Live vaccines must not be given to patients taking moderate or high doses of steroids for
longer than 2 weeks.
There is no consensus as to what is a low dose of steroid (10mg per day or below is thought
a sensible compromise). A full immunosuppressive dose may be 20mg per day and not
40mg as previously accepted.
There are no contra-indications to using live vaccines if:
• Steroid is for less than 2 weeks
• Treatment is alternate day with short acting steroid
• By topical application
• By intra articular or soft tissue injection
• Replacement therapy with physiological doses e.g. adrenal insufficiency
• Long term low dose steroids (10mg per day or less)
Moderate or high dose steroid must be stopped 3 months before live vaccines can be
administered.