ACIP recommends HBV vaccination for adults with diabetes

In a 12-2 vote, members of Advisory Committee on Immunization Practices recommended for hepatitis B virus vaccination in unvaccinated adults with diabetes who are aged younger than 60 years, and that the vaccine may be administered to unvaccinated adults with diabetes who are aged at least 60 years.

Mark Sawyer, MD, chairman of the ACIP working group, said this recommendation was prompted by a number of outbreaks of hepatitis B virus (HBV) in institutional settings.

Trudy Murphy, MD, of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said: "With the information on the increased risk for HBV among adults with diabetes, the working group considered the potential benefits that might be achieved by vaccination, 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."

Murphy presented 2009-2010 data from the Emerging Infection Program that indicate approximately a twofold increased risk for acute HBV infection among adults aged 60 years and younger with diabetes compared with adults without diabetes. A slight increased risk was observed in adults with diabetes aged older than 60 years.

She also presented results from a cost-effective analysis that suggested an HBV vaccination program would be most cost-effective among those with diabetes aged younger than 60 years — with savings of approximately $75,000 for quality-adjusted life year gained.

"Modeling estimates demonstrate that an HBV vaccination program with 10% coverage among adults with diabetes aged between 20 and 59 years would be expected to avert 4,271 HBV infections, 467 hospitalizations, 202 cases of cirrhosis, 33 cases of hepatocellular carcinoma, 13 liver transplants and 130 deaths," said Sarah Schillie, MD, MPH, MBA, epidemic intelligence service officer for the CDC. – by Ashley DeNyse

This is an interesting finding regarding increased rates of HBV in patients with diabetes. It seems that the risk would certainly be highest in patients who require hospitalization or other institutional care, as they will be exposed to assisted glucose monitoring. Targeting this particular subset of the diabetes population would likely increase the benefits of a vaccination program even further. These patients may include those with type 1 diabetes with frequent episodes of diabetic ketoacidosis, those with multiple complications, and older patients in skilled nursing facilities. Given the large percentage of patients with diabetes (around 8% of the population), this recommendation could greatly expand the level of HBV vaccination nationwide.

– Dawn Belt Davis, MD, PhD
Endocrine Today Editorial Board Member

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