Immunization Recommendations for Children With Metabolic Disorders: More Data Would Help

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Since Jenner's initial success with cowpox vaccination, active immunization with a wide variety of vaccines and toxoids has represented the most effective means of preventing infectious diseases and their disability and mortality. The benefits of successful immunization programs include not only a reduction in the disease burden associated with the infection (morbidity, pain, suffering, and even mortality) but also a significant savings of health care dollars in both developed and resource-poor countries. In the United States, declines of >95% have been noted for many infections for which universal vaccination has been implemented.1 For nearly all of the available vaccines given to children in the United States, there are significant health care dollars saved for every dollar invested. As one example, universal immunization with the measles-mumps-rubella vaccine saves $7.00 to $9.00 for every dollar spent.2 Currently recommended childhood vaccines have a significant beneficial public health impact. Despite the clear benefit to society, vaccines have a potential for reactions that might adversely affect the individual child. The actual risk/benefit of each vaccine for each individual child may vary. The spectrum of clinical manifestations and severity of illness in children with metabolic disorders are as varied as the metabolic defects responsible for these conditions. Alterations in specific enzyme systems in children with inborn errors of metabolism can result in metabolic abnormalities that may be adversely affected by the metabolic changes that result from the inflammatory response associated with most infectious diseases. In addition, infections frequently result in temporary anorexia, vomiting, or diarrhea, which may further upset the metabolic homeostasis in the child with a metabolic disorder. Even minor infections have the potential of causing clinical decompensation in fragile children with metabolic disorders. There are also reports in the literature in which the initial clinical manifestations in children with inborn errors of … Address correspondence to Michael T. Brady, MD, Columbus Children's Hospital, 700 Children's Dr, AB 7048, Columbus, OH 43205. E-mail: mbrady{at}chi.osu.edu