Timing of Flu Vaccine After Corticosteroid Use
General Recommendations
- The American College of Rheumatology recommends proceeding with influenza vaccination regardless of current steroid dose or recent steroid use 1, 2, 3
- The decision to vaccinate is based on current steroid dose, not on waiting after discontinuation, with a strong recommendation to proceed with influenza vaccination immediately for patients on low-dose steroids (≤10 mg prednisone daily) 1, 2, 3
- For patients on moderate-dose steroids (>10 mg but <20 mg prednisone daily), the American College of Rheumatology conditionally recommends proceeding with influenza vaccination, as the benefits of timely influenza protection outweigh concerns about diminished immunogenicity 1, 2, 3
- For patients on high-dose steroids (≥20 mg prednisone daily), the American College of Rheumatology still conditionally recommends giving the influenza vaccine without delay, despite potential blunting of antibody response 1, 2, 3
Special Considerations
- The American College of Rheumatology explicitly prioritizes timely influenza vaccination over concerns about steroid-induced immunosuppression, and advises against deferring influenza vaccination while waiting for steroid taper 1, 2, 3
- The Centers for Disease Control and Prevention recommends deferring vaccination until symptoms abate for patients with moderate to severe acute febrile illness, but minor illnesses with or without fever do not contraindicate influenza vaccine 4, 5