Guidance on vaccinating individuals undergoing steroid treatments
This information is sourced from:
ARMA, Versus Arthritis, Specialist Pharmacy Service (SPS), The Green Book Chapter 14a and the British Society for Rheumatology
- It is safe to have the Covid-19 vaccine alongside steroid exposure, but the patient may not mount such a good immune response. This is part of the rationale for providing a third primary dose followed by a booster to those who are immunosuppressed including those on steroids.
- Do not delay vaccination for someone who is taking, has received or is soon to receive steroids in any form (IM, intra-articular, oral, IV).
- If additional steroids are required to control inflammatory disease, that may take priority, as a flare can also worsen the risk from Covid-19.
- It may be appropriate to delay a non-essential steroid injection (by at least two weeks from the vaccination) so that the response to the vaccine is more effective.
- For a patient who is on an elective waiting list for a steroid injection of up to 80mg methylprednisolone or 80mg triamcinolone, the administration of the Covid-19 vaccine is the priority if the vaccine has been offered to the patient and the prevalence of Covid-19 is high. In this scenario, the steroid injection should be deferred by 2 weeks after the vaccine, to enable the patient to mount the best response to the Covid-19 vaccine
- A third primary dose should be offered to anyone on:
- high dose corticosteroids (equivalent to ≥ 20mg prednisolone per day) for more than 10 days in the month before vaccination or
- long term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the three months before vaccination.
- Also give a 3rd primary dose to individuals who had received high dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination.
Written by Dr Carrie St John Wright
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