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Live vaccines may not be appropriate for immunocompromised patients

December 14, 2016

Pharmacists are reminded that the influenza vaccine administered as a nasal spray (FluMist) is a live, attenuated vaccine, and therefore caution must be exercised in determining if it should be administered to immunocompromised patients. Influenza vaccines administered as an injection are inactivated and do not share the same precautions.

Recently, a pharmacist reported that one of her patients received a flu vaccine that was not appropriate given the medications the patient was taking. As the patient was a teenager, she was eligible for the nasal flu vaccine. However, the patient also receives treatment with Remicade (Infliximab) and is considered immunocompromised. It is a contraindication for patients on biologic medications, such as Remicade, to receive live vaccines. It is recommended that live vaccines not be given concurrently with Remicade. The patient’s Remicade infusion had to be delayed by almost two weeks because of the live vaccine. Delaying a Remicade infusion can be detrimental to the treatment of the patient’s disease.

For detailed information on FluMist and other vaccines, please refer to the product monographs in the Compendium of Pharmaceuticals and Specialties (CPS) or the Statement on Seasonal Influenza Vaccine 2016-2017.