Quick answer: If you take DMARDs, biologics, JAK inhibitors or steroids, most non-live vaccines, such as flu, COVID-19, pneumococcal and the non-live shingles vaccine, are safe and recommended because infections can hit harder. Live vaccines may need to be avoided or carefully timed. Ask your rheumatology team for advice before any vaccine, and never pause or change your arthritis medicines without their advice.
Why vaccines matter more on arthritis medicines
Many arthritis medicines work by calming the immune system. That helps control inflammation, but it can also make it harder for your body to fight some infections. Infections such as flu, pneumonia, COVID-19 and shingles may be more likely or more serious. Vaccines are one of the simplest ways to lower that risk. Some inflammatory conditions, such as rheumatoid arthritis and lupus, can also raise infection risk on their own.
The medicines this guide applies to include methotrexate, leflunomide, azathioprine, mycophenolate, biologics (such as anti-TNF medicines, rituximab, tocilizumab and others), JAK inhibitors and steroid tablets. Hydroxychloroquine and sulfasalazine on their own are usually considered to have little effect on the immune system, but check with your team, especially if you take them with other medicines.
Live and non-live vaccines: the key difference
Vaccines fall into two broad groups.
- Non-live (inactivated) vaccines contain no living germs. They cannot cause the infection they protect against, so they are safe for people with a weakened immune system. They may work slightly less well if your immune system is suppressed, but they still give valuable protection.
- Live vaccines contain a weakened form of the germ. In people whose immune systems are significantly suppressed, there is a small risk the weakened germ could cause illness. Live vaccines are therefore often avoided or given only after specialist advice.
Examples of live vaccines include MMR (measles, mumps and rubella), chickenpox, yellow fever, BCG (for TB), oral typhoid and the nasal spray flu vaccine given to children. Whether you can have a live vaccine depends on which medicines you take and how strongly they affect your immune system, so always ask your rheumatology team first.
Vaccines usually recommended
The NHS offers several vaccines to people whose immune system is weakened by a condition or treatment. Eligibility rules are reviewed regularly, so check the NHS website or ask your GP practice for the current offer.
Flu
The injected flu vaccine is offered free every autumn to people with a weakened immune system due to treatment, and to many people with long-term conditions. It is not live. Having it every year is important because flu strains change. Close household contacts of people with weakened immune systems may also be eligible, which adds another layer of protection. Our flu jab guide has more.
COVID-19
COVID-19 vaccines used in the UK are not live. People with weakened immune systems have been included in seasonal booster programmes. Check the NHS website each season to see whether you are eligible and how to book.
Pneumococcal (pneumonia)
The pneumococcal vaccine helps protect against a common cause of pneumonia, meningitis and blood infections. It is not live. It is offered to people with weakened immune systems and to everyone from a certain age. Some people may need more than one dose, so ask your GP practice.
Shingles
The shingles vaccine now used by the NHS, Shingrix, is not live, so it is suitable for people taking immune-suppressing medicines. People with a severely weakened immune system can be offered it at a younger age than the general population. Shingles can be very painful and can cause long-lasting nerve pain, so it is worth asking about. See our shingles vaccine guide.
RSV and others
An RSV vaccine, which protects against a virus that can cause serious chest infections, is offered to older adults in certain age groups. Other vaccines, such as hepatitis B, may be recommended depending on your circumstances. Your GP practice can tell you what you are due.
Timing: before, during and after starting treatment
- Before you start a new medicine is often the ideal time to catch up on vaccines, especially any live vaccines, which may need to be given a few weeks before immune-suppressing treatment begins. Ask about this at the appointment where a new medicine is discussed.
- Non-live vaccines can usually be given while you continue your arthritis treatment. Your team may suggest timing a vaccine around certain medicines so it works better. For example, vaccines tend to work best before a rituximab infusion rather than shortly after one. Only adjust medicine timing if your own team advises it.
- If you are unwell with a fever, vaccines are usually postponed until you are better.
Do not stop, pause or change the dose of your arthritis medicines for a vaccine unless your rheumatology team has told you to.
Travel vaccines
If you are travelling abroad, see a travel clinic or your GP practice at least six to eight weeks before you go, and tell them about all your medicines. Some destinations need vaccines, such as yellow fever, that are live and may not be suitable. If you cannot have a required vaccine, you may be given an exemption letter, and you may need to reconsider some destinations. Our guide to travelling with arthritis covers medicines, insurance and planning.
Family, grandchildren and people you live with
It is usually helpful for the people you live with to be fully vaccinated, as this reduces the chance of infections being brought into the home. Most routine childhood vaccines are fine for your household to have. After a baby has the rotavirus vaccine, which is live and given by mouth, the virus can be passed in nappies for a short time, so wash your hands well after nappy changes or ask someone else to do them if you are significantly immunosuppressed. If you have questions about a specific vaccine a family member is due, ask your GP or practice nurse.
Practical tips
- Keep a list of your medicines on your phone to show at vaccine appointments.
- Tell the person giving the vaccine about your arthritis medicines, especially if a live vaccine is mentioned.
- Record which vaccines you have had and when.
- Mild soreness, tiredness or aches for a day or two after a vaccine are common and usually settle. Seek advice if you feel very unwell afterwards.
- Carry on with everyday infection precautions, such as hand washing, as vaccines do not give complete protection.
Frequently asked questions
Can I have the flu jab if I take methotrexate?
Yes. The injected flu vaccine is not live and is recommended every year for people taking methotrexate. Ask your team whether they have any timing advice, and do not change your methotrexate yourself.
Which vaccines should I avoid on biologics?
Live vaccines, such as yellow fever, MMR, chickenpox, BCG and oral typhoid, are usually avoided while taking biologics unless a specialist advises otherwise. Non-live vaccines are generally safe.
Can I have the shingles vaccine on a JAK inhibitor?
The non-live shingles vaccine used by the NHS is suitable for people on JAK inhibitors and other immune-suppressing medicines. Ask your GP practice or rheumatology team about eligibility.
Will vaccines work if my immune system is suppressed?
They may give a slightly weaker response, but they still offer important protection. That is one reason why timing and booster doses can matter.
Can my grandchildren have their live vaccines?
Most childhood vaccines are fine. Wash your hands carefully after nappy changes for a short time after a baby has the rotavirus vaccine, and ask your GP if you are unsure.
Should I stop my arthritis medicine before a vaccine?
Not unless your rheumatology team specifically advises it. Stopping medicines can cause a flare.
Sources and further reading
- NHS: Vaccinations
- NHS: Flu vaccine
- NHS: Shingles vaccine
- UKHSA: Immunisation against infectious disease (the Green Book)
This guide is for general education and is not a substitute for personal medical advice. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.