Can Fluad (influenza vaccine) be administered concurrently with a Medrol (methylprednisolone) dose pack?

Concurrent Administration of Fluad (Influenza Vaccine) and Medrol Dose Pack (Methylprednisolone)

Yes, Fluad (adjuvanted influenza vaccine) can be safely administered concurrently with a Medrol dose pack (methylprednisolone). The Advisory Committee on Immunization Practices (ACIP) does not list concurrent corticosteroid therapy as a contraindication or precaution for influenza vaccination 1.

Key Recommendations

• Inactivated influenza vaccines like Fluad can be administered to patients receiving corticosteroids without delay 1.
• For patients taking the equivalent of prednisone ≤10 mg daily (which includes most Medrol dose packs), administering non-live influenza vaccination is strongly recommended without delay 1.
• For patients taking higher doses of corticosteroids (equivalent of prednisone >10 mg daily), administering non-live influenza vaccination is still conditionally recommended 1.

Vaccine Selection Considerations

• Fluad contains the MF59 adjuvant (an oil-in-water emulsion containing squalene) which enhances immune response, particularly beneficial for elderly patients 2.
• As an inactivated vaccine, Fluad is preferred over live attenuated influenza vaccines (LAIV) for patients on immunosuppressive therapy like corticosteroids 1.
• Fluad is specifically designed for adults aged 65 years and older to provide enhanced protection against influenza 3.

Administration Guidelines

• If receiving both the influenza vaccine and a corticosteroid injection on the same day, they should be administered at different anatomical sites to minimize local reactions 1, 4.
• No specific waiting period is required between administration of inactivated influenza vaccines and corticosteroid therapy 1.
• For optimal protection, influenza vaccination should be completed by the end of October, regardless of corticosteroid treatment status 1.

Safety Considerations

• While Fluad may cause more local injection site reactions compared to non-adjuvanted vaccines, these reactions are generally mild and transient 5, 2.
• Common reactions with Fluad may include pain at the injection site, warmth, and occasionally systemic reactions like myalgia or chills 5.
• The concurrent use of corticosteroids does not increase the risk of adverse reactions to inactivated influenza vaccines 1.

Important Distinctions for Live vs. Inactivated Vaccines

• Unlike inactivated vaccines (like Fluad), live attenuated influenza vaccines (LAIV) have more contraindications and should be used with caution in immunosuppressed patients 6.
• If a live attenuated influenza vaccine were to be used (which is not recommended in this case), it should not be administered to persons receiving immunosuppressive therapies 6.
• Fluad, as an inactivated vaccine, does not pose the theoretical risks associated with live vaccines in immunocompromised individuals 1.

Common Pitfalls to Avoid

• Do not delay influenza vaccination due to concurrent corticosteroid therapy, as this may lead to missed opportunities for protection during influenza season 1, 4.
• Do not administer live attenuated influenza vaccines to patients on immunosuppressive doses of corticosteroids 6.
• Do not mix vaccines in the same syringe unless specifically approved for mixing 4.

By following these guidelines, healthcare providers can safely administer Fluad to patients concurrently receiving Medrol dose packs, ensuring optimal protection against influenza without compromising safety.