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Rituximab Vaccination — SCE Dermatology MCQ

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ModerateDermatopharmacologyRituximab VaccinationSCE Dermatology

A 40-year-old woman with pemphigus vulgaris has achieved complete remission on Rituximab. She needs a booster vaccination. When can she safely receive live vaccines after the last Rituximab dose?

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Correct answer: B — Not until B-cell reconstitution (typically ≥6-12 months after last Rituximab dose) — live vaccines are contraindicated during B-cell depletion

After Rituximab (anti-CD20 B-cell depleting therapy), live vaccines are contraindicated until B-cell reconstitution, typically 6-12 months after the last dose (some guidelines recommend waiting until peripheral B cells are detectable on flow cytometry). Non-live vaccines can be given earlier but with reduced immunogenicity due to B-cell depletion. Ideally, all vaccinations (including live vaccines) should be completed ≥4 weeks before starting Rituximab. For patients already on Rituximab, non-live vaccines should be timed for maximal efficacy (ideally 4-6 months after the last dose, before the next planned dose). Annual influenza vaccine should still be given despite expected reduced response.

Reference: BAD 2020; BSR Rituximab; Green Book