3.0.0.0 Im­mu­niza­tions

Rec­om­men­da­tions

4.7 Pro­vide rou­tinely rec­om­mend­ed vac­ci­na­tions for chil­dren and adults with di­a­betes by age. C

4.8 An­nu­al vac­ci­na­tion against influenza is rec­om­mend­ed for all peo­ple ≥6 months of age, es­pe­cially those with di­a­betes. C

4.9 Vac­ci­na­tion against pneu­mo­coc­cal dis­ease, in­clud­ing pneu­mo­coc­cal pneu­mo­nia, with 13-‍va­lent pneu­mo­coc­cal con­ju­gate vac­cine (PCV13) is rec­om­mend­ed for chil­dren be­fore age 2 years. Peo­ple with di­a­betes ages 2 through 64 years should also re­ceive 23-‍va­lent pneu­mo­coc­cal polysac­cha­ride vac­cine (PPSV23). At age ≥65 years, re­gard­less of vac­ci­na­tion his­to­ry, ad­di­tional PPSV23 vac­ci­na­tion is nec­es­sary. C

4.10 Ad­min­is­ter a 2- or 3-dose se­ries of hep­ati­tis B vac­cine, de­pend­ing on the vac­cine, to un­vac­ci­nat­ed adults with di­a­betes ages 18 through 59 years. C

4.11 Con­sid­er ad­min­is­ter­ing 3-dose se­ries of hep­ati­tis B vac­cine to un­vac­ci­nat­ed adults with di­a­betes ages ≥60 years. C

Chil­dren and adults with di­a­betes should re­ceive vac­ci­na­tions ac­cord­ing to age-‍ap­pro­pri­ate rec­om­men­da­tions (16,17). The child and ado­les­cent (≤18 years of age) vac­ci­na­tion sched­ule is avail­able at www.cdc.gov/vac­cines/ sched­ules/hcp/imz/child-ado­les­cent.html, and the adult (≥19 years of age) vac­ci­na­tion sched­ule is avail­able at www.cdc.gov/vac­cines/sched­ules/hcp/imz/adult.html. These im­mu­niza­tion sched­ules in­clude vac­ci­na­tion sched­ules specifically for chil­dren, ado­les­cents, and adults with di­a­betes.

Peo­ple with di­a­betes are at high­er risk for hep­ati­tis B in­fec­tion and are more like­ly to de­vel­op com­pli­ca­tions from influenza and pneu­mo­coc­cal dis­ease. The Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) Ad­vi­so­ry Com­mit­tee on Im­mu­niza­tion Prac­tices (ACIP) rec­om­mends influenza, pneu­mo­coc­cal, and hep­ati­tis B vac­ci­na­tions specifically for peo­ple with di­a­betes. Vac­ci­na­tions against tetanus-‍diph­the­ria-‍pertussis, measles-‍mumps-‍rubella, human pa­pil­lo­mavirus, and shin­gles are also im­por­tant for adults with di­a­betes, as they are for the gen­er­al pop­u­la­tion.

Influenza

Influenza is a com­mon, pre­ventable in­fec­tious dis­ease as­so­ci­at­ed with high mor­tal­i­ty and mor­bid­i­ty in vul­ner­a­ble pop­u­la­tions in­clud­ing the young and the el­der­ly and peo­ple with chron­ic dis­eases. Influenza vac­ci­na­tion in peo­ple with di­a­betes has been found to significant­ly re­duce influenza and di­a­betes-‍re­lat­ed hos­pi­tal ad­mis­sions (18).

Pneu­mo­coc­cal Pneu­mo­nia

Like influenza, pneu­mo­coc­cal pneu­mo­nia is a com­mon, pre­ventable dis­ease. Peo­ple with di­a­betes are at in­creased risk for the bac­teremic form of pneu­mo­coc­cal in­fec­tion and have been re­ported to have a high risk of noso­co­mi­al bac­teremia, with a mor­tal­i­ty rate as high as 50% (19). The ADA en­dors­es rec­om­men­da­tions from the CDC ACIP that adults age ≥65 years, who are at high­er risk for pneu­mo­coc­cal dis­ease, re­ceive an ad­di­tional 23-‍va­lent pneu­mo­coc­cal polysac­cha­ride vac­cine (PPSV23), re­gard­less of prior pneu­mo­coc­cal vac­ci­na­tion his­to­ry. See de­tailed rec­om­men­da­tions at www.cdc.gov/vac­cines/hcp/acip-recs/vacc-specific/‍pneumo.html.

Hep­ati­tis B

Com­pared with the gen­er­al pop­u­la­tion, peo­ple with type 1 or type 2 di­a­betes have high­er rates of hep­ati­tis B. This may be due to con­tact with in­fect­ed blood or through im­prop­er equip­ment use (glu­cose mon­i­tor­ing de­vices or in­fect­ed nee­dles). Be­cause of the high­er like­li­hood of trans­mis­sion, hep­ati­tis B vac­cine is rec­om­mend­ed for adults with di­a­betes age <60 years. For adults age ≥60 years, hep­ati­tis B vac­cine may be ad­min­is­tered at the dis­cre­tion of the treat­ing clin­i­cian based on the pa­tient’s like­li­hood of ac­quir­ing hep­ati­tis B in­fec­tion.