Guidelines on Immunization of People with Chronic Neurological Disorders: A Systematic Review.

Abstract

Background: People with chronic neurological disorders may be vulnerable to severe outcomes from vaccine-preventable infections. However, immunization recommendations for these patients may be difficult to identify and apply. This systematic review aimed to identify and describe official guidelines on preventive active immunization for individuals with chronic neurological disorders.

Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and registered in the PROSPERO International prospective register of systematic reviews (CRD420251005848). Bibliographic databases (PubMed, Embase, Scopus) and grey literature sources were searched to identify official national or international clinical practice guidelines or comparable structured guidance documents providing recommendations relevant to chronic neurological disorders. The search was restricted to countries with a Human Development Index greater than 0.8, to allow comparison across broadly comparable healthcare and socioeconomic contexts. Data were extracted on document characteristics, neurological conditions addressed, vaccines covered, and vaccination-related recommendations.

Results: Overall, 12 unique documents were included. Four were vaccination-focused documents including recommendations for neurological disorders, four were disease-management guidelines including vaccination-related recommendations, and four specifically addressed vaccination in selected neurological diseases. Guidance was unevenly distributed across countries, neurological conditions, and document types. Influenza and COVID-19 vaccination were the most consistently addressed vaccines. Multiple sclerosis was the condition with the most detailed guidance, especially regarding vaccination before disease-modifying therapies, live attenuated vaccines, vaccine timing in relation to immunosuppression or relapse, and protection of close contacts.

Conclusions: Official immunization guidance for people with chronic neurological disorders remains limited and heterogeneous. Future guidelines should provide clearer and regularly updated recommendations to support vaccination assessment, treatment-sensitive planning, and multidisciplinary coordination.