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CDC: Hep B Vaccine Needed for Diabetic Adults

Posted: Monday, January 02, 2012

Diabetic adults should be vaccinated against hepatitis B virus (HBV) as soon as possible after the diabetes diagnosis is made.

The recommendation, adopted by the agency's Advisory Committee on Immunization Practices (ACIP) applies to unvaccinated adults ages 19 to 59. Citing more limited data for older diabetics, committee members left the decision about whether to vaccinate diabetic adults 60 and older to the treating clinician. The decision should be based on the risk of becoming infected with HBV -- including a consideration of the need for assisted blood glucose monitoring in long-term-care facilities -- and the likelihood of an adequate immune response to vaccination, which decreases with age.

No vaccination is necessary in patients who have been fully immunized at any point in the past, according to the recommendations.

ACIP first started looking into the risk of HBV infection in diabetic adults after a series of outbreaks in long-term-care facilities starting in the mid-1990s. Some of the affected individuals included diabetic patients receiving assisted blood glucose monitoring.

At one of ACIP's regular meetings in October, committee members saw data from the Emerging Infections Program, which showed that patients ages 23 to 59 with diabetes were about twice as likely to develop acute hepatitis B compared with individuals without diabetes (OR 2.1, 95% CI 1.6 to 2.8).

For older adults, the odds ratio was 1.5 (95% CI 0.9 to 2.5).

ACIP adopted the recommendations for vaccination after reviewing data on HBV infection-related morbidity and mortality, available vaccines, age at diagnosis of diabetes, cost-effectiveness, and the effectiveness of implementing infection prevention and control measures.

The authors urged efforts to increase adherence to recommended infection control practices.

"Lapses in infection control during assisted blood glucose monitoring that have led to HBV transmission include multi-patient use of finger-stick devices designed for single-patient use and inadequate disinfection and cleaning of blood glucose monitors between patients," they wrote.

"Breaches have been documented in various settings, including long-term-care facilities, hospitals, community health centers, ambulatory surgical centers, private offices, homes, and health fairs."

In the same issue of MMWR, ACIP's recommendations for vaccination of boys and young men against human papillomavirus (HPV) -- adopted in October -- became official.

The recommendations included the following:

Boys ages 11 and 12 should be routinely vaccinated with the quadrivalent HPV vaccine (Gardasil).
Males ages 13 to 21 should be vaccinated if they have not been fully immunized with the three-dose series.
Males ages 22 to 26 may be vaccinated.
The HPV vaccination series can be started as young as age 9.

Aside from direct benefits, including protection against genital warts and anal cancer, vaccination of males is expected to lessen the burden of HPV in females, who are already advised to get routinely vaccinated at ages 11 and 12.

The recommendations regarding male vaccination replace the 2009 incarnation, which advised against routine use in boys but stated that the vaccine could be given to males ages 9 to 26 to reduce the risk of genital warts.

Practice Pearls

A CDC Work Group found that persons ages 23 through 59 years with diabetes had approximately twice the likelihood of developing acute hepatitis B as those without diabetes.
Based upon these data, the CDC has recommended that all previously unvaccinated adults ages 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made.

Source: http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=11967-cdc-hep-b-vaccine-needed-for-diabetic-adults&catid=1&Itemid=8, Dunne E, et al "Recommendations on the use of quadrivalent human papillomavirus vaccine in males -- Advisory Committee on Immunization Practices (ACIP), 2011" MMWR 2011; 60: 1705-1708. Sawyer M, et al "Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP)" MMWR 2011; 60: 1709-1711. Morbidity and Mortality Weekly Report, Dec. 23, 2011.