Infections and vaccinations

Infections

Antibiotics and your medication

Ordinarily you would not need to stop your disease-modifying treatment whilst taking antibiotics. If you are taking Methotrexate however, we advise you to omit this if you develop an infection, since its immunosuppressive effects may hinder your recovery.

You should not take biologic medication if you are unwell due to an infection or on antibiotics; notify the Rheumatology team if your illness persists for more than a week.

Chicken pox / shingles

If you are on a drug that suppresses your immune system (i.e. reduces your body's defence mechanism against infections) and if you come in close contact with anyone who has chicken pox or shingles you should contact your GP for advice as treatment may be required.

Drugs that can alter your response to infection include:

• Methotrexate
• Leflunomide
• Ciclosporin
• Azathioprine
• Mycophenolate
• Adalimumab
• Etanercept
• Rituximab
• Infliximab
• Golimumab
• Abatacept.

Close contact means:

• being in the same room as someone who has shingles for more than 15 minutes; or
• having immediate contact with someone who has shingles on many parts of their body or where it is exposed, e.g. on the face.

Where possible you should keep away from anyone you know who has chicken pox or shingles.

If you get chicken pox whilst on Methotrexate, notify your own GP as soon as possible as you may need treatment to minimise the severity of the disease.

Vaccinations

If your immune system is suppressed due to medication, it is particularly important that you are adequately protected.

If you are receiving treatment with immunosuppressive drugs such as:

• Methotrexate
• Leflunomide
• Azathioprine
• Adalimumab
• Etanercept
• Infliximab

you should avoid 'live' vaccinations: these include:

• oral polio vaccine
• yellow fever vaccine
• german measles (Rubella) vaccine.

An alternative inactivated polio vaccine is available, if required.

You should also avoid contact, where possible, with adults or children who have received the 'live' oral polio vaccine, for six weeks after vaccination: in particular you should not change babies' nappies, since they will excrete the live polio virus in their faeces for this time.

Vaccination against yellow fever may be an entry requirement for some countries,so discuss this with your GP before making travel arrangements.

If you are planning to travel abroad, you should seek advice from your GP at least six weeks before your departure since some vaccinations may need ordering for you.

Flu and/or pneumonia vaccinations

If you are on immunosuppressive medication such as Methotrexate and anti-TNF (biological treatment) the Flu vaccination (which is inactivated) is recommended on a yearly basis.

Likewise, the pneumonia (pneumococcal) vaccine is recommended for all patients with rheumatological conditions on immunosuppressive drugs.