Vaccines & Med Interactions

[WebJunk]

This has been asked before but did not find any actual answers in the replies:
I am probably going on Humira soon. My current GI Doctor has said I need the following vaccines before starting Humira:
Flu, Pneumonia, Hepatitis A & Hepatitis B.

Most for Hepatitis give the combined Twinrix vaccines. When I read the website and manufacturer info it states:
Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune response to TWINRIX.
http://us.gsk.com/products/assets/us_twinrix.pdf

Have seen a similar statement with regards flu vaccines.
Am currently on Prednisone (20mg; 5mg/week taper) which would indicate that I maybe should not get the vaccine right now? Then since there are two more vaccine dosages at 1 & 6 months, also how can I get those while on Humira?
Each doctor tells me to ask the other one so not getting an answer. Calling GSK get told to ask my doctor. Get the feeling the doctor's including those that give the vaccine do not read the paperwork with it. I know they are not live vaccines but if it reduces effectiveness significantly then what are the choices?

For those wondering about the Hepatitis vaccines, I have family overseas plan to visit if ever well enough to travel and also do volunteer work at homeless shelters which evidently are at risk for it.
Thanks!

 

[Tesscorm]

My son is on remicade and I did speak with his GI re vaccines before travel. but, keep in mind this is with remicade... not sure if there's any difference with Humira

I was told he could have the twinrix vaccine but to check immunity levels to confirm it is needed.

The typical flu vaccine is fine - but not the nasal mist flu vaccine . The nasal mist is a live vaccine.

If you have time, I would also check your immunity levels to measles, mumps, etc. When we ran the immunity test for hepatitis, the doctor ran the test for measles, mumps, etc and found that my son is not completely immune to mumps. I wish the GI or GP had advised us to do this BEFORE starting remicade as he could have had the MMR vaccine prior to starting remicade - now he can't.

 

[WebJunk]

Hi Tesscorm. Nothing has been mentioned about testing for immunity and since my current doctor is dropping me don't think they will pursue anything past prescribing the Humira. But they did insist I get the vaccines BEFORE getting the Humira. Since no other meds have helped at all, don't want to put off the Humira. Then again, don't want to get vaccines at a time that does not offer the effectiveness.
Really, have two questions, hope someone can answer:

1) Can or Should I get the Hepatitis vaccine while still on 20mg of Pred? or wait either to a reduced taper or off of it?

2) Is getting the 1 & 6 month vaccines while on Humira going to invalidate the vaccine's effectiveness?

Update: Just spoke with a nurse at my County Health Dept. who gives the Hepatitis vaccine. She at first said there is no issue at all with corticosteroids or Prednisone. I had her pull out the insert for the Twinrix and read it. She again said there is nothing on it. It took five minutes to have her find & read the insert to the section I posted above. All she could do is say I should talk to my doctor about it. Catch-22.
Does make me worry, that vaccines are given without knowing what they are giving to people.

 

[Tesscorm]

WebJunk, I'm sorry I have no info re pred specifically and vaccines.

When we were checking into the vaccines with my son, I was told that immunosuppressants (any type) can impair the effectiveness of vaccines. As you probably know, vaccines are given so your body can form antibodies to the 'ingredient' of the vaccine. When you are immune suppressed, your immune system may not form sufficient antibodies (or, at least, not as strongly as would someone else). We were advised to retest for immunity level after vaccines and take an additional dose if immunity levels were not at sufficient levels. (Please take this info with a slight 'warning', this came from an Infectious Disease specialist who also told me my son should have the MMR vaccine while on remicade - a total NO-NO!!! So... take it as you will...) Twinrix was one vaccine we were discussing (in this case, it was my son's GI, who I don't doubt, who confirmed Twinrix was fine). It turned out that my son did have immunity to hepatitis so we didn't go ahead with the vaccine.

I wouldn't be too confident in the knowledge of a county nurse when it relates to something a bit more complicated such as biologics and vaccines. Call the manufacturer of Humira - they should have an information department or call the specialty pharmacy that will supply you with the humira (we were called by the specialty pharmacist when my son started remicade and told to call if we had any questions re remicade and any other supplement/medicine).

If you can't follow-up with your GI, can you ask your GP for advice?

 

[WebJunk]

Not sure about testing for "immunity level" maybe something done more in Canada. Mostly done here for dogs and according to Quest Diagnostics (one of the largest test labs) they state the test is actually to see whether you have Hepatitis and no where mentions using it for immunity.

I spoke yesterday to the manufacturer (GlaxoSmithKline) of the Twinrix vaccine who told me to speak with the Doctors or Nurse who if they administer the vaccine are supposed to be knowledgeable about these issues. Obviously, not true. I also called AbbVie (maker of Humira) and they also will not "give out medical advice" Maybe that's the reason I am posting on here for info

Guess like most things been dealing with since my Crohn's diagnosis, have to make a "Best Guess"

 

[sickofcrohns]

For what it's worth -- I have yet to look up articles on this -- I spoke with several physicians and a hospital pharmacist. A normal person takes around 2 weeks to build up an adequate immune response to a flu shot, while reactions to some other vaccines take longer. Remicade has a half-life around 2 weeks. So this means that if a person gets an infusion once every month, he or she should get the shot 2 weeks before the next dose, i.e. after some of the immune suppression has worn off, but giving the body enough time to mount an immune response to the vaccine before the next dose of immune suppressant.

For Remicade doses given farther apart, a vaccine around the middle or slightly toward the end of the treatment cycle also seems optimal.

Because Humira needs to be given every week or two, I'm assuming (you should check) that it has a shorter half-life. All the same, a dose in the middle of the treatment cycle is probably your best bet.

As for prednisone and other immunosuppressants reducing the efficacy of vaccines -- well, of course. But that's no reason to avoid getting the vaccines! It might just take longer to build up immunity or it might require another dose. (It's the case of whether to give another dose that requires testing for immune response first. This would be an unusual thing to do).

Been there, done that, had a ton of vaccines (but no live vaccines) while on prednisone and Remicade.