ACIP Group: HBV Vaccination For All Adults With Diabetes

Volume 40, Issue 12, Page 1 (July 2010)
ACIP Group: HBV Vaccination For All Adults With Diabetes
SHARON WORCESTER
pages 2 of 70

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ATLANTA — All adults with diabetes would receive hepatitis B vaccination, under a new proposal from an advisory group at the Centers for Disease Control and Prevention.

The recommendation is based on new, unpublished CDC data revealing that adults with diabetes are more likely than those without the disease to be infected with the hepatitis B virus, along with other data suggesting that the problem may be associated with a lack of proper infection control at many health care facilities,

The Hepatitis Working Group of the CDC's Advisory Committee on Immunization Practices (ACIP) introduced the proposed policy changes at a June meeting, and the group plans to present the proposals for a vote at the committee's next meeting in October, said Dr. Mark Sawyer, chair of the working group.

Specifically, in light of increasing evidence of heightened risk in the diabetic population, the group will recommend that all unvaccinated adults with diabetes complete the vaccination series as soon as feasible after diagnosis, and that those age 60 years and older undergo postvaccination serology for antibody to hepatitis B surface antigen 1-2 months after completion of the vaccination series.

Those who fail to achieve a seroprotective level of 10 mIU/mL anti-HBs would receive three additional doses of hepatitis B vaccine and repeat postvaccination serology under the working group's proposed policy.

The proposals were developed in light of the CDC data from the 1999-2008 National Health and Nutrition Examination Surveys (NHANES), which showed that overall prevalence of hepatitis B among adults older than 18 years of age with diabetes is 8.3%, compared with 5.2% in those without diabetes, Dr. Dale Hu reported at the meeting.

The odds ratio and prevalence ratio for hepatitis B in diabetic patients based on those survey data were 1.66 and 1.61, respectively, said Dr. Hu of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).

In one CDC investigation of 13 outbreaks involving serosurveys of 1,278 patients, 30.5% of 338 diabetic patients vs. 1.0% of 940 nondiabetic patients had acute infection, and 6.3% vs. 0.4% of the groups, respectively, had chronic infection, Dr. Hu said.

Numerous reports of outbreaks of hepatitis B infection in diabetic patients suggest that poor infection control practices involving the use of glucose meters may play a role in the increased risk in this population.

For example, a study published earlier this year showed that 46 of 68 (68%) ambulatory care centers had at least one lapse in infection control, and that 21% of the 68 centers used single-use lancing penlets for blood glucose monitoring in multiple patients; 32% failed to clean and disinfect glucose meters after each use (JAMA 2010;303:2273-9).

Since the increased prevalence of hepatitis B infection in adults with diabetes is comparable to the historical prevalence in certain groups of health care workers, the working group is recommending a similar vaccination program to that used for health care workers. That will include improved infection control practices, and innovations in labeling, cleaning, and design of blood glucose monitoring devices to prevent transmission of all bloodborne pathogens, in addition to vaccination of all adults with diabetes.

“Hepatitis B vaccine, coupled with universal precautions and increased infection control, has been very effective in reducing the prevalence and incidence among health care personnel, and has the potential to do the same among adults with diabetes,” Dr. Hu said.

The working group is planning a cost-effectiveness analysis to be presented to ACIP in October in regard to their recommendations, along with proposals for implementing the policies, said Dr. Sawyer, professor of clinical pediatrics in the division of pediatric infectious disease, University of California, San Diego.

ACIP members who commented on the proposals generally agreed with the working group regarding the need for vaccination of adults with diabetes, with multiple members suggesting that such policy would move the committee a step closer to recommending universal hepatitis B vaccination.

Dr. Sawyer said he had no conflicts of interest.

From a meeting of the CDC's Advisory Committee on Immunization Practices

PII: S0300-7073(10)70737-4

doi:10.1016/S0300-7073(10)70737-4

© 2010 Elsevier Inc. All rights reserved.

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ACIP Group: HBV Vaccination For All Adults With Diabetes