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Live vaccines — SCE Rheumatology MCQ

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EasyRheumatological PharmacologyLive vaccinesSCE Rheumatology

A 53-year-old man with rheumatoid arthritis is due to start adalimumab in 3 weeks. He is non-immune to varicella and has never had shingles vaccine. He has no current infection. The team is reviewing vaccination status before biologic therapy. What is the most appropriate management?

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Correct answer: C — Give indicated live vaccines before biologic therapy with appropriate interval

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

Give indicated live vaccines before biologic therapy with appropriate interval is best because live vaccines should be administered before significant immunosuppression where indicated, with appropriate timing before biologic initiation. B is less suitable because vaccination review is part of biologic preparation; C is less suitable because antibiotics do not replace immunisation; D is less suitable because live vaccines are generally avoided once biologic immunosuppression has begun; E is less suitable because rituximab impairs vaccine responses. Clinical pearl: pre-treatment immunisation planning prevents delays and avoids unsafe live vaccination later.

Reference: BSR bDMARD safety guideline 2019; Green Book immunisation guidance