What vaccines are recommended for a 46-year-old immunocompromised male patient taking Tremfya (guselkumab)?

Recommended Vaccinations for a 46-Year-Old Immunocompromised Male Taking Tremfya (Guselkumab)

For a 46-year-old immunocompromised male patient taking Tremfya (guselkumab), inactivated vaccines are recommended including annual influenza vaccine (IIV), pneumococcal vaccines (PCV13 and PPSV23), and age-appropriate inactivated vaccines, while all live vaccines should be avoided due to the immunosuppressive effects of the medication.

Assessment of Immunosuppression Status

• Tremfya (guselkumab) is an immunosuppressive medication that may increase the risk of infections, requiring careful consideration of vaccination status 1
• Patients on biologics like Tremfya are generally considered to have moderate immunosuppression, which impacts vaccination recommendations 2
• Prior to initiating Tremfya therapy, the FDA label recommends completing all age-appropriate vaccinations according to current immunization guidelines 1

Recommended Inactivated Vaccines

Essential Vaccines:

• Annual inactivated influenza vaccine (IIV) is strongly recommended for all immunocompromised patients ≥6 months of age 2
• Pneumococcal vaccination is recommended for immunocompromised adults:
  • PCV13 (13-valent pneumococcal conjugate vaccine) followed by 2
  • PPSV23 (23-valent pneumococcal polysaccharide vaccine) at least 8 weeks after PCV13 2
  • A second dose of PPSV23 should be given 5 years after the first dose 2

Additional Recommended Inactivated Vaccines:

• Tdap/Td (tetanus, diphtheria, acellular pertussis) according to standard adult schedule 2
• Hepatitis B vaccine series if not previously vaccinated or if no serologic evidence of immunity 2, 3
• Meningococcal vaccines (MCV4) should be considered, especially if the patient has complement deficiencies 2
• Hepatitis A vaccine for those at risk or without evidence of immunity 2, 3
• HPV vaccine series if not previously completed (recommended through age 26, may be given through age 45 based on individual risk) 2

Vaccines to Avoid

• All live vaccines are contraindicated while on Tremfya due to the risk of vaccine-related disease in immunocompromised individuals 1, 2
• Specifically avoid:
  • Live attenuated influenza vaccine (LAIV) 2, 1
  • Measles-mumps-rubella (MMR) vaccine 2
  • Varicella vaccine (VAR) 2
  • Zoster vaccine (live version) 2
  • Yellow fever vaccine 2
  • Oral typhoid vaccine (Ty21a) 2
  • BCG vaccine 2
  • Oral polio vaccine (OPV) 2

Special Considerations

• Timing of vaccines: Ideally, all vaccines, especially live vaccines, should be administered at least 4 weeks before starting immunosuppressive therapy like Tremfya 2, 1
• Recombinant zoster vaccine (Shingrix, which is not live) may be considered if the patient is ≥50 years old 2, 3
• Response to vaccines may be suboptimal in immunocompromised patients, but vaccination is still recommended as it may provide partial protection 4, 5
• Household members should receive all age-appropriate inactivated vaccines and can receive most live vaccines except oral polio vaccine 2
• Annual influenza vaccination is particularly important for household members to create a "circle of protection" around the immunocompromised patient 2

Monitoring and Follow-up

• Evaluate for tuberculosis (TB) infection prior to initiating Tremfya and monitor for signs of active TB during treatment 1
• Monitor for signs of infection after vaccination, as immunocompromised patients may have increased susceptibility to infections 1, 6
• Consider antibody titer testing after vaccination to assess response, particularly for critical vaccines like hepatitis B 6, 3
• Reassess vaccination needs annually, especially for seasonal vaccines like influenza 2, 5