ACIP Recommends HBV Vaccine in Patients With Diabetes

Emma Hitt, PhD

October 26, 2011

October 26, 2011 ( UPDATED October 27, 2011 ) — Vaccination against hepatitis B virus (HBV) in patients with diabetes who are younger than 60 years is now recommended by the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices.

The committee voted yesterday 12 to 2 in favor of the recommendation. The specific provisional wording voted on yesterday was that "hepatitis B vaccination should be administered to unvaccinated adults with diabetes who are <60 years of age and that hepatitis B vaccination may be administered to unvaccinated adults with diabetes who are >60 years of age."

Trudy Murphy, MD, from the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, led the vote, which took place at the 2-day session, held twice a year by the CDC.

The HBV vaccine recommendation for people with diabetes was supported by data indicating that patients younger than 60 years have about twice the risk of being infected with HBV compared with people without diabetes.

Patients with diabetes may be especially at risk of contracting HBV in settings where patients are receiving assisted monitoring of blood glucose, such as in assisted-living facilities. According to the CDC, several cases of HBV have occurred in these settings as a result of glucose monitoring procedures. However, studies found no significant increase of HBV incidence in patients with diabetes who were older than 60 years, according to data presented at the meeting yesterday.

Dr. Murphy pointed out that the data suggest that adults with diabetes benefit from HBV vaccination, but considerations include how "age of diabetes diagnosis may affect the proportion of those who would be protected by vaccination and the cost effectiveness of vaccination related to age. These considerations led to the formulation of the proposed recommendations," she said.

According to Dr. Murphy, an analysis indicated that vaccination for adults with diabetes who are younger than 60 years is cost-effective. "[The Advisory Committee on Immunization Practices] recommends that providers use clinical discretion for decisions to vaccinate adults with diabetes who are 60 years and older and are most likely to respond to [HBV] and be at increased risk of exposure through assisted blood glucose monitoring," she told Medscape Medical News.

Dr. Murphy added that "continued efforts are needed to increase adherence to recommended infection control practice related to diabetes monitoring procedures." However, she emphasized that adults with diabetes are not at risk of HBV infection when they monitor their own blood glucose with equipment that is not shared with anyone else.

"Vaccination should occur as soon as feasible after diabetes diagnosis due to declining vaccine immunogenicity associated with increasing age," she said.

The CDC first recommended routine HBV vaccination for children and adolescents beginning in 1991. At-risk adults should also be vaccinated. These include people with chronic liver or kidney disease, men who have sex with men, people with more than 1 sex partner, and those whose jobs expose them to human blood.


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