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

Abstract

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.

Headache After Vaccination: An Update on Recent Clinical Trials and Real-World Reporting

“…Greater occipital nerve blocks with corticosteroid may also be effective and corticosteroid sparing when administered peripherally. In general, it is reasonable to delay use for at least 2 weeks, especially in the case of live-virus vaccines [ 96 ].…”

Effects of Local Anesthetics With or Without Steroids in High-Volume Transforaminal Epidural Blocks for Lumbar Disc Herniation: A Randomized, Double-Blind, Controlled Trial

“…In the COVID-19 era, with most patients being vaccinated against COVID-19, the Spine Intervention Society recommends withholding steroid injections no less than 2 weeks prior to COVID-19 vaccination and no less than 1 week following vaccination. 10 Injected steroids can be taken up in the systemic circulation via diffusion and potentially alter the immune response to vaccinations, rendering them less effective. 24 Therefore, for treating LDH-associated pain, high-volume TFEBs without steroids can be considered for patients at high risk of complications from steroid injections or if they have recently received or plan to receive a COVID-19 vaccine and have persistent pain despite conservative treatment.…”

“… 9 Moreover, although no large prospective studies have investigated the immune response to coronavirus disease 2019 (COVID-19) vaccines after steroid injections, it is reasonable to delay procedures involving steroids for approximately 1 to 2 weeks after vaccine administration and to delay vaccinations for approximately 2 weeks after a procedure involving steroids. 10 …”

The COVID‐19 pandemic and its consequences for chronic pain: a narrative review

“…Across the world, the pandemic increased the physical and mental health burden in chronic pain patients, with some variations based on certain populations and subsets of patients [23,58,59] Risk factors for increased pain included social isolation, lack of psychological support, female sex, lower level of education, reduced physical activity and disabled employment status [23,77,79] Delivery of chronic pain care was affected, but telemedicine was well adapted in most developed countries for any non-interventional patient-provider interaction [120,121] Steroid exposure may reduce the efficacy of COVID-19 vaccines, but the existing data are unclear. It is best to consider avoiding steroid injections 2 weeks prior to the vaccine and at least 1 week following the vaccine [101,122] Steroid exposure does not seem to affect the SARS-CoV-2 infection rate. However, exposure to chronic opioids might be a risk factor for increased infection severity [29,117] ( Prone positioning as a ventilation strategy has been reported to add additional risk of peripheral nerve injury with possible weakness and subsequent pain [31,32].…”