Vaccines don’t always mix with compromised immune systems

DEAR DR. ROACH>> Your recent column on the shingles vaccine did not address those of us with compromised immune systems. I take Enbrel and could not take the original shingles vaccine. What is the protocol as of now with the new vaccine?

ANSWER>> Unfortunately, there is still no consensus on giving the shingles vaccine to people with compromised immune systems. Most experts will give the new subunit vaccine Shingrix — it does not contain live virus — to people whose immune systems are only mildly affected, such as people taking lowdose prednisone, say less than 20 mg/day, or low doses of other immune system suppressing drugs like methotrexate or azathioprine. For people with more significant immunosuppressive therapy, like the Enbrel you are taking, or for people with a history of leukemia, lymphoma or stem cell or organ transplant, I can’t make a recommendation.

If possible, the vaccine should be given prior to starting therapy. Unfortunately, that doesn’t help the many people like you, deciding what to do while on immunosuppression. There just aren’t enough data yet to show both effectiveness and safety of the vaccine. Most of the evidence points toward safety, but the temporary increase in immune response due to the components of the vaccine could, in theory, make some conditions worse, such as rheumatoid arthritis or multiple sclerosis. For that reason, individuals need to discuss their particular case with their own doctors as we await the results of studies.