Tdap Vaccination in Patients on Skyrizi (Risankizumab)
Yes, Tdap can be safely administered to a patient on Skyrizi, even just 2 weeks after the last injection, as immunosuppression is not a contraindication to inactivated vaccines like Tdap.
Key Guideline Framework
The Advisory Committee on Immunization Practices (ACIP) explicitly states that immunosuppression is a condition under which Td or Tdap may be administered if otherwise indicated 1. This applies to patients receiving immunosuppressive therapies, including biologic agents like Skyrizi (risankizumab), which is an IL-23 inhibitor used for psoriasis and inflammatory conditions.
Clinical Rationale
Tdap is an inactivated vaccine containing tetanus toxoid, diphtheria toxoid, and acellular pertussis components—none of which are live vaccines 2.
The CDC advises that vaccination should not be withheld from immunosuppressed patients, as some protection is better than none, particularly given the high morbidity and mortality of tetanus infection 1.
Immunosuppression is explicitly NOT listed as a contraindication or precaution for Tdap administration in ACIP guidelines 2, 1.
Timing Considerations
The 2-week interval since the last Skyrizi injection is not relevant to the decision to administer Tdap:
There is no requirement to time Tdap administration around biologic therapy dosing schedules 1.
The primary timing considerations for Tdap relate to intervals since prior tetanus-containing vaccines, not immunosuppressive medications 2.
For routine vaccination, Tdap should be given if the patient has never received it, regardless of when the last Td was administered 2, 3.
For wound management, tetanus-containing vaccine is indicated if >5 years have passed since the last dose for contaminated wounds, or >10 years for clean minor wounds 3, 1.
Actual Contraindications to Tdap
The only true contraindications are 4, 2:
- History of anaphylaxis to any vaccine component
- Encephalopathy within 7 days of previous pertussis-containing vaccine (use Td instead)
Important Precautions (Not Contraindications)
Guillain-Barré syndrome <6 weeks after previous tetanus toxoid-containing vaccine requires risk-benefit assessment 2, 5.
Moderate or severe acute illness should prompt deferral until resolved 2, 1.
History of Arthus reaction after previous tetanus/diphtheria toxoid-containing vaccine suggests deferring for at least 10 years 2.
Common Pitfalls to Avoid
Do not withhold Tdap from immunosuppressed patients based solely on their immunosuppressive therapy—this leaves them vulnerable to preventable diseases with high mortality 1.
Do not confuse immunosuppression with contraindications—the guidelines are clear that immunosuppression is neither a contraindication nor a precaution for inactivated vaccines 2, 1.
Do not give tetanus boosters more frequently than every 10 years for routine immunization, as this can cause Arthus reactions 3, 1.
Clinical Algorithm
Verify the patient has never received Tdap → Administer Tdap now, regardless of Skyrizi therapy 2, 3, 1.
If patient previously received Tdap → Follow standard 10-year Td booster schedule 3.
For wound management → Follow standard tetanus prophylaxis guidelines based on wound type and vaccination history, with Tdap preferred if never received 3, 1.
Screen for true contraindications (anaphylaxis, encephalopathy) and precautions (GBS, Arthus reaction, acute illness) 4, 2.