From the Guidelines
Oral budesonide is generally considered safe to administer alongside live vaccines, with no delay or special precautions needed for standard doses, as supported by the most recent evidence from 1.
Key Considerations
- The degree of immunosuppression with oral budesonide is typically low, especially at doses up to 6 mg/day, as indicated in 1.
- High-dose systemic corticosteroids, such as prednisone at doses exceeding 20 mg daily for more than 2 weeks, can suppress immune function and may require postponing live vaccines, as noted in 1.
- Budesonide has high first-pass metabolism in the liver, resulting in minimal immunosuppressive effects when taken orally, which is a crucial factor in its safety profile with live vaccines.
- Patients taking unusually high doses of budesonide or having other immunocompromising conditions may require individual assessment to determine the safety of live vaccine administration, as suggested by 1.
Recommendations for Vaccination
- Patients on standard doses of oral budesonide can receive live vaccines such as MMR, varicella, or yellow fever without delay or special precautions, based on the guidelines from 1.
- Vaccination providers should be informed about all medications a patient is taking, including budesonide, to ensure appropriate vaccination decisions are made, as emphasized in the general principles of vaccination from 1.
- The safety of live vaccines with oral budesonide is supported by the lack of significant systemic immunosuppression at standard doses, as detailed in 1.
From the Research
Oral Budesonide and Live Vaccines
- The use of live attenuated vaccines in patients receiving immunosuppressive agents, such as oral budesonide, is generally contraindicated in package inserts and guidelines 2.
- However, studies have shown that live attenuated vaccines can be used safely in patients receiving immunosuppressants, with a low risk of infection and no reports of life-threatening complications 2.
- A study on varicella vaccination in children treated with budesonide inhalation suspension found that the antibody response was comparable to those treated with non-steroidal conventional asthma therapy, suggesting that oral budesonide does not reduce the immunogenicity of live vaccines 3.
- Another study found that the risk of transmission of live attenuated vaccines from healthy persons to immunocompromised patients is low, and that the benefit of providing herd immunity outweighs the risk of secondary transmission 4.
- Oral budesonide has been shown to have a favorable safety profile in patients with mild-to-moderate ulcerative colitis, with few corticosteroid-related adverse events reported 5.
- However, a study on joint corticosteroid injection found that it was associated with an increased risk of developing influenza, suggesting that corticosteroids may reduce vaccine effectiveness 6.