How to Give a Strong Recommendation to Adult Patients Who Require Vaccination

Mary C. Anderson, MD; Marie T. Brown, MD; Marie-Michele Léger, MPH, PA-C; Aparna Ramakrishnan, MA, MSW


April 16, 2015

Case Presentation: The Patient With Diabetes

Joseph is a 45-year-old man with diabetes and is a new patient to your practice. During his first routine physical in December, you review his vaccination history and determine that he has recently received Tdap and pneumococcal polysaccharide vaccines but needs his annual influenza vaccine and the hepatitis B vaccine series. You recommend that he receive these vaccines, but he has questions.

He asks, "Why do I need hepatitis B vaccine? Am I at risk for that?" Providing tailored reasons why the vaccine is recommended for the patient and explaining potential consequences of not becoming vaccinated can strengthen your vaccine recommendation and encourage patients to become vaccinated.

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Diabetes and Vaccination

People living with type 1 or type 2 diabetes have higher rates of hepatitis B infection than the general population. Improper reuse and sharing of glucose monitoring equipment or other diabetes care equipment can lead to transmission of the disease. ACIP recommends that all previously unvaccinated adults aged 19-59 years with diabetes (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made. Unvaccinated adults aged 60 years or older with diabetes may be vaccinated at the discretion of the treating clinician after assessing their risk and the likelihood of an adequate immune response to vaccination. Review detailed ACIP recommendations on "Use of Hepatitis B Vaccination for Adults With Diabetes Mellitus."

Other vaccines recommended for patients with diabetes include:

  • Annual influenza vaccine;

  • Pneumococcal polysaccharide vaccine (PPSV23) before age 65 years; and

  • Pneumococcal conjugate vaccine (PCV13) at age 65 years followed 6-12 months later by PPSV23.

Joseph also asks, "Do I really need a flu shot? Flu isn't that serious, and I heard the vaccine doesn't work very well anyway. Plus, some of my friends got sick from the flu vaccine, so why should I take that chance?"

It is not surprising to HCPs to hear of the many misconceptions about influenza and influenza vaccine that are prevalent in the community. HCPs are essential to counter those myths by providing facts in plain and understandable language. Highlighting positive experiences with vaccination (whether personal or in your practice) can help reinforce benefits and boost patient confidence in vaccines as well.

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Diabetes and Influenza

Even well-managed patients with type 1 and 2 diabetes are at high risk for serious influenza complications, such as hospitalization and even death. CDC recommends that these patients, who are 6 months and older, receive an annual vaccine. The inactivated influenza vaccine (IIV) ("flu shot") has a long, established safety record in people with diabetes; live attenuated influenza vaccine (LAIV) delivered via nasal spray is not recommended for people with diabetes and some other high-risk conditions.


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