Staying Healthy on Biologics: Infection Prevention, Vaccines & Monitoring

Biologics & Infection Risk

Targeted immune modulation (TNF, IL-6, IL-17, IL-12/23, B-cell, T-cell costimulation) increases susceptibility to bacterial, viral, fungal, and opportunistic infections. Risk varies by agent and comorbidities.

10 Pillars of Safe Biologic Use

1. Adherence & follow-up: On-time dosing; rheum visits q3–6 mo; labs per protocol.
2. Vaccination strategy:
   • Inactivated: influenza (annual), COVID (current), pneumococcal (PCV20 or PCV15+PPSV23), Shingrix (≥50), HepB, HPV — give before starting if possible.
   • Live vaccines (MMR, varicella, yellow fever) — contraindicated on biologics; complete ≥4 weeks prior.
3. Infection hygiene: Handwashing, masking in crowds, food safety, avoid construction/dust (fungal spores).
4. TB screening: IGRA or TST baseline; annual if high risk; treat LTBI before biologic.
5. Hepatitis B/C screening: HBV DNA monitoring if core Ab+; antiviral prophylaxis if DNA+.
6. Skin & mucosal surveillance: Self-exam monthly; dermatology annually (↑ skin cancer risk with TNFi).
7. Dental health: Cleanings q6mo; antibiotic prophylaxis for invasive dental work if on high-dose steroids.
8. Travel medicine: Pre-travel consult 4–6 weeks; region-specific vaccines (inactivated only), malaria prophylaxis, antibiotic standby.
9. Prompt symptom reporting: Fever ≥38°C, cough, dysuria, wound changes, new neurologic symptoms → same-day contact.
10. Household illness protocol: Mask, separate bathroom, enhance ventilation if family member sick.

Special Situations

• Surgery: Hold biologic per half-life (e.g., adalimumab 2 weeks, infliximab 4–6 weeks); restart 2 weeks post-op if no infection.
• Pregnancy: Certolizumab compatible; others case-by-case; coordinate OB-rheum.

Proactive partnership with your rheumatology team keeps biologics beneficial and safe.