Mixing steroids and vaccine
A child is given a chickenpox vaccine and 3-4 days later comes down with croup. Can I give steroids (1 dose of dexamethasone) or will steroids interfere with the immune response to the vaccine? He was dyspneic the night before but not in the office. SUZANNE GOSSIER, MD, Westbank, BC
The chickenpox vaccine is a live attenuated strain that replicates in the host and induces subsequent immune response. Use of steroids within approximately 2 weeks of vaccination raises two main issues. First, immune suppression by steroids may result in clinical infection with the chickenpox vaccine. Second, the steroids may attenuate the immune response to the vaccine with potential for subsequent increased risk of vaccine failure. If steroids are clearly indicated shortly after chickenpox vaccination then vigilance for signs of and early treatment for chickenpox is recommended. One dose of steroids isn’t likely to have a major effect on long-term immunity but giving a second shot when the child is steroid free would optimize immunity.