Vaccinations

This page was last updated in September 2025.

It’s extremely important that everyone stays up to date with routine, recommended vaccinations. Your primary care provider is familiar with your vaccination schedule, and will remind you when vaccinations are due. While many vaccinations are given only during childhood, several are given later or are maintained on a schedule throughout your life. Maintaining immunity to the diseases that these vaccinations protect you against will help you to avoid additional, preventable infections.

You should bring your vaccination record to your annual neuromuscular appointments, as well as share these records with primary care providers to ensure all of your doctors are aware of your vaccination status. This is especially important if you change your primary care provider to ensure nothing is missed.

In addition to routine vaccinations, it is extremely important that you, and each member of your family, get vaccinated against influenza (flu) & COVID-19 viruses. The flu & COVID-19 can be especially harmful for people living with Duchenne & Becker because of their weakened breathing muscles. If someone with Duchenne or Becker gets sick with a respiratory illness, they may experience upper respiratory symptoms, difficulty with airway clearance, decreased oxygen levels, additional lower respiratory infections, and possibly life-threatening pneumonias. Annual flu shots, while not always 100% effective, do decrease the overall risk of getting the flu virus. Additionally, if you do end up getting sick with the flu after receiving the shot, your symptoms may be less severe. Vaccination for COVID-19 is also recommended for individuals with Duchenne and Becker and boosters should be discussed with your primary care and/or neuromuscular provider. 

Types of Vaccinations

There are many different types of vaccines. Some vaccines are created with a very small amount of live or weak germs that cause common illnesses. These germs can be types of bacteria, viruses, or other toxins. Some vaccines just contain parts of these germs that can still be recognized by the immune system. The purpose of most vaccinations is to recognize the germs and help equip your body to start fighting infections quicker and better when so you do not get sick. There are two main types of vaccines that are commonly given: live attenuated vaccines and inactivated (non-live) vaccines.

Inactivated (Non Live) Vaccinations

Some non-live vaccines are “inactivated vaccines,” meaning they contain a killed or inactivated version of the virus or bacteria. Some are sub-unit vaccines meaning that they just contain a small part of the pathogen. Some are toxoid vaccines and are made from inactivating toxins. These vaccines pose no additional risk to persons living with Duchenne or Becker, even if they are taking daily steroids. Inactivated vaccines are safe and should be administered as recommended by your primary care provider.

Live-Attenuated Vaccinations

Some vaccinations are “live-attenuated vaccines,” meaning they contain a weakened (or attenuated) living virus or bacteria. If you have Duchenne or Becker and are taking steroids (especially high dose), you should generally avoid live-attenuated vaccines. If giving a live-attenuated vaccine cannot be avoided due to a risk of infection, the recommendations below should be followed.

Vaccination Recommendations and Chronic Steroid Use

Long-term daily steroids (corticosteroids) use may cause some degree of immunosuppression, which may increase the risk of infections and becoming ill. It is best to discuss the full vaccine schedule with your medical providers prior to the start of corticosteroid treatment. If possible, childhood vaccinations should be completed prior to the start of daily corticosteroid therapy.

Live-Attenuated Vaccine Precautions

Live-attenuated vaccines should be avoided when possible. Always ask for the inactivated form of the vaccine when given the choice. For example, when you receive your annual influenza vaccine, opt for the shot form, which is an inactivated or sub-unit vaccine, rather than the nasal spray, which is a live form of the virus. If it is necessary to give a live-attenuated vaccine, the following recommendations from the Centers for Disease Control and Prevention should be followed:

  • People receiving less than 2mg/kg/day of prednisone or 2.4mg/kg/day of Emflaza daily are NOT considered to be immunosuppressed and may receive live-attenuated vaccines if necessary.
  • Younger children receiving 2mg/kg/day or more of prednisone or 2.4mg/kg/day or more of Emflaza daily are considered to be immunosuppressed and should NOT receive live-attenuated vaccines.
  • Older children, teens and adults receiving 20mg/day or more of prednisone or 24 mg/day or more of Emflaza daily are considered to be immunosuppressed. If these patients require administration of a live vaccine, it is recommended that the dose of corticosteroids be reduced to less than 20mg/day of prednisone or 24 mg/day of Emflaza daily for a period of 1 month before and 1 month after receiving the live-attenuated vaccine.
  • People receiving intermittent corticosteroid dosing (alternate day, weekend dosing, 10 days on/10 days off, etc.) are NOT considered to be immunosuppressed (regardless of dose) and may receive live-attenuated vaccines if necessary.
  • Individuals taking Agamree (vamorolone) should talk to their neuromuscular team before receiving any live vaccines, as the level of immunosuppression is not yet well understood

