Vaccinations: What’s OK, What’s Not, and What Should Be Discussed with the Doctor When You Have CAD

Emily Malcolm, PhD avatar

by Emily Malcolm, PhD |

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People with autoimmune diseases, including cold agglutinin disease (CAD), should be careful about which vaccinations they receive.

CAD patients should always discuss vaccinations with their physicians to ensure there are no possible interactions with medications they are taking.

What are vaccinations?

Vaccinations use a tiny piece of an infectious organism — a virus, bacterium, or parasite — to “teach” the immune system to recognize invaders and destroy them. For example, new research is looking at how to prevent or treat cancer with vaccines. Your immune system stores the “memory” of the infection from the encounter with the vaccine so that if it invades again, your immune system will fight it more quickly.

Types of vaccines

There is a lot of misinformation related to vaccines, so it’s a good idea to separate fact from fiction by discussing with your physician what you may have read or heard about them.

Vaccines are grouped into four major classes:

  • Live vaccines use a weakened form of the virus or bacteria. The measles, mumps, and rubella (MMR) vaccine, and the varicella (chickenpox) vaccine, are examples of live virus vaccines, but the most common is the intranasal flu vaccine, such as FluMist.
  • Killed (inactivated) vaccines are made from a protein or other small pieces taken from a virus or bacteria. Whooping cough (pertussis) vaccine is an example of this type of vaccine.
  • Toxoid vaccines contain a toxin or chemical made by the bacteria or virus. Examples include the diphtheria and tetanus vaccines.
  • Biosynthetic vaccines contain man-made substances that are very similar to pieces of the virus or bacteria. The Hepatitis B vaccine is an example of this type.

CAD patients should avoid live virus vaccines

For patients with an autoimmune disease, the immune system may over-respond to non-threats, such as normal red blood cells as in the case of CAD, but fail to respond to genuine threats of infection.

Many of the medications for autoimmune disease suppress the immune system, which can make patients more susceptible to infections.

For both of these reasons, CAD patients may be at higher risk of developing an illness from live vaccines.

If you do need a live vaccine for work, school, or travel, discuss risks and options with your physician. For the flu vaccine, there are injection forms of the vaccine that do not contain live virus.


Last updated: Aug. 20, 2019


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