With all the talk of getting the nation prepared to possibly be vaccinated against smallpox, what dangers do our immunocompromised children face that others do not face? Will we be left to make the decision whether or not to vaccinate our children?

There is no reason to think kids or adults with diabetes are at any greater risk from any immunizations including smallpox than those without diabetes. It is a live virus so would cause a viral-like illness that would require routine sick day blood glucose testing, ketone testing and perhaps some extra insulin on an individual basis based upon monitoring.

SB
Additional comments from Dr. Donough O’Brien:

Smallpox vaccination was suspended in the U.S. some thirty years ago because it became clear that the incidence of serious complications far outstripped the chances of getting smallpox itself. This happened before there was any detailed understanding of the mechanisms of autoimmunity in type 1A (autoimmune) diabetes, and for this reason, there are no studies that compare the outcome of vaccination in children with diabetes to those who do not have it.

What is known now however is that significant complications of vaccination occurred in the immunologically compromised, a group that would now include those with HIV infection as well as those with eczema and rare conditions like agammaglobulinemia. The immune disorder in type 1A diabetes is of a quite different kind and is due to the activation of a group of T-cells in certain genetically predisposed individuals by insulin, insulin fragments and other autoantigens that show molecular mimicry. These T-cells primarily target the islet cells, although in the Autoimmune Polyglandular Syndrome Type II other tissue such as the thyroid and the intestinal mucosa may be involved as well.

There is no evidence that children with this form of diabetes who are already insulin dependent and in good control are any more susceptible to bacterial and viral exposure. It is inconceivable that any widespread program of vaccination on account of terrorism would not be accompanied by advisory statements from authorities like the CDC in Atlanta, the ADA and the Academy of Pediatrics.

DOB