Immunizations
Routine immunization against childhood diseases should be recommended for all children with disabilities. The most current schedule can be obtained through the Centers for Disease Control and Prevention (CDC) and is approved by the American Academy of Pediatrics and American Academy of Family Physicians.
(11) Special consideration must be given to children with special health care needs. Although children with disabilities are not necessarily at higher risk for contracting childhood infections, they may have greater morbidity when ill with one of these infections. One of the more controversial subjects is administration of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) or measles, mumps, rubella (MMR) vaccine to children with a personal or family history of seizures. Administration of these vaccines can increase the risk of seizures in this group of children (12). The seizures are typically short in duration, generalized, self-limited, and associated with a fever. Because the pertussis immunization is given during infancy, the onset of a seizure after the vaccine can be confusing. Frequently, parents implicate the vaccine as the cause of a new-onset seizure disorder, such as infantile spasms, when in fact, the association is coincidental. It is recommended that the DTaP be delayed until a complete neurologic evaluation is completed and the cause of the seizure determined. The MMR, on the other hand, is not recommended to be withheld, even with a recent history of seizure, because it is typically first given after the onset of infantile seizures and the etiology of the seizure is generally already known.Special attention should be given to children who are immunocompromised. Children with physical disabilities, such as those with rheumatologic diseases and Duchenne muscular dystrophy who are on chronic corticosteroids, are included in this special population. In general, it is not recommended that children who are immunocompromised from corticosteroid use receive live bacterial or viral vaccines.
Although definitive guidelines do not exist, the current Red Book recommendation is that children receiving high doses of systemic corticosteroids given daily or on alternative days for more than 14 days not receive live-virus vaccines until 1 month after the discontinuation of the medications. High-dose corticosteroids are defined by receiving >2 mg/kg per day or >20 mg/day if the child weighs more than 10 kg. In the case of Duchenne muscular dystrophy, it is recommended that children receive all of their immunizations prior to the initiation of corticosteroids (13).Immunization against influenza of CSHCN, families, and medical providers on a yearly basis is critical to decrease the potential devastating morbidity and mortality associated with this virus. Chemoprophylaxis during an influenza outbreak is also recommended to decrease the ongoing spread. Influenza immunization of all high-risk children older than 6 months of age and their close contacts should be strongly encouraged each fall (14). High-risk children being seen in the rehabilitation clinics should include those with recurrent pneumonias or upper respiratory infections and those with neuromuscular diseases such as spinal muscular atrophy (SMA), congenital myopathies, and muscular dystrophies. Children who may have increased risk from complications due to pneumococcal disease should receive the pneumococcal conjugate and/or polysaccharide vaccine (12).