From the Guidelines
No, a person taking Humira (adalimumab) should not receive the Measles, Mumps, and Rubella (MMR) vaccine. Humira is a TNF-alpha inhibitor that suppresses the immune system, and the MMR is a live attenuated vaccine. According to the advisory committee on immunization practices (ACIP) recommendations 1, live vaccines should not be administered to severely immunocompromised persons due to the risk of vaccine-associated infection. Although the study from 1 does not specifically mention Humira, it highlights the risk of live vaccines in immunocompromised individuals, which applies to those taking immunosuppressive medications like Humira.
Key Considerations
- Live vaccines, such as MMR, are contraindicated for patients on immunosuppressive medications like Humira because the weakened viruses in the vaccine could potentially cause infection in someone with a compromised immune system.
- Patients should wait at least 3 months after discontinuing Humira before receiving any live vaccines, including MMR.
- If vaccination is being considered, the patient should discuss with their healthcare provider about possibly temporarily stopping Humira treatment, though this decision must carefully weigh the risks of disease flare-up against vaccination needs.
- Inactivated vaccines are generally considered safe for patients on Humira, but live vaccines like MMR pose a significant risk.
Clinical Implications
The risk of vaccine-associated measles infection is particularly concerning for severely immunocompromised persons, as highlighted by case reports linking such infections to deaths in this population 1. Therefore, it is crucial to avoid live vaccines in patients taking Humira unless the benefits clearly outweigh the risks, and alternative strategies, such as vaccinating close contacts, should be considered to protect immunocompromised patients from measles, rubella, and mumps exposure.
From the FDA Drug Label
Patients on Adalimumab-fkjp may receive concurrent vaccinations, except for live vaccines. No data are available on the secondary transmission of infection by live vaccines in patients receiving adalimumab products.
The MMR vaccine is a live vaccine. It is not recommended for a person taking Humira (adalimumab) to receive a Measles, Mumps, and Rubella (MMR) vaccine due to the lack of data on the safety of live vaccines in patients receiving adalimumab products 2.
From the Research
Vaccination with Humira (Adalimumab)
- The use of live vaccines, such as the Measles, Mumps, and Rubella (MMR) vaccine, is generally contraindicated in patients taking immunosuppressive therapy, including Humira (adalimumab) 3, 4, 5.
- However, some studies suggest that live vaccines may be safe and effective in patients with immune-mediated inflammatory diseases (IMID) or solid organ transplantation (SOT) on immunosuppressive treatment, including those taking tumor necrosis factor (TNF) inhibitors like Humira 3, 6.
- A prospective study found that live attenuated vaccines, including MMR, can be effective and safe in patients receiving immunosuppressive agents, including TNF inhibitors, if their cellular and humoral immunological parameters are within normal levels 6.
- Another study found that the administration of live vaccines, including MMR, was safe in most studies, but some serious vaccine-related adverse events occurred, and the risk of bias was high in the majority of studies 3.
- The safety of live vaccines given to immunosuppressed patients, including those taking Humira, cannot be concluded, but it is reassuring that no serious side effects or infections by the attenuated vaccine strain occurred in the examined patient groups 4.
Considerations for Vaccination
- Vaccines should be administered before treatment whenever feasible, and inactivated vaccines can be administered without treatment discontinuation 5.
- Live vaccines, including MMR, can be safely administered to infants and children ≥12 months of age who have been exposed to immunosuppressive therapies through breastmilk or intrauterine exposure, as sufficient time has elapsed for drug clearance 5.
- The decision to vaccinate a patient taking Humira should be made on a case-by-case basis, taking into account the individual's immune status, the specific vaccine, and the potential risks and benefits of vaccination 5.