Vaccination in patients with disorders of the muscle and neuromuscular junction

Abstract

Neuromuscular diseases cover a broad spectrum of conditions that have important differences. Infections are frequently associated with severe complications, mainly because the neurological involvement can cause the aspiration of respiratory secretions and be significantly worsened by progressive respiratory and/or cardiovascular disease and immunosuppressive therapy. Preventing infectious diseases in patients with disorders of the muscle and neuromuscular junction is clinically important and vaccines play an important role in this regard. The majority of experts recommend that patients with these disorders should receive the same vaccinations as those recommended for healthy subjects, with special attention being given to the fact that two doses of measles, mumps, rubella (MMR) and varicella vaccines should be administered before beginning immunosuppressive therapy. In addition, annual influenza vaccination and pneumococcal vaccination are recommended for almost all patients with disorders of the muscle and neuromuscular junction.

Keywords::

• influenza vaccination
• muscular dystrophies
• muscular spinal atrophy
• myasthenia
• myopathies
• neuromuscular disease
• pneumococcal vaccination
• poly-dermatomyositides
• prevention
• vaccine

Financial & competing interests disclosure

The authors declare that they have no conflict of interest and have received no payment for preparing this manuscript. This review was supported by a grant from the Italian Ministry of Health (Bando Giovani Ricercatori 2009). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Neuromuscular diseases cover a broad spectrum of conditions that have important differences.

• • Infections by analogy to influenza infection seem to be frequently associated with severe complications in patients with disorders of the muscle and neuromuscular junction, mainly because the neurological involvement can be significantly worsened by progressive respiratory and/or cardiovascular disease and immunosuppressive therapy.

• • Preventing infectious diseases in patients with disorders of the muscle and neuromuscular junction is clinically important, and vaccines play an important role in this regard.

• • There are few data regarding the immunization of patients with disorders of the muscle and neuromuscular junction, and further studies of vaccination coverage, immunogenicity and safety are needed.

• • Patients with disorders of the muscle and neuromuscular junction should receive the same routine vaccinations as those recommended for healthy subjects, with special attention being given to the fact that two doses of measles, mumps, rubella (MMR) and varicella vaccines should be administered before beginning immunosuppressive therapy.

• • Given the risks of the aspiration of respiratory secretions, respiratory and/or cardiac involvement and immunosuppressive therapy, annual influenza vaccinations and pneumococcal vaccination are recommended in almost all patients with disorders of the muscle and neuromuscular junction.