See the DrugPatentWatch profile for varicella
Short answer:
No – a live‑attenuated varicella (chickenpox) vaccine is not recommended for someone who is currently receiving Cosentyx (secukinumab). The vaccine is contraindicated while a patient is under significant immunosuppression, and secukinumab is considered a moderate‑to‑high‑risk biologic.
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Why the caution?
| Factor | Why it matters |
|--------|----------------|
| Live‑attenuated vaccine | It contains a weakened form of the virus that can replicate in the host. If the immune system is suppressed, the virus can cause a full‑blown infection. |
| Secukinumab’s mechanism | It blocks IL‑17A, a cytokine that is key for mucocutaneous immunity against fungal and bacterial infections, and also plays a role in antiviral defenses. |
| Guideline consensus | Major dermatology and infectious‑disease societies (AAD, CDC, IDSA, and the American Academy of Allergy, Asthma & Immunology) advise against live vaccines during biologic therapy. |
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What the current literature says
| Source | Key recommendation |
|--------|--------------------|
| American Academy of Dermatology (AAD) | “Live vaccines should be avoided during biologic therapy. If a patient is immunosuppressed, defer the vaccine until therapy is stopped and the immune system has recovered.” |
| CDC – Advisory Committee on Immunization Practices (ACIP) | For patients on biologics, live vaccines are contraindicated. The recommended window is at least 3 months after the last biologic dose for most agents, including IL‑17 inhibitors. |
| FDA label – Secukinumab (Cosentyx) | “Contraindicated: live vaccines, including the varicella vaccine.” |
| IDSA Guidelines for Immunocompromised Hosts | “Live vaccines should not be given during immunosuppressive therapy.” |
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Practical steps for the clinician
| Step | Action | Timing |
|------|--------|--------|
| 1. Check varicella status | Order a serum IgG test for varicella zoster virus (VZV). If positive, the patient has immunity and no vaccine is needed. | As soon as possible |
| 2. If seronegative | • If the patient can wait – defer the vaccine until after secukinumab therapy is discontinued and the immune system has recovered (≥ 3 months after last dose).
• If the patient has an exposure – give VZV immune globulin (VZIG) as post‑exposure prophylaxis. | Immediately for exposure; otherwise after therapy |
| 3. Vaccinate before biologic therapy | If starting secukinumab, give the varicella vaccine at least 3–4 weeks before the first dose of secukinumab. | Before starting therapy |
| 4. Consider alternative prophylaxis | For patients who are immunosuppressed and require protection from chickenpox, use VZV immune globulin or, if indicated, a non‑live vaccine (note: there is no inactivated varicella vaccine). | As needed |
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Bottom line
- Do not administer the live varicella vaccine while the patient is on Cosentyx.
- If the patient is seronegative and has no exposure, postpone vaccination until after the biologic therapy is finished and the immune system has recovered.
- If the patient is exposed to chickenpox during therapy, give VZV immune globulin and monitor closely.
- If you plan to start secukinumab, vaccinate against varicella at least 3–4 weeks before the first dose.
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Quick reference
| Question | Answer |
|----------|--------|
| Is the varicella vaccine safe during secukinumab? | No – contraindicated. |
| Can a patient receive varicella vaccine after finishing secukinumab? | Yes, after a 3‑month washout period. |
| What should be done if the patient is exposed to chickenpox while on secukinumab? | Give VZV immune globulin (post‑exposure prophylaxis). |
| Does a prior varicella infection protect the patient? | If serology is positive, the patient is immune and no vaccine is needed. |
Always confirm with the patient’s current immunology and infectious disease guidelines, and document the decision in the chart.