Table 3 Recommended vaccinations [40, 60, 61]

Influenza

Annually for everyone

Flumist should not be given to patients on immune modifying medication

Family members and close contacts should also receive the vaccine

Consider High Dose Vaccine for those ≥ 65 years

Pneumo-13 (Prevnar)

Any patient on DMARDs, biologics or immunosuppressants

Should be given 8 weeks prior to Pneumovax OR at least 12 months following Pneumovax

Pneumo-23 (Pneumovax)

Everyone age ≥ 65

If both doses were given prior to age 60, consider a 3rd dose after age 65

All patients on DMARDs, biologics or immunosuppressants, regardless of age

Immunocompromised patients should receive a booster in 5–10 years

Varicella Zoster (Shingrix)

Everyone age ≥ 50, especially those who are going to be receiving a biologic medication or JAK inhibitor

Those who have previously had the live vaccine or those who have had shingles previously can receive this vaccine after at least 1 year has passed

Hepatitis A and B

For those at high risk (e.g., travel to or residence in endemic countries for hepatitis A and/or B); increased risk of exposure or proven exposure to hepatitis A and/or B (e.g., because of medical profession, infected family member or contacts)

COVID-19 vaccination

Everyone

Guidance is evolving in this area. Current CRA guidance [40] suggests vaccination with any of the currently available COVID-19 vaccines. For those on Rituximab immunization should occur > 4–5 months after the last dose and at least 4 weeks prior to the subsequent dose. Current CRA guidelines do not recommend holding DMARDs for vaccination. A third dose of COVID-19 mRNA vaccination are currently suggested [62] for individuals immunosuppressants which could impact response (e.g., rituximab, mycophenolate mofetil, JAK inhibitors, abatacept, anti-TNF agents, antimetabolites etc.)