Vaccinations when you have a rheumatic disease

1. Why vaccines matter more for you

People with rheumatic diseases catch more vaccine-preventable infections than other people, both because the disease itself changes how the immune system works and because many of the medicines used to treat it calm the immune system down. Because of this, the Canadian Rheumatology Association advises that vaccinations be encouraged and that missed chances to catch up be kept to a minimum. It also recommends that your rheumatologist check your vaccination status when you are diagnosed and again during your follow-up care.

One honest point: some of these medicines can make a vaccine work a little less well than it would otherwise. That is a reason to make sure you have the vaccine, not a reason to skip it. Even a slightly reduced response is worth having.

2. Two kinds of vaccine, and why the difference matters

Vaccines come in two broad types. Inactivated, or non-live, vaccines do not contain any living germ. They can be given safely whatever rheumatology treatment you are on, although, as above, the response may be a little weaker if your treatment is strongly calming your immune system. Live attenuated vaccines use a weakened but still living form of the germ. In someone whose immune system is being suppressed, a live vaccine can occasionally cause an infection, so these usually need care and are often avoided or timed around your treatment.

The live vaccines available in Canada are measles, mumps and rubella (MMR, and the combined MMRV), chickenpox (varicella), the nasal-spray flu vaccine, rotavirus, yellow fever, the oral typhoid vaccine, and BCG (for tuberculosis). If you are due any of these, or you are planning travel that needs one, speak to your rheumatology team first. For international travel specifically, see our guide to travel, live vaccines, and yellow fever.

One point that often causes confusion: the shingles vaccine now used, Shingrix, is not a live vaccine. It is a recombinant vaccine, so it does not carry the same concern and is recommended for many people on immune-calming treatment.

3. The vaccines to make sure you have

Alongside your routine vaccinations, the Canadian Rheumatology Association lists the following as ones to consider if you have a rheumatic disease or your immune system is suppressed. The strength of advice below comes from the 2022 American College of Rheumatology vaccination guideline, which the Canadian statement points to.

Wherever possible, it helps to get your vaccinations up to date before you start a new medicine that calms the immune system, because vaccines tend to work best before treatment begins. If you are newly diagnosed, this is a good thing to raise early.

4. How vaccines fit around your medicines

Most of the time you do not need to change anything. Non-live vaccines are given on schedule whatever you are taking. There are a few specific situations where timing helps, and your team will guide these rather than you changing anything yourself:

If you take methotrexate, your team may suggest pausing it for two weeks after your flu vaccine, if your disease is settled enough to allow it, because a short pause improves how well the flu vaccine works. For other non-live vaccines, methotrexate is simply continued. If you have rituximab, the timing of some vaccines is planned around your infusion schedule, because vaccines given soon after rituximab work less well. And if a live vaccine is needed, some medicines have to be held for a set time before and after it. These are all decisions for your rheumatology team, made with your other doctors, not changes to make on your own.

5. In Ontario

General immunization advice for everyone in Canada comes from the Canadian Immunization Guide, but each province and territory, including Ontario, has its own schedules and its own rules about which vaccines are publicly funded. Some of the vaccines above are covered for people who are immunosuppressed; others may not be, or may depend on your age and situation. The Canadian Rheumatology Association has argued that vaccines recommended for people with rheumatic disease, including those who are immunosuppressed, should be publicly covered.

In practice, the most useful thing you can do is make sure your family doctor and your pharmacist know your diagnosis and your medicines, so they can give the right vaccines at the right time and check what is funded for you.

6. What to do next

Ask your rheumatology team to review your vaccination record, especially if you are newly diagnosed or about to start a new medicine. Tell your family doctor and pharmacist about your diagnosis and treatment. And check with your rheumatology team before any live vaccine or travel vaccine. Vaccination is one of the simpler, higher-value things you can do to stay well with a rheumatic disease.

Based on: Canadian Rheumatology Association Position Statement for Vaccinations in Patients with Rheumatic Diseases (2026); and Bass AR, Chakravarty E, Akl EA, et al. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2023;75:333 to 348. This is patient information, not a personal vaccination plan; your own schedule is set with your care team and follows current Ontario and Canadian guidance.