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

 

In order to answer the regularly asked questions, “to give or not to give, when to give, how to give and what to give,” we have teamed up with the Center for Duchenne Muscular Dystrophy (CDMD) at UCLA to provide the following recommendations. A huge “thank you!” to Drs. Stan Nelson, Paul Krogstad, and Carrie Miceli, (UCLA) for their contributions in developing this document. 

 

Please let us know if any of the information is confusing, or if anything is missing.  

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Recommended alterations to routine early childhood vaccines for children with Duchenne

CDMD at UCLA 

 

All children with Duchenne will be offered corticosteroids (prednisone or deflazacort) during childhood (usually by their 4th birthday).  Long-term steroid use will cause some degree of immunosuppression and increase the risk of infections, and will also blunt the body’s response to immunization and make some vaccines less safe.  Therefore, children taking long-term corticosteroids should NOT receive LIVE vaccines. Thus, it is our clinic policy to alter the vaccine administration schedule in order to allow your child the most complete vaccination protection. It is best to discuss the full vaccine schedule prior to the start of steroid treatment.

 

MMR Vaccine:
Protects against measles, mumps and rubella

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

Varicella Vaccine:
Protects against Chicken pox

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

Pneumonia Vaccine (PCV 13 or PPSV 23):
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 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 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 PREVNAR-13, then 1 dose of PPSV23 (8 weeks later and prior to starting daily corticosteroids)
    • The second dose of PPSV 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
    • Immunize all family members to protect the individual with Duchenne from exposure to influenza

Other Vaccines:
TDaP (tetanus), Hep B (hepatitis B), Inactivated Polio, Meningitis, HPV (human papilloma virus)

  • 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.

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

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