From the Guidelines
Patients taking prednisone can generally receive the Tdap vaccine, but the decision to administer the MMR vaccine should be based on the dose and duration of prednisone therapy, with consideration of the potential risks and benefits in the context of immunosuppression. For patients on low-dose prednisone (less than 20 mg/day) or short-term therapy, both vaccines can be administered as scheduled 1. However, for those on high-dose prednisone (20 mg/day or more for two weeks or longer), the Tdap vaccine remains safe as an inactivated vaccine, but the MMR should be deferred if possible since it's a live vaccine 1. The concern with live vaccines like MMR during significant immunosuppression is the theoretical risk of vaccine strain viral replication. After completing high-dose steroid treatment, it's generally recommended to wait at least one month before administering the MMR vaccine 1.
Some key considerations for vaccination in patients taking prednisone include:
- The dose and duration of prednisone therapy
- The type of vaccine (live vs. inactivated)
- The potential risks and benefits of vaccination in the context of immunosuppression
- The need for individual clinical assessment in certain situations
It's also important to note that the Tdap vaccine has its own set of contraindications and precautions, as outlined in the guidelines for vaccine use 1. However, these do not specifically relate to the use of prednisone. Patients should be informed that prednisone might slightly reduce vaccine effectiveness, but protection is still likely substantial and vaccination remains beneficial.
In terms of the evidence, the most recent and highest quality study is from 2018 1, which provides guidelines for the use of Tdap and other vaccines. However, the studies from 1997 and 1998 1 provide more specific guidance on the use of live vaccines like MMR in patients taking prednisone. Overall, the decision to administer the MMR vaccine to a patient taking prednisone should be based on a careful consideration of the potential risks and benefits, as well as the individual patient's circumstances.
From the FDA Drug Label
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines may be diminished and cannot be predicted Indicated immunization procedures may be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids as replacement therapy (e.g,
The patient taking prednisone can receive the TDAP vaccine as it is a killed or inactivated vaccine. However, the response to the vaccine may be diminished and cannot be predicted. The patient taking prednisone should not receive the MMR vaccine as it is a live, attenuated vaccine and its administration is contraindicated in patients receiving immunosuppressive doses of corticosteroids 2.
From the Research
Patient Taking Prednisone Who Wants Tdap and MMR
- The patient is taking prednisone, which is an immunosuppressive medication, and wants to receive the Tdap and MMR vaccines.
- According to the available studies, there is no direct evidence that addresses the safety and efficacy of administering Tdap and MMR vaccines to patients taking prednisone.
- However, a study on the safety of immunizing with Tdap less than 2 years following previous tetanus vaccination found that a short interval between Td/TT and a single dose of Tdap is safe 3.
- Another study on the cost-effectiveness of Tdap vaccination for prevention of pertussis among adults aged 19 years and older in the United States found that Tdap vaccination remains the best available preventive measure against pertussis, but its cost-effectiveness varies by age cohort 4.
- A systematic review of adult tetanus-diphtheria-acellular (Tdap) coverage among healthcare workers found that overall Tdap coverage among HCWs is low, but seems to increase over the years after the vaccine introduction and with implementation of interventions to increase coverage 5.
- There are no research papers that directly address the administration of MMR vaccine to patients taking prednisone, but a study on the epidemic process of measles under conditions of massive immunization found that the disease incidence among vaccinated persons did not depend on the time lapse after vaccination 6.
- A study on the cellular distribution of ornithine in Neurospora is not relevant to the question of administering Tdap and MMR vaccines to patients taking prednisone 7.