Can I receive an MMR (measles‑mumps‑rubella) booster vaccine while taking Humira (adalimumab)?

MMR Vaccination While Taking Humira (Adalimumab)

You should not receive the MMR vaccine while actively taking Humira, as it is a live vaccine contraindicated in patients on TNF-blocking agents due to the risk of enhanced viral replication and disseminated infection. 1

Primary Contraindication

The FDA label for Humira explicitly states that patients on HUMIRA may receive concurrent vaccinations, except for live vaccines 1. The MMR vaccine is a live attenuated vaccine, making it contraindicated during active Humira therapy.

Mechanism of Risk

• TNF-blocking agents like Humira cause immunosuppression that can lead to enhanced replication of live vaccine viruses 2
• Severely immunocompromised persons should not receive MMR vaccine due to documented cases linking vaccine-associated measles infection to deaths in some severely immunocompromised patients 2
• While Humira's degree of immunosuppression may not reach the "severe" threshold seen with high-dose steroids or HIV, the FDA has taken a conservative stance by contraindicating all live vaccines 1

Clinical Algorithm for MMR Vaccination in Humira Patients

If You Need MMR Vaccination:

1. Discontinue Humira and wait an appropriate interval before vaccination

   • The half-life of adalimumab is approximately 2 weeks 3
   • A conservative approach would be to wait 4-5 half-lives (approximately 8-10 weeks) after the last Humira dose before administering MMR 1
   • This allows adequate clearance of the TNF-blocking antibody and restoration of immune function

2. Administer MMR vaccine 0.5 mL subcutaneously 4

3. Wait before resuming Humira

   • Allow 4-6 weeks after MMR vaccination before restarting Humira to permit adequate immune response to the vaccine 2, 4
   • This timing allows vaccine virus replication and immune stimulation to occur (typically 1-2 weeks post-vaccination) with additional safety margin 2

If Vaccination Is Not Urgent:

• Consider whether you truly need MMR vaccination by checking for evidence of immunity:
  • Laboratory evidence of immunity (positive IgG antibodies)
  • Documentation of two prior MMR doses given at least 28 days apart 4
  • Birth before 1957 (presumptive evidence of natural immunity) 5

Important Caveats

Risk-Benefit Considerations

• The risk of stopping Humira must be weighed against the benefit of MMR vaccination 1
• If you are in remission from your underlying condition (e.g., rheumatoid arthritis, Crohn's disease), a temporary hold may be reasonable
• If your disease is poorly controlled, the risk of flare during the Humira holiday may outweigh the benefit of MMR vaccination

Special Circumstances

• Measles outbreak exposure: In outbreak settings, post-exposure prophylaxis with immune globulin (IG) within 6 days of exposure may be considered as an alternative to vaccination, though this would require consultation with infectious disease specialists 4
• Pregnancy planning: If MMR is needed for pregnancy planning, coordinate the timing of Humira discontinuation, vaccination, and resumption with both your rheumatologist and obstetrician

Infants Exposed to Humira In Utero

• A critical safety concern exists for infants exposed to TNF inhibitors in utero, particularly with live vaccines administered in the first months of life 6
• Fatal disseminated BCG infections have been reported in infants exposed to TNF inhibitors (including adalimumab) in utero who received BCG vaccine early 6
• While this evidence pertains to BCG rather than MMR, it underscores the serious risk of live vaccines in the setting of TNF inhibitor exposure 6

Practical Summary

Do not receive MMR while on Humira. If MMR vaccination is necessary, work with your prescribing physician to:

1. Stop Humira for 8-10 weeks before vaccination
2. Receive MMR vaccine
3. Wait 4-6 weeks after vaccination before restarting Humira
4. Monitor closely for disease flare during this period

This approach balances the contraindication to live vaccines during immunosuppression with the need for adequate vaccine response and safe resumption of therapy. 2, 1