Vaccines
Vaccines and Biologic Therapy
Patients on biologic medications need careful vaccine management. Live vaccines contain weakened organisms that can cause infections in immunosuppressed patients and must be avoided during biologic therapy. Inactivated vaccines use killed organisms or components and are safe to give during treatment.
This reference helps identify which vaccines are live versus inactivated and their FDA-approved age ranges.
How to Use:
Use the filter to find specific vaccines. Each entry shows whether the vaccine is live or inactivated and the FDA-approved age range.
Live vaccines must be given at least 4 weeks before starting a biologic, or wait until 3-6 months after stopping therapy.
Inactivated vaccines can be given before, during, or after biologic therapy. When possible, give them 2-4 weeks before starting a biologic for the best immune response.
All information is verified against FDA-approved prescribing information.
BCG (Tuberculosis)
Type:
Live bacterial
FDA-approved:
Not routinely used in US
COVID-19 (Moderna)
Type:
Inactivated/mRNA
FDA-approved:
6 months and older
COVID-19 (Novavax)
Type:
Inactivated protein
FDA-approved:
12 years and older
COVID-19 (Pfizer-BioNTech)
Type:
Inactivated/mRNA
FDA-approved:
6 months and older
DTaP (Diphtheria, Tetanus, Pertussis)
Type:
Inactivated
FDA-approved:
6 weeks through 6 years
FluMist (Intranasal Influenza)
Type:
Live viral
FDA-approved:
2-49 years
Hepatitis A
Type:
Inactivated
FDA-approved:
12 months and older
Hepatitis B
Type:
Inactivated
FDA-approved:
All ages
Heplisav-B (Hepatitis B)
Type:
Inactivated
FDA-approved:
18 years and older
Hib (Haemophilus influenzae type b)
Type:
Inactivated
FDA-approved:
6 weeks and older
HPV (Human Papillomavirus)
Type:
Inactivated
FDA-approved:
9-45 years
Influenza (Injectable)
Type:
Inactivated
FDA-approved:
6 months and older
IPV (Polio - Inactivated)
Type:
Inactivated
FDA-approved:
6 weeks and older
Meningococcal MenACWY
Type:
Inactivated
FDA-approved:
2 months and older
Meningococcal MenB
Type:
Inactivated
FDA-approved:
10 years and older
MMR (Measles, Mumps, Rubella)
Type:
Live viral
FDA-approved:
12 months and older
Oral Typhoid
Type:
Live bacterial
FDA-approved:
6 years and older
Pneumococcal PCV13 (Prevnar 13)
Type:
Inactivated
FDA-approved:
All ages
Pneumococcal PCV20 (Prevnar 20)
Type:
Inactivated
FDA-approved:
18 years and older
Pneumococcal PPSV23 (Pneumovax 23)
Type:
Inactivated
FDA-approved:
2 years and older
Rotavirus
Type:
Live viral
FDA-approved:
6 weeks through 8 months
RSV (Respiratory Syncytial Virus)
Type:
Inactivated
FDA-approved:
60 years and older
Shingrix (Shingles - Recombinant)
Type:
Recombinant
FDA-approved:
50 years and older
Td (Tetanus, Diphtheria)
Type:
Inactivated
FDA-approved:
7 years and older
Tdap (Tetanus, Diphtheria, Pertussis)
Type:
Inactivated
FDA-approved:
10 years and older
Typhoid (Injectable)
Type:
Inactivated
FDA-approved:
2 years and older
Varicella (Chickenpox)
Type:
Live viral
FDA-approved:
12 months and older
Yellow Fever
Type:
Live viral
FDA-approved:
9 months and older
Zostavax (Shingles)
Type:
Live viral
FDA-approved:
50 years and older
Special Considerations by Age Group
Infants and Children (Birth - 17 years)
Most childhood vaccines are inactivated and safe during biologic therapy. The main live vaccines to avoid are MMR, varicella, rotavirus, and FluMist. Standard childhood vaccination schedules can be followed with these exceptions. When starting a biologic in childhood, try to complete or at least initiate the MMR and varicella series beforehand. These vaccines require at least 4 weeks between administration and starting immunosuppressive therapy.
Adults (18-49 years)
Key vaccines for this age group on biologics:
Adults (50-64 years)
Add to adult recommendations:
Adults (65+ years)
All above recommendations plus:
Most childhood vaccines are inactivated and safe during biologic therapy. The main live vaccines to avoid are MMR, varicella, rotavirus, and FluMist. Standard childhood vaccination schedules can be followed with these exceptions. When starting a biologic in childhood, try to complete or at least initiate the MMR and varicella series beforehand. These vaccines require at least 4 weeks between administration and starting immunosuppressive therapy.
