Cortisone or steroid injections are utilized commonly by Orthopedic Surgeons, Rheumatologists, and Pain Management Physicians to manage inflammation and pain due to knee osteoarthritis, shoulder bursitis, back pain, and Rheumatoid disease.  Cortisone, a form of steroid can have effects on our immune function.  Covid-19 vaccinations are taking place all around the globe. Tens of millions of vaccinations have already been administered.  Do steroid injections interfere with the covid-19 vaccinations?  Maybe.  How should you time your steroid injection if you are planning on getting the Covid-19 vaccination? 

calcific tendonitis treatment with injection

 

How do vaccinations work to confer immunity to Covid-19? 

When you are vaccinated, the goal is to get your immune system to react to the vaccine and produce antibodies and alert certain cells to be on the lookout for the SARS-CoV-2 virus.  When successful, the vaccine uses your immune system to produce antibodies against portions of the spike protein that the virus uses to attach to our cells and infect us. 

If the virus cannot attach to our cells, it cannot gain entrance to the cell and replicate.  The vaccine also causes our immune system to produce a “cellular” immunity.  Cellular immunity occurs when certain white blood cells in your body are taught to recognize the spike protein.  These cells will lie asleep or dormant unless the virus is seen in your body. Then these cells will wake up and produce antibodies against the spike protein.  These cells can also activate other cells, or recruit their friends to take place in the battle against the virus.  

This is also why the current mRNA vaccines from Pfizer and Moderna require two doses.  The first dose wakes up your immune system and starts the process of antibody production.  The second injection a few weeks later revs up your immune system further to make more antibodies, and to produce the cellular component of the immune response I just mentioned.  

mRNA vaccines require a well functioning immune system to help you have the most protection possible against the virus that causes Covid-19.  

Steroid or cortisone injections and your immune system

Steroids affect your immune system.  That effect will be dose-dependent.  That means that the more steroid you receive, the larger the effect will be on your immune system function.  Will a single steroid injection into your knee, shoulder, hip or elbow affect your immune system? Maybe.  There is some evidence that steroid injections can increase your risk of getting the flu.  But there are no studies that show whether or not a steroid injection increases your risk of getting Covid-19.  

Given that millions of people around the world are currently being vaccinated against covid-19, and given that hundreds of thousands of steroid injections are given to patients around the globe every day, I think it makes sense to offer some guidance in this situation.  

Steroid injections can also affect your body’s own hormone production.  We have different types of steroid injections available to us.  Each has a slightly different effect on our hormones.  Some of the most commonly injected steroids for joint or tendon pain will diminish certain hormones in our body, such as cortisol, for up to a few weeks.   Cortisol is an important regulator of various processes in our body.  While steroid injections appear to be helping patients with covid-19 later in the disease process, it is currently believed that they are not helpful, and potentially harmful if used early in the disease course of covid-19.  

The timing of steroid injections if you are receiving a Covid-19 vaccine

There are two concerns here: 

  • The timing of steroid injections before receiving a COVID-19 vaccination
  • The timing of steroid injections after receiving a COVID-19 vaccination.  

Steroid injection before receiving the covid-19 vaccine:

If you are planning on receiving the covid-19 vaccination, and you know the date that you will be vaccinated, then based on the available research and position statements from various organizations you should wait up to 4 weeks after you received a cortisone or steroid injection before having a covid-19 vaccine.  The exact amount of time will depend on which steroid you are receiving and the dose that you will receive.  Talk this over with your doctor.  

Steroid injection timing if you have already received the Covid-19 vaccination: 

We want our immune system to function well after we receive the vaccine.  That will enable our body to produce antibodies and the cellular components of immunity that we require to minimize our risk of becoming infected with the SARS-CoV-2 virus.  

According to the manufacturers, they suggest the following: 

  • Pfizer-BioNTech COVID-19 mRNA Vaccine — Theoretically, it is unlikely for a corticosteroid injection to diminish the immunogenicity expected to be achieved by around day 28 or seven days after dose 2, and we would recommend proceeding with corticosteroid injections after this point in time.
  • Moderna COVID-19 mRNA Vaccine — Based on the data that are provided in two-week intervals, we would recommend timing corticosteroid injections at around day 42 or 14 days after dose 2.

So, based on the vaccine manufacturer’s recommendations, it appears that it is best to wait until you are two weeks past your second mRNA vaccination dose before receiving a cortisone or steroid injection.   

References: 

  1. Burns CM. The History of Cortisone Discovery and Development. Rheum Dis Clin North Am. 2016 Feb;42(1):1-14, vii. doi: 10.1016/j.rdc.2015.08.001. PMID: 26611547.
  2. Sytsma TT, Greenlund LK, Greenlund LS. Joint corticosteroid injection associated with increased influenza risk. Mayo Clin Proc Innov Qual Outcomes 2018; 2:194-198.
  3. Abdul AJ, Ghai B, Bansal D, Sachdeva N, Bhansali A, Dhatt SS. Hypothalamic pituitary adrenocortical axis suppression following a single epidural injection of methylprednisolone acetate. Pain Physician 2017; 20:E991-E1001.
  4. Habib G, Jabbour A, Salman J, Hakim G, Haddad H. The effect of epidural methylprednisolone acetate injection on the hypothalamic-pituitary-adrenal axis. J Clin Anesth 2013; 25:629-633.

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

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About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

5 comments on “Cortisone Steroid injections and Covid Vaccination: Timing is Everything

  • Perfect timing. Coincidentally, I have an appt. with the Orthopedist tomorrow. I am also 1c on the Covid Vaccination list. It looks like I’m better off getting a cortisone shot in my shoulder at least 4 weeks before my Covid Vaccination. It’s a new issue in the shoulder and don’t have a diagnosis yet but I will mention this to the Dr. or PA. tomorrow. Thank you.

  • Thank you for sharing your insight. Regarding the following recommendation:

    According to the manufacturers, they suggest the following:
    Pfizer-BioNTech COVID-19 mRNA Vaccine — Theoretically, it is unlikely for a corticosteroid injection to diminish the immunogenicity expected to be achieved by around day 28 or seven days after dose 2, and we would recommend proceeding with corticosteroid injections after this point in time.
    Moderna COVID-19 mRNA Vaccine — Based on the data that are provided in two-week intervals, we would recommend timing corticosteroid injections at around day 42 or 14 days after dose 2.

    Is this a personal recommendation based on your experience or is this directly quoted from Pfizer/Moderna documents? I was unable to locate a source from either manufacturer but if you could provide that, it would be greatly appreciated. Thank you again for your insight and help.

    All the best

    • The companies made recommendations to one of the national pain management organizations that came up with a set of guidelines for their members.

  • I took first dose of Moderna vaccine on 1/16 and scheduled for second dose 2/23. Unfortunately I already had a cortisone shot on 2/10. Is it safe to take the second dose? I am 87 years old.

    • Yes, it is safe to receive your second injection. Perhaps you could share this article with the physician who performed the cortisone injection?

      Stay safe.

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