Established practice before starting immunosuppressive drugs or biologics is to check for latent tuberculosis and hepatitis B and C, and to review vaccination status. Inactivated vaccines work best given before treatment, and live vaccines are generally avoided once treatment has started.
In India, where tuberculosis is common, latent infection should be sought and the plan agreed before a biologic is begun. Record the vaccines given and plan boosters.
- Test for latent tuberculosis and hepatitis B and C before biologic or high-dose immunosuppression.
- Review vaccines and give inactivated ones before treatment where possible.
- Avoid live vaccines once immunosuppressed, unless specialist advice says otherwise.
- Document the screening results and the plan.
Why it matters
Reactivation of silent infection is preventable with a few tests done in advance.
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