Vaccines and Biologic Medications

Which vaccines are safe · What to avoid · When to get vaccinated

Key Takeaways

Live vaccines are generally not recommended while taking biologic immunosuppressants
Inactivated vaccines (flu shot, Tdap, pneumococcal, shingles Shingrix) are generally safe and recommended
Ideally, update all vaccines before starting biologic therapy
Always discuss your vaccine schedule with your prescribing physician before receiving any immunization

Vaccines Generally Safe with Biologics (Inactivated)

Annual influenza vaccine (inactivated flu shot — not nasal spray)
COVID-19 vaccines (all currently authorized US vaccines)
Tdap (tetanus, diphtheria, pertussis)
Pneumococcal vaccines (Prevnar 20, Pneumovax 23)
Recombinant zoster vaccine — Shingrix (recommended — especially with JAK inhibitors)
Hepatitis A and B vaccines
HPV vaccine (Gardasil 9)
Meningococcal vaccines

Vaccines Generally Avoided with Biologics (Live Attenuated)

MMR (measles, mumps, rubella)
Varicella (chickenpox)
Live-attenuated influenza vaccine (nasal spray flu vaccine)
Yellow fever
Oral typhoid
Smallpox/monkeypox (ACAM2000)
BCG (tuberculosis)

Special Considerations by Drug Class

TNF Inhibitors (Humira, Enbrel, etc.)

Live vaccines are contraindicated. Shingrix is strongly recommended before or during therapy — shingles risk is elevated with TNF inhibition.

JAK Inhibitors (Rinvoq, Xeljanz)

Live vaccines are contraindicated. Shingrix is particularly important — herpes zoster reactivation risk is significantly elevated with JAK inhibitors.

IL-4/IL-13 (Dupixent)

Dupixent's targeted mechanism causes less broad immune suppression. Discuss live vaccines with your prescriber — some may be permissible. Inactivated vaccines are safe.

IL-23 / IL-17 Inhibitors

Live vaccines are generally contraindicated. Inactivated vaccines are recommended per standard schedules. Consult your prescriber for individual guidance.

Yes. The inactivated flu shot is recommended annually for patients on Humira (adalimumab). Avoid the live-attenuated nasal spray flu vaccine (FluMist). The flu shot may be slightly less effective while on immunosuppressive therapy, but protection is still significantly better than no vaccination.

Yes. Shingrix (recombinant zoster vaccine) is a non-live vaccine and is safe to administer while on biologic therapy. It is strongly recommended for patients on TNF inhibitors, JAK inhibitors, and other immunosuppressants who are 50 years or older, as shingles risk is elevated. Consult your prescriber before receiving Shingrix.

For inactivated vaccines, stopping your biologic is generally not necessary. For live vaccines that are specifically approved for use in patients on certain biologics, timing relative to your dose may matter. Always discuss the optimal timing with your prescriber — do not stop your biologic without medical guidance.

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📚 Sources & Further Reading

Content developed with reference to leading health organizations, peer-reviewed research, and FDA prescribing information.

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Adult Immunization ScheduleCDC

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Vaccines in Immunocompromised PatientsACR

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Live Attenuated VaccinesWikipedia

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Vaccine InformationFDA

Medical Disclaimer: Educational content reviewed by the BiologicHealthPlus Clinical Team. Consult your healthcare provider for personalized advice. Last reviewed: August 2026.

Medical Disclaimer: This page provides general educational information only. Always consult your prescribing physician before receiving any vaccine. Recommendations may vary based on your specific biologic, condition, and health history. Last updated: July 2026.