Hepatitis B vaccine recommended for adults with diabetes

Hepatitis B vaccination is now recommended for all previously unvaccinated adults aged 19 through 59 years as soon as possible after a diagnosis of diabetes, according to the Advisory Committee on Immunization Practices (ACIP).

This comes after ACIP studied hepatitis B outbreaks in U.S. long-term care facilities and found that of 29 outbreaks reported to CDC since 1996, 25 cases involved adults with diabetes receiving assisted blood glucose monitoring.

The move is designed to reduce the incidence of liver disease and liver cancer among people living with diabetes. Both hepatitis B infection and diabetes are risk factors for developing those diseases.

Hepatitis B virus causes chronic and acute infection of the liver, with chronic infection leading to cirrhosis and liver cancer in more than 15 percent of infected adults.

Meanwhile, people with both type 1 and type 2 diabetes are at increased risk for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, the most common form of liver cancer. Adults with diabetes are about twice as likely to develop nonalcoholic liver disease and liver cancer as those without diabetes.

Adults with diabetes aged 60 years and older should be vaccinated at the discretion of the treating physician, according to ACIP. The evidence for risk of acute HBV infection is less strong for older patients with diabetes than younger patients.

Highly infectious
Hepatitis B virus is highly infectious. It can be transmitted by medical equipment contaminated with blood. Transmission can occur from inadequate cleaning and disinfection of blood glucose monitors between patients and use of finger stick devices by many people instead of just one as intended.

CDC had documented breaches in proper handling in many settings. These include long-term care facilities, hospitals, community health centers, ambulatory surgical centers, private offices, homes, and health fairs.

An estimated 700,000 to 1.4 million people are infected with hepatitis B virus, according to CDC.

People can live for decades with chronic hepatitis B infection. Compared with healthy adults, older adults with diabetes have a higher rate of chronic hepatitis B infection stemming from acute infection.

Other data from CDC indicate a slightly higher case fatality rate among acute hepatitis B infected people with diagnosed diabetes compared with those without diabetes.

Hepatitis B vaccination usually consists of three doses of vaccine administered at zero, one and six months.

Source: Centers for Disease Control and Prevention

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