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
Specific guidance on the immunisation of infants exposed to immunosuppressive therapy in utero or through breastmilk is outlined in the Australian Immunisation Handbook. Access the guidance here.
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)
Reviewed by: Angela Berkhout (Paediatric Infectious Diseases Physician & General Paediatrician, Children’s Health Queensland)
Date: June 2025
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.