As another flu season approaches, those of us who take immunosuppressant drugs for rheumatoid arthritis (RA) start getting twitchy. One of the most unnerving things about taking these types of medications is being vulnerable to infection. Experts are looking at the just-past flu season in Australia and predicting a humdinger on this side of the world. There were “more cases of influenza than ever reported, so we could have a really bad flu season this year, but it’s unpredictable. So you’ve got to be prepared for it,” says Dr. Charles Gerba, professor of microbiology and environmental sciences at the University of Arizona.
But there is no need to move into a bubble — vaccinations can help protect your health.
The magic three
People who take an immunosuppressant can benefit from three vaccines. First, the annual flu vaccine which, although not 100 percent effective, can help protect you against whatever flu virus is running around each year. Secondly, the pneumonia vaccine protects against 15 types of bacterial pneumonia. This may be repeated five to 10 years after the initial shot. If you are vulnerable, such as over 65 or have a chronic illness, the Centers for Disease Control and Prevention recommends the one-two punch of two pneumococcal vaccines called PCV13 and PPSV23. And lastly, the tetanus shot, repeated every 10 years, keeps you safe from potentially fatal infection.
Avoid live vaccines
The flu shot, pneumonia, and tetanus vaccines are inactivated. That means they’ve been treated with for instance, heat, and are considered safe for people who are taking immunosuppressants, such as biologics. Other vaccines are considered live and not recommended for people on biologics. Live vaccines include shingles, measles, mumps and rubella, and the nasal version of the flu vaccine. Certain travel vaccines, such as the one for yellow fever, are also not recommended for people who take biologics.
Vaccines and medication — do they interact?
One concern about vaccines when you are on immunosuppressants is whether these medications lower the effectiveness of immunizations. One recent study found that temporarily discontinuing methotrexate led to a better response to the flu vaccine. The researchers tested different lengths of discontinuation, as well as before and after the flu shot. They found that stopping methotrexate two weeks before and two weeks after the flu shot worked particularly well, although stopping the medication for four weeks after the shot also had a significant response.
Although it was previously believed that immunosuppressant drugs could affect the efficacy of the pneumonia vaccine, another recent study shows that this may not be the case. It appears that taking biologics does not interact with how the pneumonia vaccine works. However, taking methotrexate does affect it somewhat.
“Your hands are the best friends a germ ever had,” says Dr. Gerba, explaining that we are constantly touching something in this age of computers and devices. “You’re going to bring your hands to your face every three or four minutes without even realizing it,” he continues. Making sure those hands are clean is the best way to enhance the protection you’ve had through vaccinations like the flu shot.
Washing your hands with soap may not be enough — most people “don’t wash their hands long enough or they just use water,” says Dr. Gerba. He recommends supplementing with hand sanitizer at least once a day, especially for people who are immunosuppressed. You should also be aware of when you’re touching areas that can be particularly dirty. Public areas that don’t get washed often (or at all), such as gas pump handles, ATM buttons, and banisters are high on the list.
Being careful about infection isn’t just important for people who take immunosuppressant drugs. It’s important for everyone who has RA. This condition can make you more susceptible to illness and make it more likely that you’ll get walloped by a virus when others are merely inconvenienced.
“Talk to your physician first,” Dr. Gerba recommends. Your rheumatologist and your family doctor will both be able to give you advice about managing the infection risk and which vaccines can help you stay healthy.