Vaccinations

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, is vaccinated against influenza (flu) virus. The flu can be especially harmful for people living with Duchenne because of their weakened breathing muscles. If someone with Duchenne gets sick with the flu, 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 end up getting sick with the flu anyway after receiving the shot, your symptoms may be less severe.

Types of Vaccinations

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. The purpose of vaccinations are to help equip your body to fight illnesses and diseases quicker when you are exposed to them so you do not get sick. There are two main types of vaccines that are commonly given: live vaccines and inactive/attenuated vaccines.

Live Vaccinations

Some vaccinations are “live vaccines,” meaning they contain a living virus. If you have Duchenne and are taking steroids you should avoid live virus vaccines if at all possible. If giving a live virus vaccine cannot be avoided due to a risk of infection, the recommendations below should be followed.

Inactive or Attenuated Vaccinations

Some vaccines are “inactive” or “attenuated” vaccines, meaning they contain a dead virus.  These vaccines pose no risk to persons living with Duchenne, even if they are taking daily steroids. Inactive or attenuated virus vaccines are safe and should be administered as recommended by your primary care provider.

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” Vaccine Precautions

As stated above, it is recommend that live virus vaccines be avoided when possible. Always ask for the inactive 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 inactive vaccine, rather than the nasal spray, which is a live form of the vaccine. If it is necessary to give a live virus vaccine, the following recommendations from the Centers for Disease Control and Prevention should be followed:

  • 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.

Recommended Vaccinations

MMR Vaccine

Protects against measles, mumps, and rubella

  • This is a LIVE 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 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 pneumococcal pneumonia

  • This is a not a live vaccine and is important to reduce bacterial pneumonia years from now.
  • If the child has received PCV13 (4 doses by 24 months of age):
    • They should receive 1 dose of PPSV23 at least 2 months after the last dose of PCV13 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 PCV13:
    • 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 the flu (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 (adult tetanus, diptheria, pertussis vaccine), Hep B (hepatitis B), Inactivated Polio, Meningococcal conjugate vaccine, HPV (human papilloma virus vaccine)

  • These are not live 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 CDC has an excellent source of information on the usual safety issues, frequency of administration. Please click here for additional information about which vaccinations are recommended for you.

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.