From the Guidelines
Yes, it is generally safe to administer oral steroids 2 weeks after a live vaccine, as the immune system has had adequate time to respond to the vaccine and develop protective immunity before being potentially suppressed by steroid therapy. When considering the administration of oral steroids after a live vaccine, it's essential to weigh the potential risks and benefits, prioritizing morbidity, mortality, and quality of life as the primary outcomes. According to the guidelines outlined in the study by 1, systemically absorbed corticosteroids can suppress the immune system, but the minimum dose and duration of therapy required to cause immune suppression are not well defined. Some key points to consider include:
- Short-term, low-to-moderate dose steroid therapy (less than 14 days) is generally not a contraindication for live virus vaccines such as MMR.
- Persons who have received systemic corticosteroids for an interval of greater than or equal to 14 days should avoid vaccination with live virus vaccines for at least 1 month after cessation of steroid therapy.
- The immunosuppressive effects of steroid treatment vary, but many clinicians consider a steroid dose equivalent to or greater than a prednisone dose of 2 mg/kg of body weight per day or a total of 20 mg per day to be sufficiently immunosuppressive to raise concern about the safety of administration of live virus vaccines. It's crucial to note that the decision to administer oral steroids after a live vaccine should be made on a case-by-case basis, taking into account the individual's overall health status, the specific vaccine administered, and the potential risks and benefits of steroid therapy, as outlined in the study by 1.
From the FDA Drug Label
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. The answer is no, oral steroids should not be given 2 weeks after a live vaccine if the patient is receiving immunosuppressive doses of corticosteroids, as it is contraindicated. However, the exact timing of when it is safe to administer oral steroids after a live vaccine is not specified in the label. 2
From the Research
Administering Oral Steroids after Live Vaccine
- The administration of oral steroids after a live vaccine is a topic of interest, with several studies providing insights into the potential effects of steroids on vaccine efficacy 3, 4.
- A study published in 2021 found that corticosteroids, when given in high dosages, can contribute to serious adverse events following live attenuated varicella vaccination and live attenuated zoster vaccination 4.
- However, another study from 2021 suggested that steroids can be used during the peri-vaccine period without significant suppression of the immune response, although the findings were not consistent across all studies 3.
- Regarding the specific timing of oral steroid administration after a live vaccine, there is no clear consensus, but one study recommended delaying vaccination if a recent steroid injection has been administered 3.
Considerations for Oral Steroid Administration
- The equivalent doses of inhaled versus oral steroids for adults with chronic asthma were compared in a 2001 study, which found that a daily dose of prednisolone 7.5-10 mg/day appears to be equivalent to moderate-high dose inhaled corticosteroids 5.
- A 2014 review of steroids highlighted the potential complications and practice delivery issues, emphasizing the importance of awareness of clinically relevant side effects, which can occur at a wide range of doses and vary depending on the route of administration 6.
- The American Society of Pain and Neuroscience (ASPN) provided recommendations and guidance for steroid injection therapy and COVID-19 vaccine administration in 2021, addressing the potential effects of pain treatments utilizing steroids on vaccine efficacy 7.