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Vaccines and methotrexate

Rheumatologist gave me a card to take to GP to ask for flu and pneumovax... I haven't had chickenpox and was wondering as a nurse who is a bit more exposure prone, should I not have that too? I really do not want shingles....

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Shingles is a live vaccine so not normally given to those immunosupressed. However you could talk to occu health about your risk specifically due to your occupation x

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As a practice nurse I wouldn't be able to give you zostavax the shingles vaccine, as it is contraindicated if immunosuppressed .

X

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I'm not immunosuppressed yet: sorry should have been clearer, I have never had chicken pox, am due to start mtx but to get my vaccines first, and I can say i am more regularly exposed to chicken pox and shingles than general population, just do not want to wait until i am on mtx to get it....

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You cannot have Shingles vaccine if on mtx, as it is a live vaccine! well that is what I was told, so could not have it.

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I was told no live vaccines. x

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As I understand it pneumovax is vaccine against pneumococcal disease for example pneumonia. I was given pneumonia vaccine 3 yrs ago at same time as my flu vaccine that year.

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If you've not had chicken pox I would definitely talk to your GP. You can have a blood test to find out if you are immune. If you're not immune you could then discuss your options.

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I was told not to have the shingles vaccine as it is live and I have a few auto immune conditions. My rheumy only had me on Plaquneil at the time but I did get prescribed steroids on occasions so maybe that was why. Now on Sulpha for arthritis bit.

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Thanks folks...I'm not immunosuppressed yet: sorry should have been clearer, I have never had chicken pox, am due to start mtx but to get my vaccines first, and I can safely say i am probably more regularly exposed to chicken pox and shingles than general population, just do not want to wait until i am on mtx to get it....but suppose it's a chance I'm going to have to take :)

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I would get everything I could in the window you have before starting MTX! I kick myself for not having having tried to squeeze in yellow fever and typhoid as I now feel frustrated that I'm not free to travel where I might want to. And that's for a speculative luxury that might never had happened anyway, whereas your risk of chicken pox is a bit more real.

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As far as pneumovax is concerned, I was first told it was for life, then for 10 years. I've had 2 now, one after I'd had pneumonia some years ago. Second one early this year as I have Bronchiectasis. 4 days later, I was admitted to hospital, with pneumonia!!!

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Hi poemsgalore1, my husband has bronchiectasis and has had pneumonia five times. He has recently been found to have rheumatoid arthritis as well, and they want to immune-suppress him, but we have refused, as I think it will mean the end for him. We live near Papworth, which is the big Chest Hospital for U.K. When my husband was a patient there, they would vaccinate him for pneumonia, then do a blood test, ten days later, to see if there were any anti-bodies. If the pneumonia vac. hadn't taken, they then re-did it, (but I don't suppose you fancy that since you have unfortunately contracted pneumonia from the jab.) There are many different strains of pneumonia and I don't think they have vaccines that include them all, anyway. I have an over active immune system myself, but last year I got flu from the flu jab, the same! Can't win, can you? Kind regards,

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Scruffyrabbit, so sorry to hear of your husband's recent diagnosis of RA. I've had that since 1987. Taking Methotrexate injections and Leflunomide tablet, so I'm very immunosuppressed. Also on steroids at the moment as I have vasculitis. Also have Sjogren's Syndrome. Have been taking Azithromycin three days a week. Still alive and kicking, not even cancer could get rid of me. Survived 5 months of chemotherapy and never once had an exacerbation of Bronch or Pseudomonas, or Pneumonia. When I had my second Pneumonvax, I also had the HIb jab. My consultant said the jabs didn't cause the pneumonia, but actually made it less troublesome. But since I was on oxygen for 10 days, and had Pseudo at the same time, I actually felt worse. :-(

