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Bev asked...

Myasthenia gravis

My daughter has myasthenia gravis and takes azathioprine. She has been offered a job in a hospice but told she will need various live vaccinations including the BCG. Her neurologist said that she can't have this with azathioprine. My question is are there any alternatives which aren't 'live' and that can be taken with azathioprine?

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The answer

Unfortunately the only way of vaccinating against TB is by using the live BCG vaccine. As your daughter’s neurologist has said, the BCG vaccine should not be given to patients who are taking immunosuppressive treatment as there is a possibility that the reaction to the vaccine may be exaggerated and they could even develop a general BCG-infection.

All other live vaccines are contra-indicated in patients who are immunocompromised for similar reasons and unfortunately there are no inactivated alternatives. It is recommended that immunosuppressed patients are given inactivated vaccines such as hepatitis B in accordance with national recommendations, although they do not always achieve a full antibody response.

This is a very important issue for the protection of both your daughter’s health and those of the patients in the hospice, as they will also be vulnerable to infection and possibly immunocompromised. I think that your daughter needs to have a discussion with her employers at the hospice and to ask them if they have a policy regarding staff who are taking immunosuppressant’s or are immunocompromised and how to move forward from here.

Answered by the Health at Hand nurses  

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