Immunization in Pediatric Neurodevelopmental disorders: Current Evidence-Based Recommendations

Pediatric Neurodevelopmental disorders (NDDs) comprise of Autism and Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), as well as NDDs due to specific genetic anomaly such as Down Syndrome (DS). This narrative review collates relevant evidence up to August 2025 pertaining to safety, immunogenicity and efficacy profile of various vaccines in NDDs. Level and grade of evidence pertaining to vaccination in these conditions with each vaccine is documented, and current recommendations for immunization in NDDs are summarised. Per current guidelines, all vaccines are recommended; and no vaccine is contraindicated in NDDs including ASD and ADHD. All vaccines are recommended in DS with special emphasis on vaccines against respiratory and middle ear pathogens. Pneumococcal conjugate and polysaccharide, Influenza, Varicella, Meningococcal conjugate, Mumps Measles and Rubella, Hepatitis B and COVID-19 vaccines are specifically recommended. Current recommendations for infant monoclonal antibodies Nirsevimab and Clesrovimab for immunization against Respiratory Syncytial Virus in DS are not different from normal children.