Hepatitis B Vaccination for People with Diabetes

Compelling evidence points to necessity of immunization

Theresa GarneroBy Theresa Garnero, APRN, BC-ADM, MSN, CDE

Add this to the list of medical things to worry about: getting vaccinated against hepatitis B. It's worth your consideration.

Adults with diabetes (type 1 and 2) less than 60 years of age have twice the risk for hepatitis B. This is one of the reasons why the Infectious Diseases Society of America recommended to the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) that all patients with diabetes receive immunization with the hepatitis B vaccine.

The ACIP, American Academy of Pediatrics, and American Academy of Family Physicians all recommend universal hepatitis B vaccination for children in the U.S. starting in infancy. That is, all children through age 18, not just children with diabetes.

What is hepatitis B?
Hepatitis B is a viral infection that attacks the liver. Symptoms last several weeks and may extend up to a year, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting, and abdominal pain. It often causes chronic (life long) liver disease and puts people at high risk of death from cirrhosis (scarring of the liver and poor liver function) as well as liver cancer.

The virus is transmitted through contact with the blood or other body fluids of an infected person. You cannot get hepatitis B through casual contact. It is a major global health problem. About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection.

Hepatitis B is 95% preventable with a vaccine that has been available since 1982. It is the first vaccine against a major human cancer (liver). Most healthcare facilities require their employees take the hepatitis B vaccine due to the occupational hazard and risk for exposure to the virus.

What is the connection to diabetes?
Outbreaks of hepatitis B have occurred in people with diabetes over the past several years when more than one person uses the monitor and the device is not cleaned adequately. The monitors can be difficult to completely clean residual blood because of their design and more thorough cleaning can damage the equipment. Sharing insulin pens with new needles is also a source of infection.

The higher risk places include assisted-living facilities, physician offices, and at pharmacies. Although healthcare systems need to adequately train staff, realize that lapses in infection control will happen; stay vigilant in all surroundings.

According to Dr. Trudy Murphy, head of the vaccine unit in the Division of Viral Hepatitis at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta, a total of 24 of 28 outbreaks at long-term care facilities identified different aspects of blood glucose monitoring as the source of the infection.

You don't have to be in a nursing home to be at risk. One outstanding example occurred at an HMO wherein a certified diabetes educator potentially exposed 2,345 patients over a 5-year period via use of a multi-lancet finger stick device and shared insulin pens. Other people have been exposed to the virus from multi-lancet finger stick devices used at health fairs and community centers, and in the hospital by sharing insulin pens. Some nurses thought it was acceptable to use the same insulin pen with a new disposable needle for different patients. Studies have shown that biological contamination of insulin occurred in up to half of all insulin pen cartridges, entering the cartridge after injection while the needle is attached to the pen.

The CDC reviewed acute hepatitis cases reported during 2009 and 2010 at eight U.S. sites. The review included 865 people with hepatitis B infections, including 95 with diabetes.

According to Ms. Meredith Reilly, an epidemiologist in the CDC's Division of Viral Hepatitis, the patients with diabetes who were 23-59 years old had a 2.1-fold higher risk of being infected with hepatitis B, compared with the people studied who did not have diabetes. This analysis controlled for gender, age, race and ethnicity, and other hepatitis B risk factors (such as injecting drug use, men who have sex with men). Among those aged 22 years or younger, the patients with diabetes had a significant, 1.9-fold increased risk for hepatitis B infection. Among those aged 60 years or older, the risk of hepatitis B infection was 50% higher in patients with diabetes, a difference that did not achieve statistical significance.

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Last Modified Date: April 04, 2013

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by Brenda Bell
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...
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