Live Vaccines and Immunosuppression — RACP Adult Medicine MCQ
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Correct answer: B — Contraindicated while on anti-TNF therapy
Live vaccines (varicella, MMR, BCG, oral polio, yellow fever, live attenuated influenza) are CONTRAINDICATED in patients receiving anti-TNF therapy or other biologic immunosuppressants due to the risk of disseminated infection from the vaccine strain. Ideally, vaccination status should be updated BEFORE commencing immunosuppression (at least 4 weeks before). Inactivated vaccines are safe and recommended. The recombinant zoster vaccine (Shingrix) is not a live vaccine and CAN be given on anti-TNF therapy.
Reference: ATAGI – 2024 – Australian Immunisation Handbook; eTG – 2025 – Immunology