IMMUNIZATION OF PATIENTS WITH NEUROLOGICAL DISORDERS – WHAT PEDIATRICIAN MUST KNOW

Abstract

Introduction: We can notice aggressive anti-vaccination rhetoric in the public. In everyday pediatric clinical practice, there are frequent dilemmas related to vaccination of children suffering from neurological diseases. The negative but also vague attitude of pediatricians regarding mandatory immunization contributes to additional confusion for parents, and on the other hand, children are exposed to serious infectious diseases that could have been prevented.

The aim of this work is to form clear and practical guidelines related to the immunization of neurologically ill children.

Method: A review of papers, relevant guides and case reports from clinical practice was performed. Neurological diseases are divided into neuromuscular, cerebrovascular and autoimmune neurological diseases, cerebral palsy as a separate unit, epilepsies, with a special focus on drug-resistant epilepsy and epileptic encephalopathies, as well as neurodevelopmental disorders, with an emphasis on delayed psychomotor development, hyperactivity. and attention disorders. Then, for each of the mentioned group. general and specific contraindications for mandatory and supplementary immunization, which is carried out in Montenegro, are listed.

Results: Most of the research on impact immunization on neurological diseases is focused on autism, acute polyradiculoneuritis, acute demyelinating encephalomyelitis and multiple sclerosis. After reviewing the academic literature, no cause-and-effect relationship was found regarding autism and vaccination. For the occurrence or relapse of the autoimmune diseases, the more common trigger than vaccines are the same infectious diseases, so the postponement of certain vaccines is suggested if the disease occurs within the sixth week of the previous dose of vaccine. In children with (progressive) epileptic encephalopathies, administration of the vaccine against diphtheria, pertussis and tetanus is contraindicated until the condition is stabilized. Additional caution is recommended in patients with epilepsy in case of administration of polyvalent vaccine against measles, rubella, mumps and varicella.

Conclusion: Very few neurological diseases are contraindications for immunization. A clear position of pediatricians on vaccination is necessary, because only with knowledge can we fight against anti-vaccination propaganda.