Can a patient on ocrelizumab (Ocrevus) receive the inactivated influenza vaccine and the 20‑valent pneumococcal conjugate vaccine (PCV‑20)?

Yes, patients on Ocrevus can receive both inactivated influenza vaccine and Prevnar 20 (PCV20)

Patients on ocrelizumab (Ocrevus) should receive both the inactivated influenza vaccine and PCV20 (Prevnar 20), as these are inactivated vaccines that are safe to administer during B-cell depleting therapy, though immune responses will be attenuated. 1, 2

Key Vaccination Principles for Ocrevus Patients

Inactivated Vaccines Are Safe But Less Effective

• Both flu and PCV20 are inactivated vaccines and can be given to patients on Ocrevus 2
• Live vaccines are contraindicated during Ocrevus therapy and should be given at least 4 weeks before starting treatment 2
• Inactivated vaccines should ideally be given at least 2 weeks before initiating Ocrevus when possible 2

Expected Immune Response Attenuation

The FDA label explicitly states that Ocrevus attenuates antibody responses to pneumococcal conjugate vaccines and seasonal inactivated influenza vaccines 2. The VELOCE study demonstrated:

• Positive response rate to influenza vaccine ranged from 55.6% to 80.0% in Ocrevus-treated patients versus 75.0% to 97.0% in controls 3
• Pneumococcal vaccine responses were reduced but still present (71.6% positive response to ≥5 serotypes versus 100% in controls) 3

Despite attenuated responses, vaccination is still recommended because even partial protection is clinically meaningful 1, 3

Specific Vaccination Recommendations

For Immunocompromised Patients on Ocrevus

Patients on iatrogenic immunosuppression (including Ocrevus) fall into the high-risk category requiring:

• PCV20 as a single dose (preferred over PCV15 + PPSV23 regimen) 4
• If vaccine-naïve: Give PCV20 alone; no additional PPSV23 needed 1
• If previously received PPSV23: Give PCV20 ≥1 year after last PPSV23 dose 4
• Annual inactivated influenza vaccine 1

Timing Considerations

• Optimal timing: Administer vaccines at least 2 weeks before starting Ocrevus 2
• If already on Ocrevus: Vaccinate anyway, as some protection is better than none 3
• Consider timing vaccines midway between Ocrevus infusions (approximately 3 months after last dose) to potentially maximize B-cell recovery, though this is not formally studied

Important Caveats

What NOT to Give

• No live vaccines (MMR, varicella, zoster live, intranasal flu vaccine, yellow fever) during Ocrevus therapy 2
• Live vaccines should be given ≥4 weeks before starting Ocrevus 2

Monitoring and Counseling

• Patients should understand that vaccine effectiveness may be reduced 2, 3
• Continue infection prevention measures (hand hygiene, avoiding sick contacts) even after vaccination
• Monitor for infections, as Ocrevus increases infection risk independent of vaccination status 2
• Check immunoglobulin levels periodically, as Ocrevus can cause hypogammaglobulinemia 2

Household Contacts

• Household members should receive all recommended vaccines, including live vaccines 1
• Inactivated vaccines pose no transmission risk
• Live vaccines (except oral polio, which is not used in the US) pose minimal transmission risk to Ocrevus patients 5

The bottom line: Vaccinate with both inactivated flu and PCV20, understanding that protection will be suboptimal but still clinically valuable for reducing morbidity and mortality from these preventable infections 1, 2, 3.