WS is a 65 year old female is seeking to make a medical mission trip overseas in next few months. She is beginning to research a number of items related to her potential trip including vaccines required prior to departure. Her past medical history is significant for hypertension, hyperlipidemia, gastroesophageal reflux disease (GERD), for which she takes lisinopril/hctz 20/12.5mg daily, atorvastatin 40mg daily, and omeprazole 20mg daily. She has a diagnosis of psoriatic arthritis and her rheumatologist is considering Enbrel therapy. Which of the following vaccines, if required due to WS not being up to date,  should not be given if currently receiving Enbrel therapy? Select all that apply.

A. MMR

B. Yellow Fever

C. Influenza (injection)

D. Varicella

E. Hepatitis A

Answer with rationale:

The correct answers are A, B, and D.

Travel medicine is a growing specialty due to increased volume of international travel occurring. It is vitally important for all patients who are considering international travel to ensure they are up to date on all vaccination requirements for that specific area. The CDC keeps this updated continually, giving recommendations by specific country with therapies that are typically required for all travelers, most travelers, and some travelers. 

Because our patient is considering Enbrel (etanercept), a TNF blocker used in a number of disease states including psoriatic arthritis, all live vaccines are not recommended to be given as these could potentially give the patient the disease it is intended to prevent due to suppression of immune system function. Most biologics recommend to avoid usage of live vaccines during therapy with the biologic. Therefore answers A, B, and D which are all live vaccines would not be recommended while on Enbrel. Answers C and E are incorrect as these could be given during Enbrel therapy. Of note, intranasal influenza vaccine (FluMist) would not be recommended as it contains live virus.

Have a great week!

Dr. B