Art of prevention: Our approach to the measles-mumps-rubella vaccine in adult patients vaccinated against measles before 1968 on biologic therapy for the treatment of psoriasis.

Audrey Worth,Reid A Waldman,Marti J Rothe,Kevin Dieckhaus

doi:10.1016/j.ijwd.2019.11.003

Audrey Worth, Reid A Waldman + Show 2 more

Open Access

https://doi.org/10.1016/j.ijwd.2019.11.003

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Abstract

BackgroundIn response to the evolving measles epidemic in the United States, the Centers for Disease Control and Prevention recommended that some adults be revaccinated against measles because they may have inadequate immunity against the virus. Patients receiving biologic medications for psoriasis face a clinical dilemma because they may be at an increased risk of developing severe measles; however, vaccination with the measles-mumps-rubella (MMR) vaccine is not recommended for those on biologic therapy according to the American Academy of Dermatology-National Psoriasis Foundation guidelines.ObjectivesThis study aimed to review available research on the safety and efficacy of live-attenuated vaccines in individuals receiving biologic therapy for psoriasis and to discuss our approach to vaccinating individuals on biologic agents for psoriasis with the MMR vaccine.MethodsA review of the literature was performed via PubMed search. Our institution’s anecdotal experiences are also discussed.ResultsData, although limited, are available suggesting that live-attenuated vaccines may be safe for individuals on tumor necrosis factor-alpha inhibitors for psoriasis. Inadequate data are available for patients receiving other biologic medications.ConclusionProviders should engage in shared decision-making to determine whether patients on tumor necrosis factor-alpha inhibitors for psoriasis should receive the MMR vaccine without an interruption in biologic therapy.

Highlights

In response to the recent measles epidemic in the United States, the Centers for Disease Control and Prevention (CDC) has recommended that individuals born after 1957 and vaccinated for measles before 1968 be revaccinated with the measles-mumpsrubella (MMR) live-attenuated vaccine (CDC, 2019)
This information is relevant to dermatologists for two reasons: 1) Patients receiving certain biologic medications may be at an increased risk of experiencing significant morbidity and even mortality from a measles infection, and 2) the current American Academy of Dermatology-National Psoriasis Foundation (AAD-NPF) joint psoriasis guidelines recommend against the administration of live-attenuated vaccines to individuals receiving biologic medications without an interruption in biologic therapy, making administration of the MMR vaccine challenging in this population (Menter et al, 2019; Rafat et al, 2013)
We offer patients with psoriasis who are on biologic medications the MMR vaccine if indicated by CDC guidelines

Summary

Background

In response to the evolving measles epidemic in the United States, the Centers for Disease Control and Prevention recommended that some adults be revaccinated against measles because they may have inadequate immunity against the virus. Patients receiving biologic medications for psoriasis face a clinical dilemma because they may be at an increased risk of developing severe measles; vaccination with the measles-mumps-rubella (MMR) vaccine is not recommended for those on biologic therapy according to the American Academy of Dermatology-National Psoriasis Foundation guidelines. Objectives: This study aimed to review available research on the safety and efficacy of live-attenuated vaccines in individuals receiving biologic therapy for psoriasis and to discuss our approach to vaccinating individuals on biologic agents for psoriasis with the MMR vaccine. Results: Data, limited, are available suggesting that live-attenuated vaccines may be safe for individuals on tumor necrosis factor-alpha inhibitors for psoriasis. Conclusion: Providers should engage in shared decision-making to determine whether patients on tumor necrosis factor-alpha inhibitors for psoriasis should receive the MMR vaccine without an interruption in biologic therapy.

Introduction

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