Rituximab and Covid vaccinations: I had my first cycle... - NRAS


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Rituximab and Covid vaccinations

Knittingsarah profile image

I had my first cycle of Rituximab infusions in September. The nurse at the clinic advised that I should contact my Consultant to ask when I could have my third Covid vaccination and my flu vaccination.

I had a phone call yesterday saying that I should wait four months until I have the vaccinations. I’m concerned about waiting for so long.

Has anyone else had similar advice ? Are there any guidelines available online ?

I’m now feeling rather vulnerable.

7 Replies

There have been lots of posts about this , if you scroll back or do a search they will come up 😊

Hi Sarah

I waited six months after my Rtx before having my Covid19 Pfizer no 1 and neither Pfizer’s worked for me (Zero antibodies.) I waited 9 weeks after Rtx in 2019 to get the flu vaccine (and pneumonia the following week) and recently found out via functional antibodies blood tests those didn’t work either due to Rtx. 😑🤨

I’ve now to wait until my B cells are back for repeating my Covid vaccines and above mentioned vaccines. You could ask your rheumy nurse what is your norm before your B cells repopulate (how long do you usually wait before you go back for infusion?) and ask her if you can have a B cell blood test to see where they are at the mo. It isn’t as cut and dried as B’s re vaccine protection, but we definitely require B cells to mount a better immune response to those vaccines. T cells can play a part but we don’t know how much as yet. I won’t risk to redo/rush my vaccines at the moment as I know I am slow to repopulate B’s after Rtx but we are all different as to our B cell recovery. The norm is around 6-8 months, so do ask your team. Maybe they can check your B cells at present. Good luck.

There is a list of advice re meds and how long to hold back on British Society of Rheumatology website and also a helpful Canadian page called Creaky Joints. Fairly near the top there is a section re Rtx timing and third covid vaccine. My phone won’t let me copy and paste or take a screenshot st the moment so can’t do that for you.


My Rheumatology department sent me a letter ten days ago which advised "... you should ideally wait 4-8 weeks after a Rituximab infusion before having any further Covid vaccine."

I think that timing is a bit short and I would have thought your consultant's advice is better. Check out what advise the British Society of Rheumatology recommends on their website. Unfortunately, it may be the case that you will get very little protection anyway, whenever you have your vaccinations.

You have probably been warned that on Rituximab you are very vulnerable to all types of infection and you will need to take extra care to avoid catching Covid, especially if you are working or in an indoor environment. So it's the hands, space, face and fresh air mantra you need to follow. If you have people into your home, check where they've been/who with and ask them to mask up or even do a lateral flow test beforehand.

This is what I do, as advised by my consultant.

It is such an individual thing. Rheumatologist all have slightly different ideas and as patients we all have different risk factors and comorbities and our reactions to medications are different. My rheumatologist has always advised me to wait 4 weeks after Rituximab before having flu or covid vaccination but I know others say 6 months, this isn’t an option for me as I need two lots of Rituximab every six months to keep my RA in check. Even delaying it by one month at the start of the pandemic caused me big flares. My rheumatologist thinks some protection is better than none rather than waiting for optimal timing.

I was told four weeks? here is the BSR guidance might be worth a check


Yes…3/4 months wait for any vaccination after infusion is the norm for those of us on Rtx.When on this drug you do have to think ahead…..I am due an infusion next month……so I made sure I got my flu vaccination ASAP… because I need at least a clear month after that before I have Rtx.

Now of course I have to decide do I have my third Primary Covid19 vaccine….& hope I can last until March for my Rtx infusion….which will be 10 months & I have never managed more than 7 months…..

Tbh it seems like wait & see time!

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