Vaccination Effectiveness During Treatment With Corticosteroids Post Splenectomy

David R. Haburchak, MD, FACP


June 17, 2004


I reviewed your article on vaccinations and antibiotics and found it very helpful. However, I have a related question. If a patient is being treated with corticosteroids for idiopathic thrombocytopenic purpura and undergoes a splenectomy, will the vaccination be effective while on the steroids, or is there a specific dose of medication (ie, lower dose vs off drug completely) in which the vaccination(s) is more likely to be effective?

Dewey Birkhofer, MD

Response from David R. Haburchak, MD, FACP

Although it would seem intuitive that the addition of corticosteroids to a treatment regimen in a splenectomized patient would result in a blunted antibody response, there is little evidence that this is so. In a study performed in 1982, Pedersen[1] immunized 66 splenectomized children with a 14-valent pneumococcal vaccine and found no significant difference in immunoglobulin (Ig)G or IgM antibody titers for 10 of the antigens as compared with the nonsplenectomized controls. Of interest, the levels were lower for types 2, 3, and 12 F, but were still within the protective range. Five splenectomized children and 7 nonsplenectomized children receiving corticosteroids had no significant differences in antibody levels than their cohorts not receiving drugs.

A very recent study by Hanania and colleagues[2] confirmed that there was no significant difference in antibody levels or serologic response to influenza A immunization in asthmatic adults or among children receiving inhaled or oral corticosteroids. This is interesting because pneumococcal vaccine is a polysaccharide in origin, whereas the influenza vaccine is a protein antigen. These antigens would be expected to be processed differently. A third investigation by Kubiet[3] demonstrated that adult patients with chronic obstructive pulmonary disease receiving corticosteroids did not have a blunted response to influenza A vaccine.


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