Influenza Vaccination in Patients Taking Humira (Adalimumab)
Yes, patients on Humira should receive the standard inactivated influenza vaccine annually, but they must not receive the live attenuated intranasal vaccine (LAIV). 1
Vaccine Selection
Inactivated influenza vaccine (IIV) is the appropriate choice for all patients receiving immunosuppressive therapy including TNF-blockers like Humira. 2, 1
Live attenuated influenza vaccine (LAIV/FluMist) is absolutely contraindicated in patients on immunosuppressive medications, including Humira, due to the theoretical risk of vaccine virus replication and disease in immunocompromised hosts. 2
The FDA label for Humira explicitly states that "patients on HUMIRA may receive concurrent vaccinations, except for live vaccines." 1
Clinical Evidence Supporting Vaccination
Patients on immunomodulators like Humira are at enhanced risk for severe influenza infection, making annual vaccination particularly important despite potentially reduced immune responses. 2
Clinical studies demonstrate that Humira does not prevent protective antibody responses to influenza vaccination—the FDA label notes that "similar proportions of patients developed protective levels of anti-influenza antibodies between HUMIRA and placebo treatment groups" when vaccines were administered concurrently. 1
While antibody titers may be moderately lower in aggregate compared to healthy controls, the clinical significance is unknown and vaccination still provides meaningful protection. 1, 3
Administration Guidelines
Administer the inactivated vaccine at any point during Humira therapy—no specific timing relative to Humira dosing is required. 2, 1
Standard intramuscular administration with 0.5 mL dose in the deltoid muscle is appropriate. 4
Optimal timing is September through November, but vaccination should continue throughout influenza season as long as vaccine is available. 4
Safety Profile
Influenza vaccination does not appear to trigger disease flares in patients with inflammatory bowel disease or other autoimmune conditions treated with TNF-blockers. 2
The vaccine is safe and well-tolerated in immunocompromised patients, with no increased risk of serious adverse events compared to the general population. 3
Standard contraindications apply: anaphylactic hypersensitivity to vaccine components and history of Guillain-Barré syndrome within 6 weeks of previous influenza vaccination. 4
Common Pitfalls to Avoid
Do not delay or withhold influenza vaccination in patients on Humira—the benefits of preventing influenza far outweigh any theoretical concerns about reduced vaccine efficacy. 2, 3
Do not use the intranasal live vaccine (FluMist) under any circumstances in patients on TNF-blockers. 2, 1
Do not assume that lower antibody titers mean lack of clinical protection—even with reduced immunogenicity, vaccination provides substantial protection against severe outcomes including hospitalization and death. 4, 3
Annual revaccination is essential as immunity wanes within one year, particularly in immunocompromised patients. 4