LIVE VACCINES

[Mary63]

A friend of mine with PMR is travelling to Colombia and Brazil at end of October. and has had spectacularly unhelpful non advice from GPS and practice nurses about whether or not to have the live yellow fever vaccine.

We are not supposed to have live vaccines. Do you know why?

As she has been told that without a vaccination certificate she will be unable to return to uk from Brazil.

Any advice for her please?

[HeronNS]

There is an inactivated yellow fever vaccine but I don't know anything about its availability.

On the other hand people with PMR are not usually as immune suppressed as people who have been on much higher doses of immunosuppressant drugs for other conditions. In my personal opinion if she's going to get the vaccine she's cutting it a bit close because she'd want to be over any reaction before she leaves.

wwwnc.cdc.gov/travel/yellow...

[HeronNS in reply to HeronNS]

Scroll down, there is a whole section on yellow fever vaccination and that it is contraindicatied in cases of severely immunocompromised people. And in my reading just now found out there is a way to test for people's immune status.

[Mary63 in reply to HeronNS]

Thanks very much.

[Hidden]

Here's a traveller's site and a bit of research on travellers, immunue cond and vaccination. Some things to look at😊

travelhealthpro.org.uk/coun...

academic.oup.com/jtm/articl...

passporthealthusa.com/desti...

Plus NHS which says who can't have yellow fever vax

nhs.uk/conditions/yellow-fe...

And nice guidelines suggest live attenuated vaccine.

bnf.nice.org.uk/drug/yellow...

By the way brazil wasn't in the required list I looked at.

[Mary63 in reply to Hidden]

Thanks very much.

[HeronNS in reply to Hidden]

There was an outbreak of Yellow Fever in Brazil in 2018 so it likely has been added to lists all over the world.

[Hidden in reply to HeronNS]

Yes. There's currently an outbreak of dengue fever in certain places. 😱

[suzy1959]

I went to Kenya in July and pondered over this . I contacted my Rheumy and he said people with PMR and on Steroids are OK. If on a DMARD, there was more of an issue. The travel clinic I went to also informed me of other risks- e.g. if you are over 60 years for example. I decided to have it especially since we were on safari and miles from any sophisticated medical facilities. I had no problems with it.

[Mary63]

Thanks. Very useful

[GOOD_GRIEF]

From travelhealthpro.org.uk/fact...

Table 1: Immunosuppressive conditions

.....

Those who are receiving or have received in the past 3 months: high-dose corticosteroids or immune modulating drugs including:

>40mg of prednisolone (or an equivalent drug) a day for more than one week in adults, or 2mg/kg/day of prednisolone (or an equivalent drug) in children under 20 kg for at least one week

>20mg prednisolone (or an equivalent drug) a day for more than 14 days in adults or 1mg/kg/day in children under 20kg

[Mary63]

Thanks. Very helpful.

[jinasc]

I would call these people who know a whole heap.

uclh.nhs.uk/OurServices/Our...

This Hospital for Tropical Diseases (HTD) is the only NHS Hospital dedicated to the prevention, diagnosis and treatment of tropical diseases and travel related infections.

[Mary63]

Thank you so much. I will ask my friend to do that.

[Noosat]

Some years ago before PMR, I had the vaccine because of travelling into Bolivia from Peru. I had no adverse reactions. I am in the U.S. so do not know if that makes a difference in vaccines. I just got it administered at the drug store

[Mary63]

Thanks for that. The problem for my friend is whether the vaccine is contra indicated because of prednisolone Following everyone's input my friend has been able to make an informed decision.

[PMRpro Ambassador]

If you have a live vaccine while immunocompromised then there is a possibility you could develop the actual disease you are being vaccinated against.

It does depend to some extent what dose of pred she is on - and it is possible to have a certificate of exemption if, in fact, she is not able to have the shot.

nathnacyfzone.org.uk/factsh...

If it were me I'd ring a School of Tropical Medicine for real advice.

lstmed.ac.uk/travel-and-med...

It is important to know WHERE she is going

co.usembassy.gov/yellow-fev...

But she really is cutting it fine - they must be done 10 days before departure usually.

[Mary63]

She did phone school of tropical medicine yesterday and as a result of their advice had the immunisation. Thanks for responding.