General Rheumatology · Travel and live vaccines For patientsFor clinicians
If you take medicines that calm your immune system, a few travel vaccines need extra thought before you go abroad. The one to plan around is yellow fever, because it is a live vaccine that is often not safe on these medicines, and some countries ask for proof of it before they let you in. The good news is that most travel vaccines are not live and are perfectly fine. This page explains the difference, how to check your own trip, and what to do if you cannot have a vaccine a country asks for.
Many arthritis medicines work by calming the immune system. Most vaccines are made from a germ that has been killed or taken apart, so there is nothing living in them; these are called non-live, or inactivated, vaccines, and they are safe to have while you are on your treatment. A smaller group of vaccines are made from a living but weakened germ. These live vaccines can occasionally cause an infection in someone whose immune system is being suppressed, so they are usually avoided or carefully timed. For travel, the live vaccine that matters most is yellow fever, partly because of your medicines and partly because it is sometimes required by law to enter a country.
This grid shows the travel vaccines that come up most often, whether each is live, whether any country requires it by law, and what it means for you. Your travel clinic and rheumatology team will tailor this to you; it is a guide, not a personal plan.
| Travel vaccine | Live? | Ever required by law to enter a country? | What it means if you are on immune-calming treatment | Non-live option |
|---|---|---|---|---|
| Yellow fever | Yes | Yes, for some countries | Usually not safe to give; needs a travel clinic, often a medical exemption on the certificate, and a careful look at whether to travel to a risk area at all | None |
| Oral typhoid (the swallowed capsules) | Yes | No | Avoid the live oral form | Yes, the typhoid injection |
| MMR (measles, mumps, rubella) and chickenpox (varicella) | Yes | No | Usually avoided while your immune system is suppressed; neither is an entry requirement | Being immune already is what counts; discuss with your team |
| Nasal-spray flu, BCG, rotavirus | Yes | No | Generally avoided on immune-calming treatment | The injected flu shot is not live and is fine |
| Hepatitis A and B, typhoid injection, rabies, Japanese encephalitis, meningococcal, Dukoral (cholera) | No | Meningococcal is required for the Hajj pilgrimage; the others are recommended, not required | Safe to have; most travel vaccines are not live | Not needed |
The takeaway: nearly all the usual travel vaccines are not live and are safe for you. Yellow fever is the main exception to plan around, with the oral typhoid capsules a smaller one that has an easy injected substitute.
Yellow fever is a serious infection spread by mosquitoes in parts of sub-Saharan Africa and in tropical South America, around the Amazon basin. The vaccine is a live vaccine, and for most people on immune-calming treatment it is not considered safe to give. That creates two separate questions for a trip: is there a real risk of yellow fever where you are going, and does any country on your route require proof of vaccination to let you in.
Those two things are not the same. Some countries ask every traveller for proof. Others ask for it only if you have recently been in, or even just passed through, a country where yellow fever occurs, so a connecting flight can matter. Requirements also change, so an old list or a friend's past trip is not a safe guide.
The most reliable way to check, for Canadians, is the Government of Canada travel advice for your destination. For every country on your route, including places you only connect through, open its Travel Advice and Advisories page, go to the Health tab, and look under pre-travel vaccinations. If anything is unusual, the destination's embassy or consulate in Canada can confirm its current entry rules. Do this well before you book, and take the results to your travel clinic.
Being unable to have the yellow fever vaccine does not automatically mean you cannot travel. A doctor at a designated yellow fever centre can record a medical exemption on the official certificate, called the International Certificate of Vaccination or Prophylaxis. Many countries accept this exemption in place of the vaccine, although acceptance is not guaranteed everywhere, so it needs checking for your specific route.
There is a second point that matters just as much. A medical exemption removes the paperwork barrier, but it does not protect you from the infection. If your trip genuinely goes into a yellow fever area, and you cannot be protected by the vaccine, that is worth an honest conversation with your travel clinic and your rheumatology team about whether, and how, to go.
In Canada, the yellow fever vaccine and its certificate, including a medical exemption, are only available at vaccination centres designated by the Public Health Agency of Canada. These centres also provide wider travel health advice. The centres below are designated sites in downtown Toronto, near St. Michael's Hospital. Always phone ahead to confirm the centre is still designated and to book, ideally about six weeks before you travel.
| Designated centre | Address | Phone |
|---|---|---|
| Cloud Care Clinics | 55 Dundas Street E, Toronto M5B 1C6 | 416-361-6000 |
| Rexall Pharmacy (159 Yonge) | 159 Yonge Street, Toronto M5C 1X7 | 416-603-4888 |
| Traveller's Medical Service and Geographic Medicine | 130 Adelaide Street W, Concourse Level, Toronto M5H 3P5 | 416-361-6142 |
| Medcan Clinic | 150 York Street, Suite 1500, Toronto M5H 3S5 | 416-350-5900 |
| Telus Health Care Centre (Bay Street) | 333 Bay Street, Suite 1500, Toronto M5H 2R2 | 416-364-3008 |
| Travelmed Vaccine Centre | 600 Sherbourne Street, Suite 204, Toronto M4X 1W4 | 416-346-4535 |
| Harbourfront Medical | 15 Queens Quay E, Toronto M5E 0C5 | 416-366-2273 |
| PinPoint-Infinity Health Centre | 39 Lower Simcoe Street, Toronto M5J 3A6 | 416-504-0628 |
This is a short selection to get you started. For the complete and current list across the province, see the Public Health Agency of Canada's Yellow Fever Vaccination Centres in Ontario.
Let them know your travel plans early, especially before any live or travel vaccine, or if you are about to start a new medicine.
About six weeks before departure, so there is time for advice, any vaccines you can safely have, and paperwork.
Including connections, using the Government of Canada travel advice Health tab.
Bring an up-to-date list of your medicines and doses to your travel appointment and on your trip.
Government of Canada, vaccines and travel and the destination advice pages. Public Health Agency of Canada, yellow fever vaccination centres. And our own guide to vaccinations with a rheumatic disease, which covers live and non-live vaccines in more detail.
Based on: Government of Canada travel health guidance on yellow fever and travel vaccinations (travel.gc.ca), accessed July 2026; Canadian Immunization Guide, yellow fever vaccine chapter; and the US Centers for Disease Control and Prevention yellow fever vaccine information. Centre list from the Public Health Agency of Canada, Yellow Fever Vaccination Centres in Ontario, page updated March 2026; centres change, so confirm directly. This is general information to plan with your care team, not personal medical or travel advice.