Patients with chronic inflammatory / rheumatic disease have an increased risk of infection.  Vaccinations should be considered at earlier ages than that prescribed for the general population.


Ideally, vaccines should be administered at least 2 weeks prior to biologics and JAK inhibitors.  However, depending on disease severity, one may need to initiate therapy and administer inactivated vaccines along the way (most frequent scenario in clinical practice).  Data suggests reduced vaccine response (antibody titres) in patients already on methotrexate, Rituximab and JAK Inhibitors.  However, this has not been shown to translate into increased risk of infection.  Please note that live attenuated vaccines* should NOT be given while on biologics or JAK Inhibitors.



Prevnar 13 is given first, followed by Pneumovax at least 2 months later.  If Pneumovax was given first, it is advisable to wait one year before giving Prevnar 13, as the vaccine response may otherwise be diminished.

Varicella Zoster

Shingrix is the preferred vaccine, with two doses given 2-6 months apart.  If it is possible to wait, biologics and JAK Inhibitors can be started 2 weeks after the first dose.  Shingrix is preferred over the (older) live attenuated Zostavax vaccine.  If Zostavax is used, it must be given at least 2 weeks prior to starting biologics and JAK Inhibitors.


The annual influenza vaccine is is highly recommended in patients with chronic inflammatory / rheumatic diseases.

Hepatitis A and Hepatitis B vaccines

These should be considered in at-risk patients.