Methotrexate and Yellow Fever Vaccine

[CagneysMum]

Hi. I’m travelling to Brazil in November so must get a yellow fever jab. I inject methotrexate weekly and I know live vaccines don’t mix well with a suppressed immune system but current thinking says methotrexate is aiming for normal immune system levels (not suppressing it). Struggling to find a health professional who will say if I need to come off methotrexate for a defined period before I can have vaccine or not. Has anyone else been in this position and what did you do?

[helixhelix]

I also view it a bit like you, that our disease makes our immune system overactive, and the drugs calm it down so you end up “normal”.

But i believe the reality is not quite as straightforward. It’s more that our immune systems are set wrong, like something firing off weapons randomly at it’s own side. And the drugs overcome that by making the weapons weaker so they don’t hit any targets, which makes the whole immune system a bit weaker. I think the other issue with live vaccines is that our bodies may well respond differently to other people, and not in a good way.

I’ve never found an answer to your vaccine question tho’, sorry. Have you phoned the NRAS help desk as they may have had this question before?

But if by any chance you are going to the small bit of Brazil where vaccines are not required, and aren’t planning camping trips and the like you could be ok just taking normal precautions? Map here...

wwwnc.cdc.gov/travel/notice...

[CagneysMum in reply to helixhelix]

Thanks for replying but I’m going to a National Park so will definitely need yellow fever vaccine. NRAS suggested a few places to try but were not able to provide the advice itself.

[helixhelix in reply to CagneysMum]

Yes, sounds as if it will be needed - but fun! Hope you work it out.

[AgedCrone]

There are multiple outbreaks of Yellow Fever at the moment in Brazil in areas which normally don’t have it. I have a friend who works in Brasilia and he says it is a very serious situation.

As you say yellow fever is a live vaccine and on the whole for people with compromised immune systems live vaccines are are no no. My rheumatologist has recently told me that I must not have a Shingles vaccine so I’m sure YF would be not be on the menu.

Are you going for work or are you going voluntarily .....if I were you I would read the FCO information on the present situation in the area you are intending to visit.

I used to travel a lot and I had three or four yellow fever vaccine’s over the years and even prior to diagnosis they used to make me feel pretty poorly.

You could also enquire at many of the travel clinics that long haul airlines have all over the UK....they are up to speed on all sorts of weird & wonderful diseases.

But I would definitely run it by your rheumatologist & take his advice...YF is not to be taken lightly.Also travel insurance may not cover you if go to Brazil unvaccinated.......lots to think about.

[CagneysMum in reply to AgedCrone]

Thanks. Rest assured I have no intention of travelling without yellow fever vaccine.

[Ontwowheels]

I had a yellow fever vaccine prior to starting methotrexate. I was advised 6 weeks prior to starting or once started you need to stop methotrexate and not restart for 6 months, but do check with your rheumatologist.

[CagneysMum in reply to Ontwowheels]

How long ago was that?

[Ontwowheels in reply to CagneysMum]

In September 2017 I delayed going onto methotrexate so that I could have the yellow fever and MMR Vaccines ( both live).

[janmary]

I have been told that YF vaccines are not allowed on M/X. ( that was a frw years ago) Check with rheum clinic as well as travel advice centres.

[AgedCrone]

Have a look at citydoc.org.uk

It is a commercial concern with clinics in the UK....there is a good section on Yellow Fever vaccinations.

It might be worth calling a branch near you.

[HappykindaGal]

One of my clients is the Vaccination Group - the advise is not to have Yellow Fever jab when taking methotrexate (sorry). The nurses at the clinic advise not to travel to places where there is YF.

[Loura in reply to HappykindaGal]

That's really very informative information. Do you know if this is also the case for people taking imraldi?

[HappykindaGal]

It also depends on your age - apologies, forgot to say that! For people over 65, the YF vaccine is sometimes not recommended. You 'may' be able to get a cert of non vaccination. You will also need to go to a specialist YF centre - not all places can give YF. travelvaccination.co.uk/vac...

Reply

[CagneysMum in reply to HappykindaGal]

Thanks.

[CagneysMum]

Further to my earlier post. My Rheumatologist has reviewed Green Book (medical practitioners bible) latest advice on yellow fever vaccination and doesn’t see any problem with me having it (see extract below Chapter 35, page 7), and has given me a letter saying so. Just need to find someone who will vaccinate me now ! Wish me luck 😀

Many adults with chronic inflammatory diseases (e.g. rheumatoid arthritis, inflammatory bowel disease, psoriasis, glomerulonephritis) will be on stable long term low dose corticosteroid therapy (defined as up to 20mg prednisolone per day for more than 14 days in an adult or 1mg/kg/day in children under 20kg) either alone or in combination with other immunosuppressive drugs. Long term stable low dose corticosteroid therapy, either alone or in combination with low dose non-biological oral immune modulating drugs (e.g. methotrexate 25mg per week in adults or up to 15mg/m2 in children, azathioprine 3.0mg/ kg/day or 6-mercaptopurine 1.5mg/kg/day), are not considered sufficiently immunosuppressive and these patients can generally receive live vaccines. However in the case of yellow fever vaccine data is limited, and a cautious approach is recommended. Specialist advice may be sought in these circumstances.

[CagneysMum]

Final update on Yellow Fever Vaccine.

My RA consultant and travel clinic agreed that if I came off methotrexate for 2weeks to clear system before having the vaccine and remained off mtx for two weeks after so that the vaccine could establish itself in my body uninterrupted - then it was ok to go ahead. So I have done this.

First two weeks off mtx before the yellow fever vaccine we’re fine, but the following two weeks have been very difficult. My ankles became inflamed to a point where walking was difficult, but I had steroid injections in both ankles and restarted mtx last week so everything is now back to normal and I’m looking forward to my holiday in 5 weeks time. I had no ill effects from the vaccine itself.