{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T07:16:15Z","timestamp":1793776575436,"version":"4.6.1"},"reference-count":236,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2018,11,21]],"date-time":"2018-11-21T00:00:00Z","timestamp":1542758400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Dermatology Association of Ontario"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Cutan Med Surg"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children \u2a7e12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1203475418811335","type":"journal-article","created":{"date-parts":[[2018,11,22]],"date-time":"2018-11-22T00:51:56Z","timestamp":1542847916000},"page":"50-74","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":106,"title":["Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies"],"prefix":"10.1177","volume":"23","author":[{"given":"Kim A.","family":"Papp","sequence":"first","affiliation":[{"name":"K Papp Clinical Research, Waterloo, ON, Canada"},{"name":"Probity Medical Research, Waterloo, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boulos","family":"Haraoui","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepali","family":"Kumar","sequence":"additional","affiliation":[{"name":"University Health Network, Toronto, ON, Canada"},{"name":"Faculty of Medicine, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5927-6587","authenticated-orcid":false,"given":"Robert","family":"Bissonnette","sequence":"additional","affiliation":[{"name":"Innovaderm Research, Inc, Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Bitton","sequence":"additional","affiliation":[{"name":"McGill University Health Centre, Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Bressler","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada"},{"name":"St Paul\u2019s Hospital, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda","family":"Gooderham","sequence":"additional","affiliation":[{"name":"Probity Medical Research, Waterloo, ON, Canada"},{"name":"Faculty of Medicine, Queen\u2019s University, Kingston, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Ho","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Jamal","sequence":"additional","affiliation":[{"name":"Vancouver Coastal Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet E.","family":"Pope","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Western Ontario, London, ON, Canada"},{"name":"St Joseph\u2019s Health Care, London, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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