An 18-month-old is due for the first dose of MMR. The child received oral prednisolone 2 mg/kg/day for 14 days for nephrotic syndrome 4 weeks ago. Steroids have now been stopped. Can the MMR vaccine be given now?
- A Yes; steroids are now stopped and immunosuppression has resolved sufficiently
- B No; must wait 3 months after high-dose steroid therapy
- C No; MMR is permanently contraindicated in nephrotic syndrome
- D No; must wait 1 month after stopping a course >14 days at ≥2 mg/kg/day ✓
Explanation
High-dose corticosteroids (≥2 mg/kg/day or ≥20 mg/day prednisolone equivalent in children) given for ≥14 days constitute sufficient immunosuppression to potentially impair response to and safety of live vaccines. Per IAP/ACVIP recommendations, live vaccines should be deferred for at least 1 month (4 weeks) after stopping high-dose steroids for courses ≥14 days. The 3-month wait applies to significantly more intense immunosuppression (e.g., anti-cancer chemotherapy, biological agents). Since the course was exactly 14 days at 2 mg/kg and stopped only 4 weeks ago, a 1-month wait is needed — the child can receive MMR now if 4 weeks have passed. MMR is not permanently contraindicated in nephrotic syndrome.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.