Waiting time before live vaccines
When live attenuated vaccines can be given to people who are taking or have taken immunosuppressants, immunoglobulin, antisera or blood products. These are reference points for screening and specialist referral; patients must not stop their medicines on their own.
Basis: Appendices I.1 and I.2 of Ministry of Health Decision No. 3160/QD-BYT of 10/10/2026 (Guidance on pre-vaccination screening for adults).
Content clinically reviewed on 14/10/2026 · Quản trị viên YHDP.
Immunosuppressive medicines (Appendix I.1)
No or minimal immunosuppression
Examples: Hydroxychloroquine; sulfasalazine/mesalazine
When a live vaccine can be given after the last dose/stopping treatment: No waiting time per the Australian Handbook
Note: Vaccinate as indicated if the disease is stable.
Low-dose or short-course corticosteroids
Examples: Prednisolone < 20 mg/day; or ≥ 20 mg/day for < 14 days
When a live vaccine can be given after the last dose/stopping treatment: Usually no wait; a high-dose course of < 14 days can be followed straight away by vaccination if stable
Note: Also consider the underlying disease.
Immunosuppressive-dose corticosteroids
Examples: Prednisolone ≥ 20 mg/day for ≥ 14 consecutive days
When a live vaccine can be given after the last dose/stopping treatment: At least 4 weeks after stopping
Note: Live vaccines should be given ≥ 4 weeks before starting the medicine if possible.
Low-dose methotrexate/azathioprine/6-MP
Examples: MTX ≤ 25 mg/week; AZA ≤ 3 mg/kg/day; 6-MP ≤ 1.5 mg/kg/day
When a live vaccine can be given after the last dose/stopping treatment: May be considered after specialist assessment; ACR usually recommends holding 4 weeks before and 4 weeks after
Note: Not automatically allowed; weigh the disease, the vaccine and the risk of flare.
High-dose conventional immunosuppressants
Examples: MTX > 25 mg/week; AZA > 3 mg/kg/day; 6-MP > 1.5 mg/kg/day; mycophenolate; ciclosporin/tacrolimus; cyclophosphamide
When a live vaccine can be given after the last dose/stopping treatment: Australian Handbook: ≥ 3 months after stopping; ACR: if the drug is held for vaccination, usually 4 weeks before and 4 weeks after
Note: Refer to a specialist to choose the right timing.
Leflunomide or mTOR inhibitors
Examples: Leflunomide; sirolimus; everolimus
When a live vaccine can be given after the last dose/stopping treatment: At least 4 weeks after stopping per the Australian Handbook
Note: Leflunomide persists for a long time; consider washout/specialist advice case by case.
JAK inhibitors and some small-molecule targeted drugs
Examples: Tofacitinib, baricitinib, upadacitinib, ruxolitinib; some BCR-ABL/BTK inhibitors
When a live vaccine can be given after the last dose/stopping treatment: Australian Handbook: ≥ 4 weeks after stopping; ACR: hold JAK inhibitors 1 week before, restart ≥ 4 weeks after
Note: Adjust with the specialist according to the risk of flare.
TNF/IL/integrin inhibitors
Examples: Adalimumab, etanercept, infliximab; anakinra; tocilizumab; secukinumab; ustekinumab/guselkumab; vedolizumab/natalizumab
When a live vaccine can be given after the last dose/stopping treatment: At least 4 weeks after stopping per the Australian Handbook; ACR: hold one dosing interval before, restart ≥ 4 weeks after
Note: "One dosing interval" follows the schedule in use; if there are several schedules, use the longer interval.
T-cell or cell-marker inhibitors
Examples: Abatacept, basiliximab; blinatumomab, daratumumab
When a live vaccine can be given after the last dose/stopping treatment: At least 3 months after stopping per the Australian Handbook
Note: ACR may use the rule of one dosing interval before and 4 weeks after for some drugs; specialist input needed.
