In the past, I have made the claim that vaccinations, including vaccination with live attenuated viruses such as yellow fever, are relatively safe post-IRTs (immune reconstitution therapies) such as alemtuzumab, cladribine and HSCT.
I even have two Alemtuzumabers on my books who have both had yellow fever vaccines before travelling to Ecuador and the Galapagos Islands. who I frequently mention in talks who had no problems with the vaccine. I will have to retract that advice. HCPs have just been sent the following warning from the MHRA (Medicines and Healthcare products Regulatory Agency).
Yellow fever vaccine (Stamaril) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed and those 60 years and older
“We have recently received 2 reports of fatal adverse reactions to the yellow fever vaccine (Stamaril). Due to an increased risk of life-threatening reactions, the vaccine must not be given to anyone with a medical history of thymus dysfunction or who is immunosuppressed. In addition, extreme caution must be used and a careful risk assessment conducted before vaccination of people aged 60 years and older due to a substantially increased risk of such adverse reactions in this age group.”
This is particularly relevant to Alemtuzumabers in that there is recent data that has been presented that it damages the thymus. If you are HCP who works with MSers please read the advice on the MHRA’s website.
A few years ago, WHO issued a new policy for Yellow Fever vaccines—one vaccination is now sufficient for life, no need to be vaccinated every 10 years. You should get a stamp or a letter from a travel clinic advising that you do not require an additional vaccination. The WHO has advice on appropriate wording.
I don’t know whether my initial comment survived. Apologies for a second posting. The WHO now has a policy that one Yellow Fever vaccination is good for life. No need for a new vaccination after 10 years. You should get your immunization booklet stamped to that effect or a physician’s letter. The WHO website has guidance on the correct phrasing to use.
Does this advice apply to highly effective maintenance therapies as well?
This month has been terrible for alemtuzumab
So, as Ocrevus patient, this warning applies given depletion of B cells?
Plasma cells don’t get depleted so no need to worry
Crumbs. What about natalizumab and the Yellow Fever vaccine these days? Before going to a borderline Yellow Fever zone some years ago, I asked that question and was advised, after a search of the literature at the time to ‘not get the Yellow Fever vaccine, but to not get Yellow Fever either’. I was happy to accept this excellent advice.
So where are we with shingles live vaccine now? I decided against it unilaterally