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Dear Dr. Roach: My rheumatologist wants me to start Arava for my newly diagnosed rheumatoid arthritis. I have refused to start this medicine because the info sheet states to avoid contact with people who have recently received the oral polio vaccine. My 6-month-old grandson will be getting his polio vaccines at 9 months, 12 months and 18 months, and I can’t avoid contact with him since my daughter depends on my baby-sitting him three days a week. I can’t find any info on what exactly would happen if I were on this medicine and were exposed to the polio vaccine. Of course, I got the vaccine years ago, when it was first given. Do you have any suggestions?

J.G.

Dear J.G.: The danger to those with weakened immune systems — such as cancer patients, especially after chemotherapy; patients with severe immune deficiency, such as advanced HIV; and those treated with medications that can hurt the immune system, such as leflunamide (Arava) — is from live vaccines. The weakened form of the germ in a live vaccine can be shed by the vaccinated person for up to two weeks.

Oral polio vaccine is live, but hasn’t been used in the U.S. since 2000. Don’t be concerned about exposer to your grandson after polio vaccination, since we now use the IPV, which isn’t live.

Live vaccines include the nasal flu vaccine, chickenpox and shingles vaccines, and typhoid and yellow fever vaccines. Unless your provider tells you otherwise, these vaccines should not be given to a person with a weakened immune system. You also should avoid contact with people who have been vaccinated for these diseases within the past two weeks. The regular flu vaccine by injection is not live, and it is recommended for most people with weakened immune systems and their caregivers.

The measles, mumps and rubella vaccines are live vaccines, but there has never been a reported case of any of these being transmitted from a vaccinated person to another person.

Dear Dr. Roach: My son, 40, after a recent stress test, he ended up with five stents in his arteries, and also was diagnosed with diabetes. His doctor ordered him not to go back to work for three or four weeks, but he went back after three days. How will this affect his health?

V.B.

Dear V.B.: We don’t normally have people stay home for long periods after stent placements. My experience is that after getting life-changing diagnoses, such as diabetes or coronary artery disease, it’s best to keep some habits, such as work, the same and change others.

Email questions to ToYourGoodHealth@med.cornell.edu.

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