What is the recommended time interval to separate cortisone (corticosteroid) shots from influenza (flu) vaccinations?

Timing Between Cortisone Shots and Flu Vaccinations

There is no specific recommended time interval required between cortisone (corticosteroid) injections and influenza vaccinations, as corticosteroid therapy does not significantly impact the immune response to influenza vaccines.

Effect of Corticosteroids on Influenza Vaccine Response

• Research demonstrates that patients receiving long-term corticosteroid therapy (both oral and inhaled) develop adequate antibody responses to influenza vaccines, comparable to those not on corticosteroids 1, 2.
• A study of patients with chronic pulmonary diseases showed that 84% of corticosteroid-treated patients achieved a fourfold rise in antibody titers after influenza vaccination, similar to the 79% response in patients not receiving corticosteroids 2.
• No corticosteroid dose-response relationship affecting antibody response has been identified 2.

Influenza Vaccination Recommendations for Special Populations

• The Advisory Committee on Immunization Practices (ACIP) does not list concurrent corticosteroid therapy as a contraindication or precaution for influenza vaccination 3.
• Contraindications for influenza vaccines are primarily related to:
  • History of severe allergic reaction to vaccine components 3
  • Moderate to severe acute febrile illness (vaccination should be deferred until symptoms resolve) 3

Administration Considerations

• For inactivated influenza vaccines (IIVs), the standard administration is intramuscular injection in the deltoid muscle for adults 3.
• If receiving both injections on the same day, they should be administered at different anatomical sites to minimize local reactions 3.
• For patients with compromised immune systems (which is not typically caused by standard corticosteroid injections alone), ensuring optimal vaccine response is important:
  • Complete vaccination at least 2 weeks before initiation of immunosuppressive therapy when possible 3.
  • However, this applies to more significant immunosuppression than typical corticosteroid injections 3.

Safety Considerations

• A study of individuals with asthma or COPD found no increased risk of adverse outcomes in the first two weeks following influenza vaccination, even in those using corticosteroids 4.
• While some patients may have diagnoses recorded or prescriptions for oral corticosteroids given on the day of influenza vaccination, this represents standard clinical practice rather than adverse reactions 4.

Practical Recommendations

• Influenza vaccines can be administered to patients receiving corticosteroid therapy without timing restrictions 1, 2.
• For optimal protection, influenza vaccination should be completed by the end of October, regardless of corticosteroid treatment status 3.
• For children requiring two doses of influenza vaccine, these should be administered at least 4 weeks apart 3.

Common Pitfalls to Avoid

• Unnecessarily delaying influenza vaccination due to unfounded concerns about corticosteroid therapy affecting vaccine efficacy 2.
• Confusing the contraindications for live attenuated influenza vaccine (LAIV) with those for inactivated vaccines - LAIV has more contraindications but is still not contraindicated solely due to corticosteroid injections 3.