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Vaccination Recommendations

Vaccination Recommendations

Vaccinations are important to protect us against infection and disease – but they are also confusing. 

Some vaccines are “live,” some are “attenuated (killed),” some protect against viral infections, some protect against bacterial infections, some are given only in childhood, some need a “booster” later in life, some are only given later in life. Adding Duchenne – medications, pulmonary, and cardiac function – to the picture adds even more confusion. 

The recommendations below should help to answer the regularly asked questions, “to give or not to give, when to give, how to give and what to give.”

Please bring your vaccination record to your annual appointment, and provide this information to your general pediatrician.

General Vaccination Recommendations for People Living with Duchenne

The use of corticosteroids (prednisone or deflazacort) should be discussed with the parent of every child living with Duchenne by age 3yo (or as soon as possible after receiving a diagnosis). Long-term daily corticosteroid use may cause some degree of immunosuppression and may increase the risk of infections. 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" Vaccine Precautions:

If vaccinations are not complete prior to starting corticosteroids, the Centers for Disease Control and Prevention (CDC) report that:

  • People receiving more than 2mg/kg/day of daily corticosteroids are considered to be immunosuppressed and should NOT receive live virus vaccines.
  • People receiving more than 20mg/day of daily corticosteroids 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 20 mg/day of daily corticosteroids for a period of 1 month before and 1 month after receiving the live vaccine.
  • People receiving less than 2mg/kg/day of daily corticosteroids are not considered to be immunosuppressed and may receive live virus vaccines if necessary.
  • 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 virus vaccines if necessary.

We realize that this is a change and contradicts what has been reported in the past. We do continue to recommend that live virus vaccines be given before daily corticosteroids are started, when possible, and that live virus vaccines be avoided when possible (i.e., people with Duchenne should receive the “flu shot” [not a live virus vaccine] rather than the “nasal spray” [live virus] annually).

MMR Vaccine:

Protects against measles, mumps, and rubella.

  • This is a LIVE vaccine
  • 1st dose: usually given between 12-15 months of age
  • 2nd MMR vaccine (generally given between 4-6 years old) should be given before age 4yo and, if possible, prior to starting daily corticosteroids; can safely be 4 weeks (minimum) after your child’s 1st MMR vaccine 

Varicella Vaccine:

Protects against Chicken pox.

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

Pneumococcal Vaccine:

Pneumococcal pneumonia

  • This is a not a live vaccine, and is important to reduce bacterial pneumonia years from now.
  • If the child has received PCV 13 (4 doses by 24 months of age):
    • They should receive 1 dose of PPSV23 at least 2 months after the last dose of PCV 13 and, if possible, prior to starting daily corticosteroids
    • The second dose of PPSV23 should be given 5 years later
    • No more than 2 lifetime doses of PPSV23 are recommended
  • If the child has NOT received PCV 13:
    • They should receive 1 dose of PCV13, then 1 dose of PPSV23 (8 weeks later and, if possible, prior to starting daily corticosteroids)
    • The second dose of PPSV23 should be given 5 years later
    • No more than 2 lifetime doses of PPSV23 are recommended

Annual Flu Vaccine:

Protects against prevalent yearly strains of influenza.

  • The “flu shot” is not a live vaccine; the “nasal spray” is a LIVE vaccine
  • All children with Duchenne, whether on corticosteroids or not, should be immunized annually against influenza, as soon as the vaccine becomes available
  • Nasal spray: appropriate for children between 2-6 years old, not taking corticosteroids, without lung disease or asthma; may be appropriate for siblings living in the same house as children with Duchenne
  • Flu shot: appropriate for everyone over 2 years old and is the best choice for people living with Duchenne.
  • Immunize all family members to protect the individual with Duchenne from exposure to influenza

Other Vaccines:

Tdap (tetanus), Hep B (hepatitis B), Inactivated Polio, Meningococcal conjugate vaccine, HPV (human papilloma virus vaccine)

  • These are not live vaccines
  • These should all be given as recommended and are not influenced by corticosteroid use

CDC webpage is an excellent source of information on the usual safety issues, frequency of administration, etc: CDC - Immunization Schedules

The recommendations in this summary are consistent with recommendations from the AAP Redbook Committee and CDC’s Advisory Committee on Immunization Practices, and were made in consultation between the UCLA Pediatric Infectious Disease Division and the Pediatric Neuromuscular Team of the Center for Duchenne Muscular Dystrophy at UCLA and the CDC.

Related links

Emergency Care Information
Care Guidelines

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