Hope your hubby keeps well. xx

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Hi, poemsgalore1,

That's truly amazing, as my husband has the Azithromycin three days a week prescribed for his bronchiectasis, as well! He has had no chest infections since he went on it about three years ago, but has developed this RA in hands & feet. He cannot walk with osteo-arthritis in his knee, due to being employed as an electrician all his life. He has just had one knee replaced, and will have to fight them to replace the other, as he is 67 and all the medical people want is you on the cheap and cheerless immunno-suppressants, so they can save the cost of the joint replacements. My husband has had RA since February this year and hasn't taken any of the DMARDS - we just ripped the prescriptions up! (We get into some fairly bad rows with the Medical People and had one yesterday, at Peterborough Hospital Chest Clinic!) We like to go out to concerts and abroad a lot and wouldn't have any quality of life just sitting at home trying not to catch things. My husband is thinking of ditching the Azithromycin, to see is the RA will disappear when his normal immunological state returns. I've got the Sjogren's Syndrome like you and have lost the sight in one eye, from inflammatory disease. I just take large doses of steroids, as and when my remaining eye gets inflammation. My joints are atrocious!

We think you are amazing, all you have survived, and for nearly thirty years. My husband wanted to know how long you had the bronciectaisis and if you are a lady or a man! (which you don't have to say if you don't want to!) He has had bronchiectasis since he was 2 years old, (since 1949,) and his middle name is "Penicillin!" Kind regards,

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I've had Bronchiectasis for about 10 years. Developed Pseudomonas in 2012 - the same year I was diagnosed with breast cancer. Aren't I lucky!! I'm female by the way. :-)

Many people on immunosuppressants go to concerts and take holidays abroad. Although I'm on steroids at the moment, I wouldn't recommend them as they can (and do) cause Osteoporosis and cataracts. It may also cause you to catch more infections:

drugs.com/cdi/prednisolone....

I'll take my chances with the DMARDS I'm on and will get off the steroids as soon as my consultant will let me. Been on them since September 2014, starting at 40mg as well as 5x1,000mg infusions. Currently down to 10mg daily. Next month I can reduce that to 10mg on alternate days.

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Hi poemsgalore1 & thanks for reply. These immune things are interesting. We were always told at Papworth that my husband had bronchiectasis due to a weak immune system. He now has R.A. because his immune system needs supressing because it's too strong and it has started to "eat the inside of his joints!" My viciously over-active immune system has caused me to lose one eye and most of the cartilage in my joints and I have been on 2.5 mg. to 5mg. a day of Prednisolone since 1995. Despite being 62 and not having taken any drugs to prevent osteo-porosis, I don't have it, according to my latest dexa scan. The plus side of having an over active immune system for me has been that I virtually never catch anything! I look after all the friends and family with seasonal flus and diarrhoea & vomiting, and never so much as sneeze myself. I was sorry to hear about your breast cancer - you had enough to cope with, without that. I don't know anything about that Pseudomonas, as we never got that. We never go in to hospital and I have got my husband through the five pneumonias he has had in the last thirty years, at home. I always feared he would catch something like that, if I let him go in hospital, so we refused. Kind regards,

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If it is a live virus we are told not to take them. If it is live the answer would be no.

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Yep I gather that, what I meant was should I have it before I start mtx, as I quite often nurse people with cpox/shingles ,- my patients are young adults and immunocompromised so slightly higher risk though not as much as a teacher. Il just check my immunity and try my best not to catch it if I have none.

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Yes I think if you can get it before you start treatment with your docs permission it would be a good bet but would this mean no treatment for a period of time ???? Ie the vaccine is still active for a time , don't know ask occu health !?

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You should talk to your occupational health about your risks of chickenpox. preferably your should have a blood test to see what your level of immunity is. Some people do have chickenpox without developing the full blown picture, but that often means that they don't develop a good level of immunity either.

Of course, you can't get shingles unless you have had chickenpox as it's the same virus that has hidden away in your nerve roots.

At present in the UK, only 70+ and 79+ people are being immunised against shingles because of shortage of vaccine. People who are on SOME immuno-suppresants can have the vaccine, I believe Methotrexate is one of them - but check.

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Ah I hadn't realised there is a shortage of vaccine, so there may be no point in worrying! I might ask if I can be checked for immunity as at least I can legitimately ask to avoid seeing patients with suspected chicken pox...

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