1. They are elderly; 2. They are on high dose steroids; 3. This report says they are at increased risk for infection, including serious infection. You have plenty of reasons to be aggressive with vaccinating these patients. There is nothing tricky about this. If they are on prednisone up to 20 mg a day they can get live virus vaccines (eg, Zostavax); if higher then wait till the first opportunity and complete you vaccination plan w/ the live virus vaccines as indicated by CDC guidelines. JJC