Recommended Vaccinations

MMR Vaccine

Protects against measles, mumps, and rubella

  • This is a live-attenuated vaccine
  • First dose: usually given between 12-15 months of age
  • Second dose: MMR vaccine (generally given between 4-6 years old) should be given before age 4 and, if possible, prior to starting daily corticosteroids; can safely be given 4 weeks (minimum) after your child’s first MMR vaccine

Varicella Vaccine

Protects against Chicken Pox

  • This is a live-attenuated vaccine
  • Varicella booster vaccine (usually given between 4-6 years old) should be given, if possible, prior to starting daily corticosteroids

Pneumococcal Vaccine

Protects against invasive pneumococcal disease

  • This is a non-live conjugate sub-unit vaccine and is important to reduce bacterial pneumonia years from now.Pneumococcal vaccination is recommended for children and adults with Duchenne and Becker due to the increased risk of pneumococcal disease 
  • If the child has received PCV13 (4 doses by 24 months of age):
    • They should receive 1 dose of PCV20 with a minimum of 8 weeks between PCV vaccines 
  • If the child has NOT received PCV13:
    • They should receive 1 dose of PCV20 or
    • PCV15 followed by PPSV23 8 weeks to 1 year later

Annual Influenza (Flu) Vaccine

Protects against prevalent yearly strains of the flu (influenza).

  • All children with Duchenne or Becker, whether on corticosteroids or not, should be immunized annually against influenza, as soon as the vaccine becomes available.
  • Nasal spray: The nasal spray flu vaccine is a live-attenuated virus and should be avoided by people with Duchenne or Becker, regardless of their steroid use. It is safe for siblings 2 years of age or older living with a person with Duchenne or Becker to receive the nasal flu vaccine.
  • Flu shot: Flu shots are non-live vaccines (you cannot get the flu from the “flu” shot) and are the best protection against the flu for people living with Duchenne or Becker.
  • Immunize all family members to protect the individual with Duchenne or Becker from exposure to influenza

COVID-19 Vaccine

  • Due to weakness in the skeletal, heart and lung muscles, individuals with Duchenne and Becker have an increased risk of serious complications from COVID‐19 & should be vaccinated
  • Family members should also be vaccinated against COVID-19 to help protect individuals with Duchenne or Becker from exposure to COVID-19
  • Talk to you/your child’s neuromuscular provider and/or pulmonologist about the COVID-19 vaccine and how it can help protect against serious illness
  • For the most up to date information on COVID-19 vaccinations, visit the cdc.gov or American Academy of Pediatrics (AAP)

Other Vaccines

  • Tdap (adult tetanus, diptheria, pertussis vaccine)
  • Hep B (hepatitis B)
  • Inactivated Polio
  • Meningococcal vaccine
  • HPV (human papilloma virus vaccine)

These are not live-attenuated vaccines and do not contain live virus

These should all be given life long, as recommended, and are not influenced by corticosteroid use.

More Questions?

The Center for Disease Control (CDC) and American Academy of Pediatrics (AAP) can provide the most up to date information of vaccine safety and frequency recommendations. If you are ever unsure about a vaccine, always reach out to your primary care provider and neuromuscular team (including pulmonologist)  

The recommendations in this summary are consistent with recommendations from the AAP Redbook Committee and CDC’s Advisory Committee on Immunization Practices.  PPMD would like to recognize and thank the following for review and contribution to this page:  

UCLA Pediatric Infectious Disease Division and the Pediatric Neuromuscular Team of the Center for Duchenne Muscular Dystrophy at UCLA

Anne Pham-Huy, MD Associate Professor, University of Ottawa, Program Director, Pediatric Infectious Diseases Training Program, Division of Infectious Diseases, Immunology and Allergy, Chair, Immunize Canada .

Jane Taylor, MD, MsCR, FAAP Professor of Pediatrics, University of Pittsburgh School of Medicine, Clinical director for the Division of Pediatric Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh