Vaccines and liver disease

If you have a liver condition you could have a higher risk of being very unwell if you pick up an infectious disease.

It is very unlikely that you will have any serious side effects from a UK vaccine.

So your safest option is usually to have the vaccine and reduce your risk of getting ill.

If you have had a transplant, or you are taking strong immunosuppressant medicines, you will not be able to have “live” vaccines. This is because your immune system is weakened. So there is a small chance that you could catch the disease from the vaccine. So always ask the person giving or recommending a vaccine if it is “live”.

If you have had a transplant you may be told not to have any vaccines for 3 months. If you are not sure, always ask your transplant team.

Infectious diseases are usually caused by a virus or bacteria. Vaccines teach your immune system to look out for a particular infection. There are different ways they can do this. Some use a small part of the virus or bacteria. Some use a whole virus or bacteria that has been killed. “Live” vaccines use a whole virus or bacteria that has been weakened. These are also called “live attenuated” vaccines.

Live vaccines are safe for most people as they are too weak to make you ill. But there is a small chance that they could cause the disease if your immune system is very weak.

The live attenuated vaccines currently used in the UK are:

• MMR (measles, mumps, and rubella)
• The BCG vaccine for TB (tuberculosis)
• Yellow fever
• Oral typhoid (a vaccine you swallow)
• Some flu vaccines (usually the nose sprays given to children)
• Rotavirus vaccine
• Shingles vaccine
• Varicella vaccine (chicken pox vaccine)

The flu vaccines given to adults are usually not live vaccines. The person giving you the vaccine should know if it is “live”. If you are not sure, contact your liver team before having the vaccination.

The polio vaccine now used in the UK is not a live vaccine. But the live vaccine is used in some other parts of the world. The live polio vaccine is also known as the oral polio vaccine because it is swallowed not injected.

Some other vaccines that used to be used in the UK were live vaccines. But these have now been replaced by other types of vaccine.

This list was accurate at the time of writing in  November 2023

The government publish their vaccine guidelines in the vaccine green book. This is aimed at health care professionals so is quite complicated. You can find it here. There is also information about vaccines on the NHS website.

Most people with a liver condition can have live vaccines.

But there is a very small chance that a live vaccine could cause the disease it is trying to prevent. This is more likely to be dangerous if your immune system is not working properly. This is called being immunosuppressed.

You should not have live vaccines if:

• You have had a liver transplant

After your transplant you will need to take strong medicines to prevent your liver being rejected. These medicines (immunosuppressants) stop your immune system working properly.

• You are having chemotherapy or radiotherapy that suppresses your immune system. Or you have completed this treatment in the last 6 months.
• You are having an immunosuppressant biological therapy. Or you have had this treatment in the last 12 months.
• You are taking any of these medicines or have taken them in the last 3 months:
  • High dose steroids taken for more than 7 days.
  • Lower dose steroids taken for more than 14 days.
  • Immunosuppressants including azathioprine, methotrexate and 6-mercaptopurine.

You need to avoid live vaccines if you swallow your steroid medicines or if they are injected or given to you in a drip.

You can have live vaccines if you are taking steroid medicines in an inhaler or cream.

If you are not sure if your medicine means you cannot have live vaccines, always check with your GP or liver team

You will probably have had most of your vaccines as a child. If you think you might have missed some, talk to your doctor to see if you need catch up vaccinations.

If you have a long term (chronic) liver disease then you should also have vaccines against:

• Hepatitis A
• Hepatitis B
• Flu (influenza)
• Pneumonia (pneumococcal vaccine)

You might also be advised to have extra vaccines against COVID-19. You can find out more about COVID-19 vaccines and who should have them here.

These diseases can become very dangerous if you have a liver condition. Some of them can also cause more damage to your liver.

If you are travelling overseas, ask your doctor about any other vaccines you should have. You may not be able to have live travel vaccines if you have had a transplant. Or are taking strong immunosuppressant medicines.

Vaccines work by teaching your body to find and get rid of things that shouldn’t be there. This might not work properly if your immune system has been weakened. For example because of medicines you take or a medical condition.

