Hepatitis B vaccination should be administered to unvaccinated adults with diabetes mellitus who are aged 19 through 59 years.
Hepatitis B vaccination may be administered at the discretion of the treating clinician to unvaccinated adults with diabetes mellitus who are aged ≥60 years.
Atlanta, USA – The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has published guidelines recommending adults with diabetes mellitus should be vaccinated against hepatitis B. [1]
In the United States, since 1996, of the total 29 outbreaks of HBV infection in one or multiple long-term–care (LTC) facilities, 25 involved adults with diabetes receiving assisted blood glucose monitoring [2].
The committee concluded that although an estimate of the risk for HBV infection for adults with diabetes living in multiple long-term–care facilities was unavailable; continuing outbreaks suggest that the risk might be substantial.
Dr Sarah F. Schillie, MD (Epidemic Intelligence Service, CDC, Atlanta, Georgia), a co-author of the guidance told the HbA1C blog: “Persons with diagnosed diabetes are at increased risk of hepatitis B infection. This occurs through exposure to small (even invisible) amounts of blood from an infected person who earlier used a shared medical or glucose-monitoring device. Hepatitis B virus can infect the body fluids of persons who do not know they carry it. The virus is environmentally stable and easily transmissible. Exposures can occur, for example, when finger-stick devices or blood glucose monitors designed for one individual are used for more than one person without appropriate cleaning or infection control practice.
The Advisory Committee on Immunization Practices (ACIP) therefore recommended hepatitis B vaccination for all unvaccinated adults with diabetes through age 59 years, and hepatitis B vaccination for older, unvaccinated adults with diabetes at the discretion of their physician. Hepatitis B vaccine may be administered during healthcare visits scheduled for other purposes as long as minimum intervals between doses are observed; there is no maximum interval between doses that makes the hepatitis B vaccination series ineffective.”
ACIP Recommendations
On the basis of available information about HBV risk, morbidity and mortality, available vaccines, age at diagnosis of diabetes, and cost-effectiveness, ACIP recommends the following:
- Hepatitis B vaccination should be administered to unvaccinated adults with diabetes mellitus who are aged 19 through 59 years.
- Hepatitis B vaccination may be administered at the discretion of the treating clinician to unvaccinated adults with diabetes mellitus who are aged ≥60 years.
ACIP further notes that the estimated cost per quality-adjusted life-year saved, based on vaccinating adults with diabetes against hepatitis B was $75,100 for persons aged between 20 and 59 years but increased substantially with increasing age. While, available data do not confirm an advantage to any specific hepatitis B vaccine.
Dr Schillie added, “administration of the hepatitis B vaccine series should be completed as soon as feasible after diabetes is diagnosed. Initiatives are ongoing to improve infection control training of staff responsible for providing or assisting with diabetes care, and to improve the design and labeling of devices used in diabetes monitoring and treatment.” She highlighted that more information can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6050a4.htm
Sources
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Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6050a4.htm - CDC, unpublished data
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