If Your Immune System Is Compromised, Can You Get Vaccinated?

For people with compromised immune systems, getting vaccinated often involves making complex decisions. The protection a vaccine provides is especially important to prevent illness. But do vaccines come with added risks?

Maybe conditions like rheumatoid arthritis or Crohn’s disease have weakened your immune system. Maybe medications, such as biologics or monoclonal antibodies, are the culprit. Either way, you should check with your healthcare provider before receiving a vaccine.

Rheumatologic and immunologic disease specialist Cassandra Calabrese, DO, explains what risks and options patients should consider.

Who qualifies as “immunocompromised?”

Your immune system can be compromised in several different ways. One example is an immunodeficiency, such as an acquired disease like HIV or congenital condition such as common variable immunodeficiency (CVID).

But common autoimmune inflammatory diseases can leave your immune system weakened, too. These include multiple sclerosis (MS), Crohn's disease, rheumatoid arthritis, psoriasis and many others.

Medications play a part, too.

There are several different kinds of medications that can suppress the immune system. One widely used class of immunosuppressants is biologics. This type of drug can treat everything from gout and cancer to diabetes and inflammatory bowel disease. These drugs are designed to quiet the immune system and stop it from turning on itself, Dr. Calabrese says.

Are vaccines always off limits?

The simple answer is no: Vaccines aren’t always off-limits if you’re immunocompromised. Being up to date with recommended vaccines is extra important because your condition (or the medical treatments you’re on, depending on your health circumstances) places you at increased risk of infections that vaccines can help prevent. But there are certain factors you and your provider have to consider when determining which vaccines you should be getting, including the type of vaccine, your diagnosis and the type of medications you’re on.

“Live vaccines — such the measles, mumps and rubella (MMR) vaccine — should generally be avoided in the setting of immunosuppression, because they can cause infection,” Dr. Calabrese explains. “Most vaccines, however, are not live and are generally recommended for people who are immunocompromised. That said, certain immunosuppressive medications may reduce the effectiveness of vaccines.”

Other factors come into play too. For example, your risk-benefit calculation may shift based on your lifestyle. Yellow fever vaccination, for example, is more important if you live in an area where the disease is endemic.

If you have a compromised immune system, talk to your doctor about risks and benefits specific to your condition and any other factors that you think are important to keep in mind. Then weigh your options carefully, Dr. Calabrese advises.

How can immunosuppression affect vaccination?

Being immunocompromised can impact the timing and effectiveness of vaccines. And in the case of live vaccines, it can also raise your risk of complications.

Effectiveness

If your immune system isn’t functioning properly, it might not respond to vaccines effectively — or at all.

“People who are immunocompromised sometimes need additional doses or more frequent boosters to make sure they’re adequately protected,” Dr. Calabrese explains.

Timing

In some cases, timing is everything. Patients whose disease may progress to the point of needing an organ transplant in a few years, for example, might want to get vaccinated sooner rather than later.

“Anybody who’s a candidate should get routine vaccinations while they still can,” Dr. Calabrese says.

Time can also be important for logistical reasons. If you’re getting infusions to treat your condition, for example, you may have to schedule around them, or wait longer in-between doses.

“It’s best to be vaccinated before starting immunosuppressive medications, but it isn’t always possible. Some protection is better than no protection at all, so speak with your doctor about ideal timing,” Dr. Calabrese advises.

Which vaccines pose the greatest risk?

So-called “live” vaccines carry the biggest risk for immunocompromised patients. Examples of live vaccines include the chickenpox vaccine (varicella); the measles, mumps and rubella (MMR) vaccine; and yellow fever vaccines. The FluMist® version of the flu vaccine is live, too.

For people who aren’t immunocompromised, live vaccines gently “poke” the immune system to create antibodies. If your immune response is compromised, a live virus vaccine may:

• Be ineffective or offer only partial protection.
• Give you the condition you’re being vaccinated against.

In rare (but serious) cases, Dr. Calabrese says, a live virus vaccine can cause the immune system to become so suppressed that it enters the bloodstream. That means that, instead of just presenting in one area, the virus or bacteria can show up everywhere in the body. It’s called viremia if it’s a virus that’s been disseminated through the bloodstream and bacteremia if it’s bacteria.

“Both viremia and bacteremia can be fatal without prompt treatment,” Dr. Calabrese adds.

What about COVID-19 vaccines?

All of the COVID-19 vaccines currently available in the U.S. are inactivated. That means you can’t get COVID-19 from them. The CDC currently recommends all people over age six — including those who are moderately or severely immunocompromised — get and stay up to date with COVID vaccines.

It’s still important to speak to your providers about getting vaccinated as — just like any other vaccine — your personal health situation may complicate things.

There are few things Dr. Calabrese recommends keeping in mind:

1. You may not get the same level of protection from the COVID vaccine that other people do.
2. It’s not unusual for people who’ve been vaccinated against COVID to get a breakthrough infection, since we haven’t established herd immunity. That means it’s important to continue taking preventive measures even after being vaccinated.

Stay up to date

As the COVID-19 pandemic taught us, vaccine development is getting more sophisticated all the time. And it can be hard to keep up. Case in point: shingles prevention.

“Up until 2020, the only shingles vaccines we had available were live virus vaccines. That made preventive care a no-go for many people” Dr. Calabrese says. “Then a more effective, inactivated vaccine called Shingrix® came out. Now we can advise people who are immunocompromised to get the vaccine.”

Check in with your primary care provider regularly to see if there have been any changes that could impact your vaccine eligibility.

To jab, or not to jab?

Being immunocompromised means different things for different people. It can be temporary or permanent, inherited or acquired, and mild, moderate or severe. Two people with the exact same condition may have different needs and vulnerabilities.

While there are some general principles providers can follow, there isn’t a one-size-fits-all approach to vaccination against infectious diseases. If you are immunocompromised, talk to your doctor about each potential vaccine you could get, as well as alternative prevention methods. Together, you can run through your options and make an informed decision.