{"id":3653,"date":"2019-03-19T13:32:34","date_gmt":"2019-03-19T12:32:34","guid":{"rendered":"https:\/\/mvec.mcri.edu.au\/?page_id=3653"},"modified":"2023-04-06T10:26:09","modified_gmt":"2023-04-06T00:26:09","slug":"rituximab-and-immunisation-recommendations","status":"publish","type":"references","link":"https:\/\/mvec.mcri.edu.au\/hi\/references\/rituximab-and-immunisation-recommendations\/","title":{"rendered":"Rituximab \u0914\u0930 \u091f\u0940\u0915\u093e\u0915\u0930\u0923 \u0938\u093f\u092b\u093e\u0930\u093f\u0936\u0947\u0902"},"content":{"rendered":"

Rituximab is becoming a frequently used treatment option for many patients with complex medical needs, including in oncology and rheumatology. It is an immune suppressive medication which greatly impacts the production and functionality of immune cells, including the near complete depletion of B-cells. Once treatment with rituximab has been completed, recovery of immune cell function can take 3-12 months, and even longer in some cases. It may be used as a once-only dose or as a long term therapy.<\/p>\n

Due to the effects on lymphocytes, patients on rituximab therapy are considered immune suppressed and are at a greater risk of vaccine preventable diseases. However, recommendations for immunisation of these patients is complicated by the inability to produce an immune response to vaccines without functioning B- and T-cells.<\/p>\n

Many patients on rituximab are also receiving concomitant immunoglobulin therapy. As this is a blood product, it further complicates the immunisation recommendations involving live-attenuated vaccines.<\/p>\n

Prior to commencing treatment<\/h2>\n

Where possible please ensure patients are up to date for their age with the current immunisation schedule. Ideally inactivated vaccines should be completed at least 1 week prior, and any live-attenuated vaccines should be completed a minimum of 4 weeks prior to commencing treatment. The same principle also applies to COVID-19 vaccines.<\/p>\n

During treatment<\/h2>\n

Due to lack of immune cell function, all future immunisations should be withheld whilst on rituximab. An immunisation medical exemption form should be completed where appropriate to ensure that the patient is not considered overdue [see resources].<\/p>\n

The exception to this, may be for influenza and COVID-19 vaccines. Some studies have indicated that a partial immune response to the influenza vaccine in patients receiving rituximab therapy may occur. For this reason MVEC recommends that patients continue to be immunised against influenza whilst on therapy and receive 2 doses of the age-appropriate vaccine annually, minimum of 4 weeks apart (regardless of age or vaccine history).<\/p>\n

Due to the potential risk for severe COVID-19 disease and its complications in this population, which may outweigh the lack of vaccine response, COVID-19 vaccination whilst on rituximab could be considered.<\/p>\n

COVID-19 vaccination and rituximab<\/h2>\n

Studies are still ongoing to determine optimum timing and vaccine efficacy in patients on rituximab. However, based on evidence from other vaccines, the assumption is that there is a diminished response to COVID-19 vaccination.<\/p>\n

Therefore, important principles to consider for this group of patients include:<\/p>\n