Question

• In asthmatic children requiring short course oral steroid burst therapy, is the influenza vaccine as effective as in asthmatic children not on steroids?

Clinical Bottom Lines

1. The influenza vaccine in asthmatic children on oral steroid burst therapy was equally effective when compared with the response in asthmatic children not on burst steroids.¹
2. Giving the influenza vaccine to asthmatic children on oral steroid burst therapy was not associated with increased adverse side effects.

Summary of Key Evidence

1. Data was from pre-immunization and post-immunization titer samples drawn on patients between October 1993 and January 1994.¹
2. 109 asthmatic children recruited from a pediatric allergy and pulmonology clinic and a pediatric ED.
3. 59 of the children did not have asthma symptoms when recruited and 50 of the children in the prednisone group. There were 3 groups within the prednisone group: group 1 (n=38) started 5 day burst on the day of vaccination, group 2 (n=8) received prednisone within the 14 days before the vaccination, group 3 (n=4) received 20 mg every other day chronically for 6-15 mos before the vaccination.
4. Prevaccination and post-vaccination (2-4 wks after vaccine) titers were drawn on all participants.
5. Postvaccination titers to the A components of the trivalent vaccine were not significantly different though the prednisone group had a significantly greater response to the B component. This finding was unexpected and could not be easily explained by the researchers.

Additional Comments

• This study was published approximately 10 years ago. It has been cited multiple times since its publication in 1996, but the vaccination rate of asthmatic children has remained low.
• This study was limited to only 109 subjects (only 50 on steroids). A larger study would provide additional data.
• The results of the study also raises possibilities of administration in alternative
  medical sites (ER, urgent care, etc.).
  

Citation

1. Park CL, Frank AL, et al. Influenza Vaccination of Children During Acute Asthma Exacerbation and Concurrent Prednisone Therapy. Pediatrics. 1996;98:196-200.

CAT Author: Sarah DeHann, MD

CAT Appraisers: Robert Schumacher, MD

Date appraised: January 25, 2006