Rituximab and flu jab : Hi all. I had my infusion back... - NRAS

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Rituximab and flu jab

Tessthomy profile image

Hi all. I had my infusion back in June. Is it ok to have a flu jab now? Seem to be so many conflicting comments on here. Plus they seem quite old comments so thought there maybe new advice ..

My rheumatology nurse says to wait until 7 months after first infusion which brings me to January which is worrying me as we all know the flu season is upon us already... I know she’s probably right but sometimes I do question if they really do know...I really don’t want the flu!!

Seems crazy we’re given a drug to dampen our immune systems but then not allowed the flu shot. I had it on embrel every year.. I know Rituximab works in a slightly different way but surely it’s more advisable to have protection against flu .. unless it doesn’t work within those 6 months?

Any advice or similar scenarios out there? TTx

14 Replies

Can you double check with your rheum nurse? Im sure she wouldn’t mind if you are worried. I know it’s hard when you hear lots of stuff online and from other people but I’d recommend you follow the advice of the person who knows you, your medication and your history.

Tessthomy profile image
Tessthomy in reply to crashdoll

Are you on Rituximab crashdoll?

My instructions re RTX & flu jab are. ....That I must have the Flu vaccine at least ONE MONTH before my Rtx infusion...if I miss that, I must wait THREE MONTHs ,after the infusion,

I had my last infusion in June, I'm having Flu jab October & next RTX infusion in December.

But do check again with your Rheumy Nurse...maybe different RTX dosage has different time levels...but I wouldn't honestly think so.

I did this last year ...but still had Flu in January....so although I will still have the vaccine I wonder if it will work this year ...it's all a bit hit & miss!

Tessthomy profile image
Tessthomy in reply to AgedCrone

So your nurse said 3 months after?Well let’s hope that works for you this year and you don’t get the flu again... or indeed any of us! TTx

AgedCrone profile image
AgedCrone in reply to Tessthomy

Yes she said if you have it too soon after the infusion it lessens the efficacy of the RTX.......which sounds sense. If you think about it...having 6 monthly infusions....if you wait 7 months, you could never have the flu vaccine......because you'd always be too close to your next dose...before or after.

My nurse is a highly trained Biologics nurse, not just a Practice Nurse who looks after the odd rheumy patient...I am an ex nurse & was interested to know there is specialist training for Rheumatology nurses treating patients on Biologics.

Maybe your nurse was thinking of drifting your infusions a couple of months further apart......but didn't mention that to you?

I'm hoping after my next infusion, I might only have them every 9 months....I was going to do that last time, but I developed a terrible rash which was thought "might" be a reaction to RTX....but in fact after biopsies it turned out to be a Post Viral Rash following on from having the flu! Seems I couldn't win that time!

Think I might get myself a gauze mask & walk around like the Japanese do if they have a cold.....they try not to infect others....I'd be trying not to catch anything from others !

Hope you sort it out....but get on it...if you are having an infusion in

December you need to have the Flu vaccine by the end of October don't you?

Tessthomy profile image
Tessthomy in reply to AgedCrone

Well the nurse said they’d assess me to see if I need another infusion..

she says some patients can go a year or so before another one but it’s down to the individual patient.

I’ve had a pretty bad flare lately but put it down to my grandsons christening where i did all the catering myself .. which I was proud of but suffered for a few days during and after. Us RA-ers just keep going .. !

I’m guessing they will assess how many flares I’ve had in the 6months after infusion as to whether a) it’s worked and b) if I need another one.

All so complicated and totally up in the air with so many ifs and buts!

Onwards and upwards warriors. TTx

AgedCrone profile image
AgedCrone in reply to Tessthomy

Yes, how you have been since your last infusion is paramount in deciding when you have your next treatment....do you have regular blood tests?

Where I am treated they are so booked up they will give me my 2019 infusion date in December when I have my treatment........hence I will know if I can or I can't book my usual June summer holiday.

I see my Rheumy nurse between the two infusions & looking at my blood tests & asking me how I was feeling after a 6 month gap she makes the decision on my next dates.

Needless to say I will push for a 9 month gap...June holiday safe & hopefully next time I could have a 12 month gap.

As you say it is not simply " go away & take the pills".

I am very happy with the way I feel on RTX. I feel if it suits you it's the least intrusive Biologic...I feel very fortunate after 20 years not to be swallowing drugs that made me feel worse than I did without them.

I always write a list of anything I can't work out for myself & give it to my nurse when I see her, & she sorts me out with the answers.

If I were you I'd try to get at least a telephone consult with your nurse to answer all your questions.....so that you know what is happening about both your RTX & the Flu vaccine.

I think anyone in NHS rheumatology is so busy you have to push to get answers ....they just don't have the time to prioritise ...she who shouts loudest gets heard .

Good Luck!

That nurse doesn’t sound right. If you’re worried I’d check but I had rituximab in July and will have jab as soon as it’s available

Tessthomy profile image
Tessthomy in reply to cathie

I certainly feel like doing this too but I guess if the jab won’t work at this stage after infusion anyway what’s the point? I shall try and last the clear 6/7 months (ish) in the hope I don’t get struck down with the lurgie!!! TTx

Hi Tessthony, the flu jab too close to RTX will offer some protection, maybe as much as only 40%. Ideally I should wait six months clear of my last infusion taking the date to the last week in December, which as you say the flu season will be upon us. I may push it to late November but next time work ahead with my dates so as not to create this predicament. Keep well. X

Tessthomy profile image
Tessthomy in reply to juneann

Good idea. I’d come to that assumption too. I had my first infusion of the two on 5th June. So I, like you will wait 6 months(nurse said 7🙄) which will take me to end of November so that means two months without protection. 😱 Lots of hand gel and keeping away from germs will not guarantee the flu but let’s hope!

You are right I shall have to work it out next time. A month before or 6/7 months after. Makes my brain hurt as it’s obviously when and how long the infusion lasts and when the winter flu season starts! Thanks for your input TTx

Failed to mention that I work in a school so exposed to all sorts and how many kids wash their hands. I clean and dress superficial wounds with no gloves or immediate way to clean my own hands afterwards.

Tessthomy profile image
Tessthomy in reply to juneann

Yes I’m also a teacher (music) and have little children with germs coming into my house for piano lessons. It’s not unusual for me to ‘gel’ their hands before they play ! I also tell their parents if they have anything lurking to stay away!

I just found this...

Rheumatoid arthritis (RA) patients are partially protected by the influenza vaccine 6-10 months after treatment with rituximab. Researchers determined that while the flu vaccine is safe, it is ineffective for RA patients in the first 6 months following rituximab treatment. Previous influenza vaccination in rituximab-treated patients does increase pre- and post-vaccination titers, providing some defense to influenza strains. RA activity was not influenced by administration of the flu vaccine.

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