As the school year wraps up, many families are beginning to prepare for summer activities. We have recently received questions about vaccination requirements, especially if parents are planning to send their child to camp. Specifically, most camps are requiring that Varicella (“chickenpox”) and MMR (measles, mumps, and rubella) vaccinations are up to date, and families are asking whether giving these vaccinations to their children is  safe to give with steroids.

According to the CDC Immunization Schedule, the first dose of both Varicella and MMR vaccinations should be given between 12-15 months. A second dose, or “booster” is then recommended at 4-6 years to increase immunity to these viruses. Both varicella and MMR vaccinations are live-attenuated vaccines, meaning the vaccine contains a weakened, but live virus. If your child living with Duchenne is taking daily steroids, they may be considered immunosuppressed. This is important to know, because an immunosuppressed child may be at risk for acquiring diseases from live-attenuated vaccinations. 

It is important to talk to your child’s primary care provider before receiving required vaccinations for camp. It may be possible for them to order a titer, which is a blood test that checks the antibody level that you have to a virus.  If you have a high enough titer, it means that you are immune to the disease and do not require further vaccination. Viral titers can show whether your child is immune to chickenpox, measles, mumps, and rubella, and if they require the booster dose of these vaccinations.

However, if it is necessary to receive either of these vaccinations, the following recommendations from the Centers for Disease Control and Prevention should be followed:

• Younger children receiving 2mg/kg/day or more of prednisone or 2.4mg/kg/day or more of Emflaza daily are considered to be immunosuppressed and should NOT receive live-attenuated vaccines.
• Older children, teens and adults receiving 20mg/day or more of prednisone or 24 mg/day or more of Emflaza daily are considered to be immunosuppressed. If these patients require administration of a live vaccine, it is recommended that the dose of corticosteroids be reduced to less than 20mg/day of prednisone or 24 mg/day of Emflaza daily for a period of 1 month before and 1 month after receiving the live-attenuated vaccine.
• People receiving less than 2mg/kg/day of prednisone or 2.4mg/kg/day of Emflaza daily are NOT considered to be immunosuppressed and may receive live-attenuated vaccines if necessary.
• People receiving intermittent corticosteroid dosing (alternate day, weekend dosing, 10 days on/10 days off, etc.) are NOT considered to be immunosuppressed (regardless of dose) and may receive live-attenuated vaccines if necessary.

We hope you have a fun and safe time at camp! If you have any more questions about vaccinations, please visit our Vaccination Recommendations webpage for more information.