New Guidelines Recommend Hep B Vaccine for Adult Diabetics

New guidelines from the US Advisory Committee on Immunization Practices (ACIP) advise all diabetes patients between the ages of 19 and 59 to receive the hepatitis B vaccination and urge those over the age of 60 to consult a physician prior to receiving the vaccine. The recommendations were published by the Centers for Disease Control and Prevention (CDC) in the December 23 issue of Morbidity and Mortality Weekly Report.

Chronic hepatitis B virus (HBV) can lead to severe and enduring liver infection, which often results in a serious decline of overall physical wellbeing and even death. HBV is transmissible via bodily fluids, but the virus can survive outside the body for an extended period of time. The report authors write that diabetes patients have a heightened risk of infection because “HBV can be transmitted by medical equipment that is contaminated with blood that is not visible to the unaided eye."

According to the report, 29 outbreaks of HBV have been reported to the CDC since 1996 in long-term care facilities, such as nursing and assisted-living homes, 25 of which involved adult diabetes patients being administered assisted blood glucose monitoring. These incidents motivated the ACIP Hepatitis Vaccines Work Group to assess the risk of HBV infection among adults with either type 1 or type 2 diabetes.

The assessment involved individuals who did not take part in activities related to increased HBV risk, such as drug use or intercourse with multiple partners. The researchers found that diabetes patients between the ages of 23 and 59 had 2.1 times the risk of developing acute hepatitis B compared with non-diabetic patients.

This increased risk among the diabetic population could be attributed to “lapses in infection control during assisted blood glucose monitoring,” write the authors, including “multipatient use of finger stick devices designed for single-patient use and inadequate disinfection and cleaning of blood glucose monitors between patients.”

The authors added that programs have been implemented to promote better labeling of equipment used in diabetes monitoring and care in assisted living centers. Improved training regarding how HBV is transmitted is also being encouraged for health workers who care for diabetes patients.

The authors, however, write that more needs to be done to stress the importance of adherence to disease control guidelines. Misuse of blood-contaminated equipment not only increases the chance of spreading HBV, but also of spreading other bloodborne pathogens such as hepatitis C and the human immunodeficiency virus (HIV).