Vaccination Recommendations for Immunocompromised Patients on Tremfya

Introduction to Vaccination Guidelines

The Centers for Disease Control and Prevention recommends that immunocompromised patients, including those on Tremfya (guselkumab), receive inactivated vaccines such as annual influenza vaccine, pneumococcal vaccines, and age-appropriate inactivated vaccines, while avoiding live vaccines due to the risk of vaccine-related disease 2, 3
Patients on biologics like Tremfya are generally considered to have moderate immunosuppression, which impacts vaccination recommendations, according to the Clinical Infectious Diseases society 1, 2

The American College of Physicians recommends annual inactivated influenza vaccine (IIV) for all immunocompromised patients ≥6 months of age, with a strong recommendation based on high-quality evidence 2, 3
The Infectious Diseases Society of America recommends pneumococcal vaccination for immunocompromised adults, including PCV13 (13-valent pneumococcal conjugate vaccine) followed by PPSV23 (23-valent pneumococcal polysaccharide vaccine) at least 8 weeks after PCV13, with a moderate strength of evidence 2, 4, 5
The Advisory Committee on Immunization Practices recommends Tdap/Td (tetanus, diphtheria, acellular pertussis) according to standard adult schedule, with a strong recommendation based on high-quality evidence 3, 4
The Centers for Disease Control and Prevention recommends hepatitis B vaccine series if not previously vaccinated or if no serologic evidence of immunity, with a moderate strength of evidence 3
The American Academy of Family Physicians recommends meningococcal vaccines (MCV4) for those at risk or without evidence of immunity, with a moderate strength of evidence 3, 5
The Infectious Diseases Society of America recommends hepatitis A vaccine for those at risk or without evidence of immunity, with a moderate strength of evidence 3
The American College of Physicians recommends HPV vaccine series if not previously completed, with a strong recommendation based on high-quality evidence 6

The Clinical Infectious Diseases society recommends avoiding all live vaccines while on Tremfya due to the risk of vaccine-related disease in immunocompromised individuals, with a strong recommendation based on high-quality evidence 2
The Journal of Allergy and Clinical Immunology recommends specifically avoiding live attenuated influenza vaccine (LAIV), measles-mumps-rubella (MMR) vaccine, varicella vaccine (VAR), zoster vaccine (live version), yellow fever vaccine, oral typhoid vaccine (Ty21a), BCG vaccine, and oral polio vaccine (OPV) 1, 7, 8, 9

The Clinical Infectious Diseases society recommends that ideally, all vaccines, especially live vaccines, should be administered at least 4 weeks before starting immunosuppressive therapy like Tremfya, with a moderate strength of evidence 10
The American College of Physicians recommends recombinant zoster vaccine (Shingrix, which is not live) if the patient is ≥50 years old, with a moderate strength of evidence 3
The Infectious Diseases Society of America recommends that household members receive all age-appropriate inactivated vaccines and can receive most live vaccines except oral polio vaccine, with a moderate strength of evidence 4, 10
The Centers for Disease Control and Prevention recommends annual influenza vaccination for household members to create a "circle of protection" around the immunocompromised patient, with a strong recommendation based on high-quality evidence 4, 10

The Clinical Infectious Diseases society recommends reassessing vaccination needs annually, especially for seasonal vaccines like influenza, with a moderate strength of evidence 3