological tests for measles, varicella and rubella serology are checked. If possible then vaccinations should be given before starting immunosuppression but often the window of time is short for the child with severe disease or complications. 
• In certain situations (e.g., an outbreak of measles) and the non-immune child is at risk, then specialist advice is needed.