Major joint corticosteroid injections may decrease influenza vaccine efficacy, according to a retrospective study data published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.
A retrospective chart review captured vaccination status and influenza prevalence in patients who received a major joint corticosteroid injection in Olmsted County, Minnesota for the 5 influenza seasons between August, 2012 and March, 2017. Injections in the hip, knee, shoulder joint, or bursa were identified as major joint injections. Vaccinated control patients without corticosteroid joint injection were also followed for influenza outcome. All participants were older than 50 years.
During the study period, 15,068 patients received major joint corticosteroid injections, 4804 of whom were vaccinated against influenza. Vaccinated patients receiving a major joint corticosteroid injection were at increased risk (relative risk [RR], 1.52; 95% CI, 1.20-1.93) for influenza infection compared with vaccinated control patients. According to multivariate analyses, joint corticosteroid injections were identified as strongly predictive of influenza (P =.002). In patients receiving major joint injections, age younger than 65 years (P =.001) and female sex (P =.002) were both strongly predictive of influenza. The overall influenza rates were 1.08%, 1.64%, and 1.70% for the control group, vaccinated injection group, and unvaccinated injection group, respectively. Among those in the vaccinated injection group, the rate of influenza was 2.28% in patients younger than 65 years, compared with just 1.18% in patients 65 years and older (P <.001). Researchers hypothesized that the high-dose influenza vaccine given to patients older than 65 years may have mitigated the effects of corticosteroid injections on vaccine efficacy.
These data suggest that major joint corticosteroid injection has a deleterious effect on influenza vaccination efficacy and that the risk is particularly high in women younger than 65 years. Further research is necessary for a more detailed profile of these risks, including the impact of corticosteroid injection dose and timing relative to influenza vaccination.
Sytsma TT, Greenlund LK, Greenlund LS. Joint corticosteroid injections associated with increased influenza risk. Mayo Clin Proc Innov Qual Outcomes. 2018;2(2):194-198.