Anti-B-cell therapy
Examples: Rituximab, ocrelizumab, obinutuzumab
When a live vaccine can be given after the last dose/stopping treatment: At least 6 months after the last dose with confirmed immune recovery; ACR: ≥ 6 months before, restart ≥ 4 weeks after the vaccine
Note: May need longer depending on CD19/IgG and the underlying disease.
Conventional chemotherapy/radiotherapy
Examples: Cancer treatment regimens
When a live vaccine can be given after the last dose/stopping treatment: At least 3 months after finishing, with disease in remission and immune recovery
Note: Live vaccines should be given ≥ 4 weeks before treatment if possible.
Anti-rejection drugs after solid organ transplant
Examples: Tacrolimus/ciclosporin, MMF, sirolimus and combinations
When a live vaccine can be given after the last dose/stopping treatment: Usually > 12 months after transplant, with confirmed immune recovery
Note: Must be decided by the transplant centre.
Some biologics not considered significantly immunosuppressive in the Australian table
Examples: Omalizumab; mepolizumab/reslizumab; eculizumab/ravulizumab; denosumab
When a live vaccine can be given after the last dose/stopping treatment: Can be given at any time per the Australian Handbook
Note: Check each product's package leaflet; assess the underlying disease.
Table compiled from CDC/ACIP, the Australian Immunisation Handbook and the ACR 2022 guideline. Where sources differ, follow the national immunisation programme guidance, the product information and the specialist's decision.
"Live vaccines" include live attenuated vaccines given by injection, nasal spray or mouth according to the product. Live vaccines remain contraindicated in pregnant women because of the pregnancy, whatever the timing of immunosuppressants.
Immunoglobulins, antisera and blood products (Appendix I.2)
Minimum interval before measles- or varicella-containing live vaccines, to avoid passive antibodies reducing vaccine effectiveness. Non-live vaccines, yellow fever, rotavirus, oral typhoid Ty21a and live intranasal influenza vaccines do not need this interval.
| Reference dose/route | Minimum interval | |
|---|---|---|
| Washed red blood cells | 10 mL/kg, IV | No interval needed |
| Red blood cells in adenine-saline | 10 mL/kg, IV | 3 months |
| Packed red blood cells | 10 mL/kg, IV | 6 months |
| Whole blood | 10 mL/kg, IV | 6 months |
| Plasma/platelets | 10 mL/kg, IV | 7 months |
| Hepatitis B immunoglobulin (HBIG) | 0,06 mL/kg, IM | 3 months |
| Human rabies immunoglobulin (HRIG) | 20 IU/kg, IM | 4 months |
| Human tetanus immunoglobulin (TIG) | 250 units, IM | 3 months |
| Varicella zoster immunoglobulin (VZIG/VariZIG) | 125 units/10 kg, maximum 625 units, IM | 5 months |
| IVIG 300–400 mg/kg | IV | 8 months |
| IVIG 1.000 mg/kg (1 g/kg) | IV | 10 months |
| IVIG 2 g/kg | IV | 11 months |
| Hepatitis A immunoglobulin | 0,1–0,2 mL/kg, IM | 6 months per the current CDC table |
| RSV monoclonal antibody (palivizumab/nirsevimab) | Per product dose | No interval needed |
If an MMR/varicella vaccine was given less than 14 days before an antibody-containing product, or earlier than the required interval after the product, consider repeating it after the full interval or checking serology as indicated.
Animal-derived antisera and products not in the table must be checked against the package leaflet and specialist advice.
Pre-vaccination screening Adult vaccination
References
- Ministry of Health Decision 3160/QD-BYT of 10/10/2026, Appendices I.1 and I.2
- CDC/ACIP, Australian Immunisation Handbook, ACR 2022 guideline (sources compiled in the Appendix)
Reference information for screening. The screening doctor and the specialist decide when to vaccinate; patients must not stop their medicines on their own.