skip to main content

Vaccination in Immunosuppression — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatology PharmacologyVaccination in ImmunosuppressionSCE Rheumatology

A 45-year-old woman with rheumatoid arthritis receives weekly subcutaneous abatacept. Her disease is stable. Specialist travel assessment confirms that she has an unavoidable itinerary with a significant risk of yellow fever exposure and that yellow fever vaccination is indicated. Temporary interruption of abatacept is clinically feasible. Which approach to vaccination is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Stop abatacept and give yellow fever vaccine only after at least a 3-month drug-free interval

Yellow fever vaccine is live attenuated and must not be administered during clinically significant immunosuppression. The abatacept SmPC specifies that live vaccines should not be given concurrently with abatacept or within 3 months after its discontinuation. Therefore, if specialist assessment confirms that vaccination is essential and interruption is safe, abatacept should be stopped and vaccination deferred until at least 3 months after the last dose. Restarting abatacept should subsequently be coordinated with rheumatology rather than using the unsupported fixed 2-week interval in the original item. Switching to a TNF inhibitor does not make live vaccination safe because TNF inhibitors are also immunosuppressive biologics. Omitting one dose provides an inadequate washout. Continuing abatacept while vaccinating risks vaccine-associated infection, whereas proceeding unvaccinated does not address a significant unavoidable exposure risk.

Reference: Bristol Myers Squibb. ORENCIA (abatacept) Summary of Product Characteristics, sections 4.4 and 4.5: Vaccinations. Revised 2024. https://www.medicines.org.uk/emc/product/10244/smpc