But research has found that most people who are immunosuppressed get some immunity from having a vaccine. It might be a bit less than most people get. And it will vary for different vaccines and for different people. So you may need to speak to your doctor to get information that is right for you. But for most people it is usually best to get the vaccine.

If you are immunosuppressed, check with your medical team that vaccines are not live and are safe for you to take.

Close contacts are people who you spend a lot of time with. They are usually your family or other people you live with.

It is important that these people do get any live vaccines that they are due. Even if you cannot have a live vaccine.

The advice used to be that close contacts should not have live vaccines. This was because there is a small risk of someone who has had a live vaccine passing the virus on to the person at risk.

However, this is very rare. For some live vaccines there is no evidence that it has actually ever happened. Even though millions of people around the world have had the vaccines.

The safest option is to make sure that those closest to you are protected. So they cannot catch these conditions and pass them on to you.

You do not need to stay away from someone who has had a live vaccine.

There are rare exceptions to this for people who are very severely immunocompromised. For example, if you have recently had a bone marrow transplant. If you are unsure, talk to your health care team.

For some of the vaccines there are a few things you can do to help make sure you do not get the virus. You can find out more about this below. But for all the others, including MMR and flu vaccines, you can carry on as normal.

Rotavirus

Rotavirus causes a tummy bug. The vaccine is usually given to babies at about 8 and 12 weeks old. If you have close contact with a baby who has recently had the rotavirus vaccine you should wash your hands very well. Especially if you have changed a nappy or you are preparing food.

Chicken pox and shingles vaccines (Varicella Zoster)

There are no known cases of someone getting chicken pox or shingles after a close contact has had a vaccine. But it could be possible.

Sometimes people get a rash after having a chicken pox or shingles vaccine. This rash could possibly spread the virus.

If this happens to one of your close contacts you should try to avoid face to face contact with them. If the rash is only in a small area you could ask them to cover it. Once the rash has crusted over it can no longer spread the virus.

It is important that your close contacts have all the vaccines they would normally have. This will protect them. It will also protect you by making it harder for a dangerous infection to get to you.

In some cases it might be recommended that your close contacts also have some extra vaccines:

Chicken pox vaccine

Your close contacts should have a chicken pox vaccine if all these things apply:

• you are immunosuppressed and
• they have never had chicken pox or shingles and
• they have never had a vaccine for chicken pox or shingles.

They should be able to get this vaccine from their GP. This is usually easier if you are both registered at the same GP surgery. It is possible to get it privately at some travel health clinics and pharmacies. But this can be very expensive.

Flu vaccine

If you are immunosuppressed, close contacts should have a flu vaccine every year. Even if they would not normally get it. They should be able to get this from their GP. This is usually easier if you both go to the same GP surgery. Flu vaccines can also be paid for from lots of pharmacies in the autumn.

Covid-19 Vaccines

The advice for COVID-19 vaccines still changes regularly. You cannot buy COVID-19 vaccines in the UK.

For more information about the COVID-19 vaccine and links to the latest NHS information see our COVID-19 vaccine page here.

Vaccine availability for close contacts

Sometimes there are problems with the supply of vaccines. When this happens, clinics will usually try to prioritise the people who are most at risk. But this can make it hard for close contacts to get the vaccines.

If you need a vaccine to keep someone close to you safe, and you cannot get it, please let us know. We can take the issue up with policy makers. You can find out how to contact us here.

There are lots of claims that you can boost your immunity using foods or supplements. Unfortunately there is no evidence that any of them work.  The best way to protect yourself against infectious diseases is to get vaccinated.

If you have a liver condition you must also be very careful about taking supplements. Or alternative or complementary medicines.

One of your liver’s jobs is breaking down food and medicine. If your liver is damaged it cannot do this properly. So you have a higher risk of side effects and even of more damage to your liver. So always talk to your doctor before trying any supplements or alternative or complimentary medicines.

Find out more about supplements for liver disease. 

Find out more about complementary and alternative medicines for liver disease.