Table. Recommended timing of live vaccine administration for people receiving corticosteroids
| Administration route and dose type | Corticosteroid agent and dose regimens | Administration of live vaccines |
|---|---|---|
| Local administration, any dose |
Any agent:
|
Any time before, during or after treatment |
| Oral administration, any dose | Budesonide | Any time before, during or after treatment |
| Fluticasone | ||
| Single dose of dexamethasonea | ||
| Physiological maintenance doses (replacement therapy) | Hydrocortisone, prednisolone or fludrocortisoneb | Any time before, during or after treatment |
| Non-physiological (maintenance) doses, long-term treatment | Hydrocortisone |
|
| Oral administration, prednisolone-equivalent dosec for infants and children <10 kg | <1 mg/kg/day for <28 days | Any time before, during or after treatment |
| <2 mg/kg/day for <14 days | ||
| <2 mg/kg/day for ≥14 days |
|
|
| ≥2 mg/kg/day for <14 days | ||
| ≥2 mg/kg/day for ≥14 days |
|
|
| Oral administration, prednisolone-equivalent dosec for children aged <16 years, weight >10 kg | <10 mg/day for <28 days | Any time before, during or after treatment |
| <20 mg/day for <14 days | ||
| <20 mg/day for ≥14 days |
|
|
| ≥20 mg/day for <14 days | ||
| ≥20 mg/day for ≥14 days |
|
|
| Oral administration, prednisolone-equivalent dosec for children aged ≥16 years and adults | <20 mg/day, any duration | Any time before, during or after treatment |
| ≥20 mg/day for <14 days |
|
|
| ≥20 mg/day for ≥14 days |
|
|
|
Footnotes: a A single dose of dexamethasone to manage an acute respiratory illness in children is not associated with immunosuppression. These children can receive live vaccines before or after the dose. b Physiological maintenance doses include a daily dose of 15–25 mg hydrocortisone or equivalent in people with adrenal insufficiency (such as 3–5 mg/day for adults, or 8–10 mg/m2 body surface area/day for children, prednisolone-equivalent dosing). Physiological maintenance doses of fludrocortisone (0.05–0.2 mg/day) may be prescribed for mineralocorticoid replacement levels in adrenocortical insufficiency. c Prednisolone-equivalent dose of other glucocorticoids should be used to assess a person’s suitability to receive live viral vaccines. See Table. Prednisolone-equivalent dosing, duration of action and anti-inflammatory activity for various systemic corticosteroid preparations. |
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