Influenza Vaccine and Tardive Dyskinesia
No, influenza vaccine is not contraindicated in patients with tardive dyskinesia. There is no evidence or guideline that identifies tardive dyskinesia as a contraindication or precaution for influenza vaccination.
Established Contraindications to Influenza Vaccination
The only true contraindications to influenza vaccines are 1:
- Severe allergic reaction (anaphylaxis) to a previous dose of influenza vaccine or any vaccine component
- Severe allergic reaction to eggs (contraindication for egg-based vaccines only, though ACIP recommends any appropriate vaccine can still be used)
- Severe allergic reaction to cell culture components (contraindication for cell culture-based vaccines only)
- Severe allergic reaction to recombinant vaccine components (contraindication for recombinant vaccines only)
Why Tardive Dyskinesia Is Not a Contraindication
Tardive dyskinesia is a movement disorder, not an immunologic or allergic condition, and does not appear in any major vaccination guidelines as a reason to withhold influenza vaccine 1. The condition itself—characterized by involuntary movements typically caused by antipsychotic medications—has no mechanistic relationship to vaccine safety or efficacy.
Neurologic Disorders and Influenza Vaccination
Children and patients with neurologic disorders are actually at higher risk for influenza complications and should receive annual influenza vaccination 2. Neurologic conditions increase vulnerability to influenza-related complications due to compromised pulmonary function, decreased muscle tone, and impaired ability to handle secretions 2.
Psychiatric Medication Considerations
Patients with psychiatric disorders (who may have tardive dyskinesia as a medication side effect) have been shown to have higher influenza vaccine uptake compared to those without psychiatric diagnoses (OR=1.18,95% CI=1.17-1.19) 3. This suggests no clinical concern about vaccinating this population.
One historical study found transient increases in anticonvulsant levels after influenza vaccination, but this pertains to drug metabolism, not vaccine contraindications, and would not apply to antipsychotic medications typically associated with tardive dyskinesia 4.
Clinical Recommendation
Proceed with influenza vaccination in patients with tardive dyskinesia without delay. The vaccine should be administered according to standard guidelines based on age and any relevant immunosuppressive conditions, not based on the presence of this movement disorder 1.