Children with severe epilepsy should receive flu vaccination: Research

According to a recent study, children with a severe type of epilepsy should take the flu vaccination due to the higher risk of seizures caused by an influenza infection. The risk of severe neurological symptoms and complications, such as worsening seizures, declining language and motor skills, and even death, led the Murdoch Children’s Research Institute and the University of Melbourne researchers to conclude that the safe administration of the seasonal influenza vaccine should be a priority in people with SCN1A-positive Dravet syndrome.

According to Murdoch Children’s paediatric neurologist Dr Katherine Howell, the decision for parents to vaccinate their children with this syndrome is complex since seizures can be caused by both illness and immunisation. Despite the fact that the condition has been connected to a high prevalence of extended seizures during infections, Dr. Howell claims that the consequences of influenza have yet to be studied.

The research, published in Neurology, included children with SCN1A-positive Dravet syndrome who had a confirmed flu infection at The Royal Children’s and Austin Hospitals. Researchers observed that 21 children were infected with the flu 24 times, with brain abnormalities occurring in 88% of those cases.

All presented to the hospital, with 75% healing promptly, but one in every five infections resulted in death or long-term brain damage. They each got 60 influenza injections, with the majority of them tolerating the vaccine well.
“Concerns about giving the flu vaccine and incomplete routine immunisations are common in this patient group due to the risk of seizures after vaccination,” Dr Howell said.

However, because this syndrome is also associated with a high risk of seizures during infections, it highlights the critical need to protect patients from the complications of vaccine-preventable infections like the flu. Our research highlights that the benefits of flu vaccines for these children far outweigh the risks of seizures being triggered following vaccination.”

SCN1A-positive Dravet syndrome, the most common severe form of genetic epilepsy, affects one in every 15,000 children.
Fraser Caddy, 4, of Melbourne, started having seizures as a baby and was subsequently diagnosed with SCN1A-Dravet syndrome. Renae noted that her child now gets an annual flu vaccination to avoid experiencing long seizures, which are usually caused by sickness. Fraser spent four days in the hospital after having a two-hour seizure due to the virus when he was 11 months old.

“The seizures have gone from monthly to weekly, but they are much shorter now, resolving after a few minutes rather than a couple of hours,” she said. But if he has a viral infection he will seize for as long as his temperature is high and may need a lot of medication and even intubation to get his seizures under control. “It can take Fraser up to four days to get back to normal after he experiences a severe seizure so anything we can do to avoid him getting sick we will do.” Renae said all his influenza vaccines had been well-tolerated with no seizures.

“The research is reassuring for parents that it’s beneficial for children with this condition to have the flu shot to try and avoid an onset of seizures caused by an infection, which are damaging and terrifying to watch,” she said.
University of Melbourne Professor Ingrid Scheffer said the findings would change clinical practice.

“Identifying safe strategies and strongly encouraging influenza vaccination in children and adults with SCN1A-Dravet syndrome is critical,” she said. “Prior to influenza vaccination, vaccine providers should review the child’s regular anti-seizure medications and ensure a seizure management plan is in place. The use of additional anti-seizure medications in the post-vaccination period, such as benzodiazepines, is now recommended to reduce the risk of seizures following a vaccine and is becoming routine practice.”