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Vaccination in RA — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisVaccination in RASCE Rheumatology

A 48-year-old man with rheumatoid arthritis takes methotrexate 15 mg once weekly and adalimumab 40 mg every 2 weeks. He has not previously received a shingles vaccine. His GP is considering vaccination against herpes zoster. What is the most appropriate action?

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Correct answer: D — Do not give live Zostavax; offer a 2-dose course of recombinant Shingrix

Adalimumab is a monoclonal TNF inhibitor and therefore meets the Green Book definition of severe immunosuppression. Live attenuated vaccines should not be administered during clinically significant immunosuppression, so neither briefly withholding methotrexate nor timing vaccination between adalimumab doses makes Zostavax appropriate. Since September 2025, severely immunosuppressed people aged 18 years and over are eligible for two doses of recombinant, non-live Shingrix, normally separated by 8 weeks to 6 months. His age therefore does not exclude vaccination. Rheumatoid arthritis alone is not the decisive indication, but his targeted biologic therapy places him in the eligible high-risk group. Zostavax has also ceased to be available through the UK national vaccination programme.

Reference: UK Health Security Agency. Immunisation against infectious disease: Chapter 28a, Shingles (herpes zoster), sections ‘Severely immunosuppressed individuals aged 18 years and over’ and Box 1, updated 12 August 2025. https://assets.publishing.service.gov.uk/media/689cba1b1c63de6de5bb12a9/Green-book-chapter-Shingles_12_8_24.pdf