The COVID‐19 vaccine and interventional procedures: Exploring the relationship between steroid administration and subsequent vaccine efficacy

Chow, Robert M.; Rajput, Kanishka; Howie, Benjamin A.; Varhabhatla, Narayana

OBJECTIVE: Collate available evidence and provide guidance on whether to delay steroid injections after receiving a vaccine, and whether to delay vaccination if a recent steroid injection has been administered, leaving formal recommendations to various national societies. METHODS: A literature search was performed to identify information pertinent to steroid administration and the subsequent downstream effects on vaccine efficacy. The search was initiated on December 20, 2020, and the terms used were (steroid OR cortisone OR dexamethasone) AND (vaccine). The studies were limited to articles in the English language. RESULTS: Six studies specifically addressed the effect of steroids on vaccine efficacy. Three of the 6 studies indicated that steroids could be used during the peri‐vaccine period without significant suppression of the immune response. One study associated intra‐articular steroid injections with an increased risk of developing influenza even when vaccinated. The remaining 2 studies had mixed findings. One study showed that patients who received dexamethasone, but not prednisolone were able to mount an immune response resulting in increased IgG. Another study showed that vaccine efficacy was maintained if patients were on continuous steroids or steroids after vaccination, but not if they stopped steroids prior to vaccination. CONCLUSIONS: Although there is no shared consensus in the studies reviewed, all but one study noted scenarios in which patients receiving steroids can still be successfully vaccinated.