Vaccinations & General Advice for Autoimmune Patients
Vaccinations are an important part of autoimmune care.
If you have an autoimmune condition, or you are taking medicines that affect your immune system, certain infections can become more serious. Vaccination helps reduce that risk and is an important part of long term health planning.
Why vaccinations matter for autoimmune patients
Autoimmune conditions happen when the immune system becomes overactive or misdirected. Some of my patients also need medications that calm the immune system, such as steroids, methotrexate, biologics, JAK inhibitors or other immunosuppressive treatments.
Because of this, some infections may be more serious or harder to recover from. Vaccination helps the body prepare protection before infection happens.
- Lower the risk of serious infections
- Reduce complications from flu, pneumonia and shingles
- Protect patients who are taking immune suppressing medications
- Reduce hospitalisation risk
- Support safer long term treatment planning
- Protect patients before starting certain medications
Vaccines I commonly discuss with autoimmune patients
These are three vaccines that come up most often in my clinic.
Influenza vaccine
The influenza vaccine is recommended once a year. Flu can be more serious in patients with autoimmune disease, especially those taking medicines that affect the immune system.
Anyone who is immunosuppressed.
Every year
This is not the same as a common cold. Influenza can cause high fever, body aches, chest infection and serious complications in higher risk patients.
Pneumococcal vaccine
Pneumococcal infection can cause pneumonia, bloodstream infection and meningitis. Patients with autoimmune conditions or weakened immune systems are advised to receive pneumococcal vaccination.
Anyone above 50, or anyone who is immunosuppressed.
Every 5 years, depending on age, vaccine history, immune status and doctor's advice.
I discuss pneumococcus vaccination. Prevenar 13 or 20 provides stronger long lasting immunity when compared to the polysaccharide pneumovax vaccine and is recommended in immunosuppressed patients.
Shingrix vaccine
Shingles, also known as kayap, is caused by reactivation of the chickenpox virus. It can cause a painful rash and nerve pain. The risk can be higher in older adults and in some people with weakened immune systems.
Anyone over 50, and anyone 18 and above who is immunosuppressed.
Given as 2 doses, and confers around 10 years of coverage.
Shingrix is recommended in anyone over 50, and 18 and above if immunosuppressed. It is a non live recombinant vaccine and offers long lasting protection of around 10 years. I can advise whether it is suitable and when it should be given, especially if you are on immune suppressing medication.
EULAR vaccine recommendations: 2019 vs 2026
EULAR (the European Alliance of Associations for Rheumatology) publishes guidance on vaccination for patients with autoimmune and rheumatic diseases. Here is a plain summary of how the 2026 update differs from the 2019 recommendations. I use this alongside Malaysian practice to decide what is right for you.
| Vaccine | EULAR 2019 | EULAR 2026 (key updates) |
|---|---|---|
| Influenza | Strongly recommended; no formulation preference. | High-dose formulation preferred in immunosuppressed patients. Holding methotrexate for 1 to 2 weeks after vaccination is advised (1 week appears similar to 2 weeks). |
| Pneumococcal | Strongly considered; no conjugate preference. | Conjugated vaccines (PCV20 or PCV13) are strongly preferred. Consider a 1 month methotrexate delay around the vaccine. |
| Tetanus | Standard schedule; passive immunisation for patients on rituximab. | Standard schedule; passive immunisation still advised for cell depleting therapy. Over 90 percent seroprotection after booster. |
| Hepatitis A / B | For at risk patients; check anti-HBs level. | For at risk patients. Reduced immunogenicity with TNF inhibitors, so extra doses and antibody check are advised (boost if anti-HBs less than 10 mIU/mL). |
| Herpes Zoster | Given cautiously (live Zostavax era). | Strongly recommend the recombinant zoster vaccine (Shingrix). ZOE-50 showed around 90.5 percent efficacy in autoimmune inflammatory rheumatic disease. |
| Yellow Fever | Avoid if immunosuppressed. | Still avoided in most cases. May be considered with low level immunosuppression or after temporary withdrawal of biologic therapy. |
| HPV | General guidelines; highlight in SLE. | Catch-up vaccination emphasised in SLE (roughly 2x cervical and up to 5x non-cervical HPV related risk). |
| Household contacts | Follow national guidance; avoid oral polio vaccine. | Follow national guidance; explicitly exclude oral polio vaccine. Diaper hygiene precautions for 4 weeks after rotavirus vaccination. |
| Newborns (mother on bDMARD) | Avoid live vaccines for 6 months. | Same principle. Rotavirus vaccine appears acceptable after in-utero TNF inhibitor exposure, with no major adverse events reported. |
| SARS-CoV-2 | Not applicable. | Strongly recommended, based on 58 studies. Safety and immunogenicity are well established. |
Source: adapted from EULAR recommendations. 2019 reference: Furer V et al, "2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases," Annals of the Rheumatic Diseases 2020;79:39-52. This summary is for education. Please speak with me before making changes to your own vaccine or medication plan.
The best time to plan vaccines is before treatment changes
For some of my patients, vaccines work better when given before starting certain immune suppressing medications. If you are already on treatment, vaccination may still be possible, but the timing may need to be planned carefully.
- 1Review diagnosis and current medication
- 2Check previous vaccine history
- 3Identify recommended vaccines
- 4Plan timing around treatment
- 5Keep a record for future care
Some vaccines may not be suitable during immune suppressing treatment
Not all vaccines are the same. Some are non live vaccines, while some are live vaccines. Live vaccines are not suitable for patients who are significantly immunosuppressed.
Please do not take any vaccine without first telling your doctor about your autoimmune condition and current medications.
Before any vaccination, tell your doctor if you:
- Are taking steroids
- Are taking methotrexate
- Are taking biologic injections or infusions
- Are taking JAK inhibitors
- Recently had rituximab or similar treatments
- Are pregnant or planning pregnancy
- Had a previous serious vaccine reaction
- Are currently unwell or feverish
Who should discuss vaccination with a rheumatologist?
Please ask me about vaccination if you have an autoimmune condition, especially if you are starting or already taking immune suppressing medication. Common examples include:
General health advice for autoimmune patients
A few simple habits can help you stay well between visits. I share these often in clinic, and I am always happy to talk through them with you in more detail.
Keep an updated vaccine record
Ask before starting new supplements or medications
Do not stop rheumatology medication without medical advice
Inform your doctor before travelling
Seek medical advice early if you develop fever or infection symptoms
Keep regular follow ups
Tell your doctor if you are planning pregnancy
Ask whether family members should also be up to date with routine vaccines
Personalised vaccination advice for your condition and treatment
I can review your autoimmune diagnosis, current medications, previous vaccination history and infection risk before advising on a suitable vaccination plan. The goal is to help you stay protected while continuing appropriate rheumatology care.
Vaccination advice may be especially important before starting biologics, JAK inhibitors, rituximab, long term steroids or other immune suppressing medicines.
- Review of diagnosis, medications and vaccine history
- Discussion of suitable vaccines and timing
- Planning around biologics, JAK inhibitors and steroids
- Clear notes you can keep for future care
Questions my patients often ask about vaccines
Not sure which vaccines you need?
If you have an autoimmune condition or are taking immune suppressing medication, vaccination planning should be personalised. A specialist review can help you understand what protection may be suitable for you.
Other conditions I treat
More patient guides are on the way. These pages will be linked here as they become available.