title: Vaccination recommendations for patients with neuromuscular disease.
abstract: Neuromuscular diseases (NMDs) encompass a broad spectrum of conditions. Because infections may be relevant to the final prognosis of most NMDs, vaccination appears to be the simplest and most effective solution for protecting NMD patients from vaccine-preventable infections. However, very few studies have evaluated the immunogenicity, safety, tolerability, and efficacy of different vaccines in NMD patients; therefore, detailed vaccination recommendations for NMD patients are not available. Here, we present vaccination recommendations from a group of Italian Scientific Societies for optimal disease prevention in NMD patients that maintain high safety levels. We found that NMD patients can be classified into two groups according to immune function: patients with normal immunity and patients who are immunocompromised, including those who intermittently or continuously take immunosuppressive therapy. Patients with normal immunity and do not take immunosuppressive therapy can be vaccinated as healthy subjects. In contrast, immunocompromised patients, including those who take immunosuppressive therapy, should receive all inactivated vaccines as well as influenza and pneumococcal vaccines; these patients should not be administered live attenuated vaccines. In all cases, the efficacy and long-term persistence of immunity from vaccination in NMD patients can be lower than in normal subjects. Household contacts of immunocompromised NMD patients should also be vaccinated appropriately.
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. Electronic address: susanna.esposito@unimi.it.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Centro Traslazionale di Miologia e Patologie Neurodegenerative, IRCCS Giannina Gaslini, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bruno
authors.affiliation: Child Neurology and Psychiatry Department, Neurological National Institute C. Mondino, IRCCS, Pavia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Berardinelli
authors.affiliation: Section for Neuromuscular Diseases and Neuropathies, Clinical Neurology, University Hospital "Spedali Civili", Brescia, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Filosto
authors.affiliation: Neuromuscolar Diseases Unit, Azienda Ospedaliera Universitaria S. Giovanni Battista, Torino, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Mongini
authors.affiliation: Immunology and Neuromuscolar Diseases Unit, Istituto Nazionale Neurologico "Carlo Besta", Milan, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Morandi
authors.affiliation: Department of Neurosciences, University of Messina, Messina, Italy.
authors.forename: Olimpia
authors.initials: O
authors.lastname: Musumeci
authors.affiliation: Department of Neurosciences NPSRR, University of Padua, Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Pegoraro
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Siciliano
authors.affiliation: Department of Neurological Sciences and Movement, University of Verona, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tonin
authors.affiliation: Neuromuscolar Unit, Multiple Sclerosis Centre, University of Cagliari, Cagliari, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Marrosu
authors.affiliation: Pediatric Neurology and Neuromuscolar Diseases Unit, IRCCS Giannina Gaslini, Genoa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Minetti
authors.affiliation: Neuromuscolar Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Servida
authors.affiliation: Molecular Medicine Unit, Fondazione IRCCS Stella Maris, Pisa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fiorillo
authors.affiliation: Primary Care Pediatrician, FIMP Genoa, Genoa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conforti
authors.affiliation: Primary Care Pediatrician, FIMP Genoa, Genoa, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Scapolan
authors.affiliation: Department of Health Science, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.affiliation: Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vianello
authors.affiliation: Quality Unit, Department of Biomedical Science for Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Castaldi
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.affiliation: Department of Neurosciences, University of Messina, Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Toscano
authors.affiliation: Neuromuscolar Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Moggio
mesh_terms: D000075202:Contraindications; D006801:Humans; D016867:Immunocompromised Host; D007252:Influenza Vaccines / Q000627:therapeutic use*; D009468:Neuromuscular Diseases / Q000276:immunology*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D014611:Vaccination; D014613:Vaccines, Attenuated / Q000627:therapeutic use
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines; D014613:Vaccines, Attenuated
keywords: Chronic disease; Immunocompromised patients; Influenza vaccination; Neurologic disease; Neuromuscular disease; Pneumococcal vaccine