A mother brings her 15-month-old child for varicella vaccination. The child is on low-dose prednisolone (0.5 mg/kg/day) for nephrotic syndrome in remission for the past 2 months. Which statement about varicella vaccination in this situation is CORRECT?
- A Varicella vaccine is absolutely contraindicated in a child on any dose of systemic corticosteroids
- B Varicella vaccine can be safely given if the prednisolone dose is less than 2 mg/kg/day and the child has been in remission, as low-dose steroids do not constitute sufficient immunosuppression to contraindicate live vaccines ✓
- C Varicella vaccine should be delayed until the child has been off steroids for at least 2 years
- D Inactivated varicella vaccine (VZIG) should be substituted because live vaccine is contraindicated
Correct answer: B. Varicella vaccine can be safely given if the prednisolone dose is less than 2 mg/kg/day and the child has been in remission, as low-dose steroids do not constitute sufficient immunosuppression to contraindicate live vaccines
Explanation
Live attenuated vaccines (including varicella) are generally contraindicated in children receiving immunosuppressive doses of steroids (≥2 mg/kg/day prednisone or ≥20 mg/day, for ≥14 days). Below these thresholds (low-dose systemic steroids), live vaccines are generally considered safe. In this scenario, prednisolone 0.5 mg/kg/day is below the immunosuppressive threshold, and the child is in remission, making varicella vaccination appropriate. The delay recommended after high-dose steroids is 1 month (not 2 years). VZIG is post-exposure prophylaxis, not an alternative vaccine.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.