Background

Immunosuppressive therapies play an important role in the treatment of many medical conditions. Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are a specific subset of immunosuppressive medications primarily used for the treatment of inflammatory rheumatic diseases. However, they are increasingly being used to treat many other conditions.  Examples of bDMARDs include adalimumab, tocilizumab, etanercept, infliximab and rituximab.  

If exposed to vaccine-preventable diseases, individuals with suppressed immune systems may have an increased risk of developing severe disease (and of hospitalisation, intensive care admission and death). However, some vaccines (live-attenuated vaccines) may be contraindicated in individuals with immunosuppression due to the potential risk of vaccine-related disease. Additionally, immune responses to vaccines may be suboptimal.  

Immunosuppression use in pregnancy and infant vaccines

Due to the broadened scope of use of bDMARDs, including during pregnancy, there is an increasing number of infants exposed to bDMARDs in utero. The effect that this has on an infant’s immune system is not well understood, but there is the potential for significant implications regarding the safe use and effectiveness of routine and additional vaccines in infants. 

Recommendations

The following guidance outlines recommendations for specific investigations and vaccines for infants exposed to maternal immunosuppression (bDMARDs) in utero. This guidance has been developed as a collaboration between MVEC, Queensland Children’s Hospital and Royal Brisbane and Women’s Hospital. 

Vaccination recommendations for infants exposed to maternal immunosuppression (PDF)

NB: This document provides guidance on the maternal use of bDMARDs only (not other conventional DMARDs). It outlines the implications for infants and does not replace investigations or vaccine recommendations for pregnant women who are receiving/have received bDMARDs.  

Resources

Authors: Angela Berkhout (Paediatric Infectious Diseases Physician & General Paediatrician, Children’s Health Queensland), Sophie Wen (Paediatric Infection Specialist, Children’s Health Queensland) , Michael Nissen (Infectious Diseases, Microbiology and Paediatric Consultant, Royal Brisbane and Women’s Hospital), Rachael McGuire (MVEC Education Nurse Coordinator) and Nigel Crawford (Director, SAEFVIC and MVEC, Murdoch Children’s Research Institute)

Date: December 2023

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.