From the Guidelines
Patients on Remicade (infliximab) should ideally receive the meningitis B vaccination at least 2 weeks before starting treatment, but if already on Remicade, the vaccine can still be administered during treatment, with a recommended schedule of 3 doses at 0,1–2, and 6 months for MenB-FHbp or 2 doses ≥1 mo apart for MenB-4C, as outlined in the 2020 recommendations by the Advisory Committee on Immunization Practices, United States 1.
Key Considerations
- The immune response to vaccines may be reduced but not eliminated in patients on Remicade, making vaccination still beneficial 1.
- Live vaccines should be avoided, but meningitis B vaccines are inactivated and considered safe.
- Patients should consult their rheumatologist or gastroenterologist before vaccination to ensure timing aligns with their Remicade infusion schedule.
- Monitoring for vaccine side effects is important, as they may overlap with disease flare symptoms.
Vaccination Schedule
- For patients aged ≥10 years, primary vaccination with MenB-FHbp can be given as 3 doses at 0,1–2, and 6 months, or MenB-4C as 2 doses ≥1 mo apart, with boosters given at 1 yr after completion of primary vaccination and every 2–3 yrs thereafter, if the person remains at increased risk 1.
- It is crucial to note that MenB-FHbp and MenB-4C are not interchangeable.
Clinical Implications
- The recommendation to vaccinate at least 2 weeks before starting Remicade, if possible, aims to maximize the immune response to the vaccine, given that complement inhibitors like Remicade can increase the risk of meningococcal disease 1.
- The choice between MenB-FHbp and MenB-4C should be based on the patient's age, risk factors, and the physician's clinical judgment, considering the vaccination schedule and potential for boosters.
From the Research
Meningitis B Vaccination Timing on Remicade
- The provided studies do not directly address the optimal timing for a patient to receive a meningitis B vaccination while on Remicade (Infliximab) 2, 3, 4, 5, 6.
- However, studies suggest that the timing of vaccination is crucial in preventing meningococcal disease, particularly in high-risk populations 4, 6.
- A study on the vaccination of infants with meningococcal group B vaccine (4CMenB) in England found that the vaccine was effective in reducing the incidence of meningococcal group B disease, with a 75% reduction in age groups that were fully eligible for vaccination 4.
- Another study on the distribution of invasive meningococcal B disease in the Italian pediatric population found that the highest incidence of disease occurred in the first year of age, with a peak between 4 and 8 months of life, suggesting that starting MenB vaccination in the first months of life could provide the greatest prevention 6.
- While these studies do not provide direct guidance on the timing of meningitis B vaccination for patients on Remicade, they highlight the importance of timely vaccination in preventing meningococcal disease 3, 5.
Considerations for Patients on Remicade
- Patients on Remicade may be at increased risk of infections, including meningococcal disease, due to the immunosuppressive effects of the medication 2, 5.
- The studies provided do not address the specific interaction between Remicade and meningitis B vaccination, and therefore, do not provide guidance on the optimal timing of vaccination for patients on this medication 2, 3, 4, 5, 6.
- Healthcare professionals should consider the individual patient's risk factors and medical history when determining the optimal timing for meningitis B vaccination, including the potential impact of Remicade on the immune system 4, 6.