Joint Corticosteroid Injection Associated With Increased Influenza Risk

Abstract

Aging and immunocompromising conditions or medications may reduce influenza vaccine effectiveness. The high-dose vaccine has been used to improve vaccine response in patients 65 years and older. Because of systemic immunosuppressive effects, oral corticosteroids may reduce vaccine effectiveness; however, despite over half a century of use, no data are available regarding the effect of joint and bursa corticosteroid injection on influenza vaccine effectiveness. The aim of this retrospective study was to determine whether joint corticosteroid injection was associated with reduced influenza vaccine effectiveness. During the 5 influenza seasons between August 1, 2012, and March 31, 2017, a total of 15,068 major joint corticosteroid injections were given to patients residing in Olmsted County, Minnesota. Vaccinated patients receiving a major joint corticosteroid injection (n=4804) were at increased risk (relative risk, 1.52; 95% CI, 1.20-1.93) for developing influenza compared with vaccinated control patients. Women younger than 65 years were at the highest risk, suggesting that perhaps the high-dose vaccine should be considered for this group to enhance protection when possible.

Corticosteroid Injections and COVID-19 Infection Risk

“…Early evidence of the potential effect of single-dose corticosteroid exposure is described in a report on an observational cohort from the Mayo Clinic. This study investigated the association of a single intra-articular corticosteroid injection with increased risk of influenza infection [ 18 ]. Over a period of five influenza seasons, the rate of influenza infection was compared in vaccinated patients who had received an intra-articular corticosteroid injection vs those who had not.…”

Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises—Evaluating the Risk of Infection Associated with Corticosteroid Injections

“…Evidence for the effects of corticosteroid (CS) injection on risk of viral infection is even more limited. A large retrospective study from 2018 reported an increased risk of influenza among flu-vaccinated patients who had a CS injection compared with those without [4]. The authors reported a single unadjusted relative risk (RR) corresponding to a 52% higher risk of influenza associated with CS injections.…”

Pain During COVID‐19: A Comprehensive Review and Guide for the Interventionalist

“…However, no literature exists specifically examining whether steroid injections potentiate the risk of contracting COVID‐19. Several studies have found increased risk for immunosuppression 38 and contraction of influenza 39 . If use of steroid is deemed necessary, consider reducing the steroid dose or using dexamethasone or betamethasone as the duration of immune suppression is less 40 .…”