How long after receiving a steroid injection should someone wait before getting a vaccine?

Timing of Vaccination After Steroid Injections

After receiving a steroid injection, patients should wait at least 1 month before receiving a live-virus vaccine, and at least 2 weeks before receiving an inactivated vaccine to ensure optimal vaccine efficacy. 1

Recommendations Based on Vaccine Type

Live-Virus Vaccines

• Wait at least 1 month after discontinuation of high-dose systemically absorbed corticosteroid therapy administered for more than 2 weeks 1
• Examples: MMR, varicella, live attenuated influenza vaccine

Inactivated Vaccines

• Wait at least 2 weeks after steroid injection 2, 3
• Examples: COVID-19, influenza (non-live), pneumococcal, tetanus

Factors Affecting Recommendations

Steroid Dose Considerations

• High-dose steroids (defined as >20 mg/day of prednisone or equivalent for adults, or >2 mg/kg/day for children who weigh >10 kg) administered for >2 weeks are considered immunosuppressive 1
• Low-dose or short-term steroids (less than 2 weeks) generally do not require postponing vaccination 1
• Local steroid injections (intra-articular, bursal, tendon) may have less systemic effect but can still suppress the hypothalamic-pituitary-adrenal axis 3

Route of Administration

• Topical steroids (skin, eyes), inhaled steroids, or intra-articular injections are generally not contraindications to vaccination 1
• Systemic steroids have greater potential to suppress immune response 1

Special Considerations

COVID-19 Vaccines

• The American Academy of Orthopedic Surgeons recommends avoiding musculoskeletal corticosteroid injections for 2 weeks before and 1 week after COVID-19 vaccine administration 3
• For double-shot COVID-19 vaccines, consider avoiding steroid injections for a total of 4 weeks (1 week before and after each dose) 2

Influenza Vaccines

• Some evidence suggests that systemic steroids may not significantly affect response to adjuvanted influenza vaccines 4
• Annual influenza vaccination is recommended even during immunosuppressive therapy, though timing should be optimized when possible 1

Common Pitfalls to Avoid

1. Failing to distinguish between live and inactivated vaccines when determining appropriate waiting periods
2. Overlooking the dose and duration of steroid therapy - higher doses and longer durations require longer waiting periods
3. Assuming all steroid administrations have equal immunosuppressive effects - route of administration matters
4. Delaying essential vaccinations unnecessarily - balance the risk of delayed vaccination against the theoretical risk of reduced efficacy

Algorithm for Decision-Making

1. Determine the type of vaccine needed (live vs. inactivated)
2. Assess steroid therapy:
   • Dose (>20 mg/day prednisone equivalent?)
   • Duration (>2 weeks?)
   • Route (systemic vs. local)
3. For live vaccines:
   • If high-dose systemic steroids >2 weeks: Wait 1 month after discontinuation
   • If low-dose or short-term: No delay necessary
4. For inactivated vaccines:
   • If receiving steroid injection: Wait 2 weeks
   • If low-dose or topical: No delay necessary

When in doubt, prioritize vaccination timing that maximizes both vaccine efficacy and protection against the target disease, as the primary goal is to reduce morbidity and mortality.