Sense and sensibility
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1 Vaccination in diabetes and morbidly obese Sense and sensibility C. Mathieu Endocrinology UZ Leuven
2 Advice Superior Health Council Diabetes Mellitus Children < 16 years Influenza (annually) Adults and adolescents > 16 years Influenza (annually) Metabolic conditions, including morbid obesity (BMI>35) Influenza (annually) HGR nr. 8561
3 Questions Are patients with diabetes/obesity more susceptible to viral infections? Is there higher morbidity/mortality in patients with diabetes/obesity in case of viral infections, eg. influenza
4 Diabetes and infections: is there a link?
5 Diabetes and infections: is there a link? Casqueiro et al. Indian Journal of Endocrinology and Metabolism 2012
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10 Questions Are patients with diabetes/obesity more susceptible to viral infections? Not clearly Is there higher morbidity/mortality in patients with diabetes/obesity in case of viral infections, eg. influenza
11 Diabetes and influenza, not a desirable combination potential of loosing glycemic control increased risk of complications of influenza, ICU admission and death
12 Allard et al. Diabetes Care 2010
13 Diabetes and mortality in pandemic A/H1N1 Chowell PLoS ONE 2012
14 Obesity and influenza, not a desirable combination Outcome Event rate per 1000 person-years OR a (95% CI) Respiratory hospitalizations resulting in admission to an Intensive care unit (2002/2003 through 2007/2008 influenza seasons only) 0.67 <18.5 (underweight) ( ) (normal weight) (overweight) ( ) (obese class I) ( ) 35 (obese class II or III) ( ) Kwong et al. Clin Infect Dis 2011
15 Effectivity of influenza vaccination in diabetes? YES Annual influenza vaccination in patients with (type 2) diabetes lowers the risk of severe complications, hospitalisatioin and mortality with more than 50% < 65 y: NNT to avoid 1 hospitalisation/death ± y: NNT to avoid 1 hospitalisation/death ± 130
16 Standpunt VDV griepvaccinatie bij diabetes Iedereen die door leeftijd of ziekte meer risico loopt op complicaties, heeft baat bij jaarlijkse griepvaccinatie Griepvaccinatie bij diabetes is doeltreffend Dus: griepvaccinatie voor IEDEREEN MET DIABETES, jong of oud, diabetescomplicaties of niet, op insuline/incretinemimetica of behandeling met orale medicatie Bevraging diabetesconventiecentra 2008: 80% diabetologen volgt dit standpunt, echter 40% niet overtuigd van nut vaccinatie kinderen/adolescenten (T1) Positieve trend vaccinatie < 65 j diabetici laatste jaren (griepcampagne?)
17 2. Pneumokoccal vaccination and diabetes? ADA. Diab Care 2004 Immunization against influenza and pneumococcal disease is an important part of preventive services for many chronic diseases such as diabetes.
18 Risk for pneumococcal infections is increased in diabetes Kyaw et al. J Infect Dis RRdiabetes (adjusted): 3.4
19 Mortality upon pneumococcal infection in diabetes?? Cohortstudy Denmark (Thomsen, Diab Care 2004) After correcting for age, gender, comorbidity: RR mortality = 0.6 vs nondiabetics
20 Cost-effectiveness vaccination? Rozenbaum et al. BMJ 2012.
21 3. Hepatitis B vaccination and diabetes? Kirkman & Schaffner. Diab Care 2012.
22 ACIP Recommendations 2011 ACIP recommended that all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made (recommendation category A). Data on the risk for hepatitis B among adults aged 60 years are less robust. Therefore, ACIP recommended that unvaccinated adults aged 60 years with diabetes may be vaccinated at the discretion of the treating clinician after assessing their risk and the likelihood of an adequate immune response to vaccination (recommendation category B).
23 Hepatitis B risk in residential homes
24 WISE Recommendations to ensure the safety of injections in diabetes K. Strauss, WISE Consensus Group. Diabetes & Metabolism 2012
25 EU Directive Needle Sharps (2010/32/EU)
26 ADA: Conclusions Influenza vaccination Annually Pneumococcal vaccination /5years Hepatitis vaccination yes HGR: Influenza vaccination Annually = Diabetes =BMI >35 =BMI <18.5
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