Adults (18-49 years)
Key vaccines for this age group on biologics:
- Annual flu shot
- COVID-19 vaccines and boosters
- Tdap once, then Td every 10 years
- HPV if not previously vaccinated (through age 26, optional 27-45)
- Meningococcal if indicated by risk factors
Adults (50-64 years)
Add to adult recommendations:
- Shingrix (2-dose series starting at age 50)
- Pneumococcal vaccines if not received earlier
- Consider hepatitis B if risk factors present
Adults (65+ years)
All above recommendations plus:
- Pneumococcal vaccines (PCV15/PCV20 and PPSV23 per CDC schedule)
- High-dose or adjuvanted flu vaccine options
- RSV vaccine (per current recommendations)
Vaccination Timing with Biologic Therapy
Before Starting a Biologic
Review vaccination status and update as needed:
During Biologic Therapy:
After Stopping a Biologic
Live vaccines can typically be given 3-6 months after the last biologic dose, depending on the medication's half-life. Consult prescribing information for specific recommendations.
Review vaccination status and update as needed:
- Administer any needed live vaccines at least 4 weeks before first biologic dose
- Give inactivated vaccines 2-4 weeks before starting if possible (for best immune response)
- Complete or start MMR and varicella series if patient lacks immunity
During Biologic Therapy:
- Continue all recommended inactivated vaccines on schedule
- Do not administer live vaccines
- Annual flu shot each fall
- Stay current with COVID-19 boosters
After Stopping a Biologic
Live vaccines can typically be given 3-6 months after the last biologic dose, depending on the medication's half-life. Consult prescribing information for specific recommendations.
Common Questions
Can vaccines be given on the same day as a biologic injection?
Yes. Inactivated vaccines can be administered the same day as biologic injections. Some practitioners prefer spacing them by a few days to distinguish vaccine-related reactions from biologic reactions, but this is not medically required.
What if a patient accidentally receives a live vaccine while on a biologic?
Contact the prescribing physician immediately. The biologic may need to be temporarily held, and the patient should be monitored for signs of infection. Document the incident thoroughly.
Are vaccines less effective during biologic therapy?
Vaccines may produce a somewhat reduced antibody response in immunosuppressed patients compared to immunocompetent individuals. However, vaccination still provides important protection and is strongly recommended.
Can household members receive live vaccines?
Yes, in most cases. Household contacts can safely receive live vaccines like MMR, varicella, and FluMist. The main precautions involve oral polio (not used in US) and rotavirus in infants—extra hand hygiene around diaper changes is recommended for 2 weeks after infant vaccination.
How do I know which flu vaccine to give?
Always use the injectable flu shot for patients on biologics. Do not use FluMist nasal spray, which is a live vaccine. The specific injectable formulation (standard dose, high-dose, adjuvanted) can be chosen based on age and availability.
What about the shingles vaccine?
Always use Shingrix (recombinant, 2-dose series) for patients on biologics. Do not use Zostavax (live vaccine). If a pharmacy offers shingles vaccination, verify they are administering Shingrix, not old Zostavax stock.
Yes. Inactivated vaccines can be administered the same day as biologic injections. Some practitioners prefer spacing them by a few days to distinguish vaccine-related reactions from biologic reactions, but this is not medically required.
What if a patient accidentally receives a live vaccine while on a biologic?
Contact the prescribing physician immediately. The biologic may need to be temporarily held, and the patient should be monitored for signs of infection. Document the incident thoroughly.
Are vaccines less effective during biologic therapy?
Vaccines may produce a somewhat reduced antibody response in immunosuppressed patients compared to immunocompetent individuals. However, vaccination still provides important protection and is strongly recommended.
Can household members receive live vaccines?
Yes, in most cases. Household contacts can safely receive live vaccines like MMR, varicella, and FluMist. The main precautions involve oral polio (not used in US) and rotavirus in infants—extra hand hygiene around diaper changes is recommended for 2 weeks after infant vaccination.
How do I know which flu vaccine to give?
Always use the injectable flu shot for patients on biologics. Do not use FluMist nasal spray, which is a live vaccine. The specific injectable formulation (standard dose, high-dose, adjuvanted) can be chosen based on age and availability.
What about the shingles vaccine?
Always use Shingrix (recombinant, 2-dose series) for patients on biologics. Do not use Zostavax (live vaccine). If a pharmacy offers shingles vaccination, verify they are administering Shingrix, not old Zostavax stock.
Patient Counseling Points
Educate patients to:
- Get an annual flu shot every fall (injection, not nasal spray)
- Verify shingles vaccine is Shingrix, not Zostavax
- Inform any healthcare provider giving vaccines that they are on immunosuppressive medication
- Avoid live vaccines while on biologic therapy
- Ask questions when unsure about a recommended vaccine
Disclaimer
While all storage data is carefully verified against official manufacturer prescribing information, ACDOSA assumes no liability for any errors, omissions, or clinical outcomes. This tool is for reference purposes only. Always consult current prescribing information for complete storage requirements and contact manufacturers for specific storage questions.