Guidance for steroid injection therapy & COVID-19 vaccine administration
Following the COVID-19 vaccine rollout North Coast Radiology Group has updated its policy regarding steroid injection therapy in line with best available evidence.
There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of a COVID-19 vaccine decreases the efficacy of the vaccine. However, based on the known timeline of hypothalamic-pituitary-adrenal axis suppression following spinal and musculoskeletal corticosteroid injections, and the timeline of the reported peak efficacy of vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than two weeks prior to a COVID-19 vaccine dose and no less than one week following a COVID-19 vaccine dose, whenever possible.
- There is no evidence that patients receiving steroid therapy for the management of pain are at increased risk of adverse outcomes from COVID-19 vaccination;
- Synthesis of available information indicates that there is a suspected immunosuppressive effect in the majority of individuals who receive a corticosteroid injection, greatest at one week, and to a lesser extent at two weeks following injection;
- We recommend a shared decision-making process with each unique patient in the context of his or her indications for injection, as well as risk factors for a reduced adaptive immune response to vaccine exposure and risks for morbidity and mortality associated with COVID-19;
- These recommendations may change as more direct evidence regarding the effect of corticosteroid injection on COVID-19 vaccine efficacy becomes available.
• Steroid injection therapy to continue during the COVID-19 vaccination roll out;
• Depending on symptom severity it is recommended that corticosteroid is administered:
• no less than two weeks prior to a COVID-19 vaccine;
• no less than one week following a COVID-19 vaccine;
• If severity of symptoms warrants steroid injection therapy within this timeframe, then there is currently insufficient evidence to recommend against this;
• Prior to steroid injection therapy all patients will be provided with a safety information sheet and asked to sign a consent form prior to procedure.
Please contact the referrer hotline if you would like to speak to a radiologist for further information or advice.