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ARTICLE OF THE MONTH

Diabetes and Immunization

By: DR. MARIA JOCELYN C. ISIDRO

Optimal diabetes care starts from a holistic approach by the health care provider together with psychosocial support from the family of diabetic patients. This approach consists of lifestyle change, correct patient attitudes and behavior, counseling, smoking cessation, proper management of co morbid medical conditions, preventive care such as proper immunization and many others.

Through the years, the number of deaths due to vaccine preventable illnesses is increasing. People die of community acquired pneumonia, chronic viral hepatitis, and a few from tetanus and from other communicable diseases. Vaccination not only prevents a person from getting sick but also it prevents possible spread of the disease in the community. Diabetes no matter how well controlled the blood sugars have been, poses an increased risk for infection due to an impaired immune system that is inherent to it. This makes the people with diabetes at a higher risk for more serious complications arising from an illness compared to their non-diabetic counterparts. Hence, an important part of effective diabetes management is being able to provide these diabetic patients adequate vaccination.

In general, people with diabetes, both young and adults should receive the same recommended vaccines for the general population. In this article, our main focus is on adult type 2 diabetics. According to Centers for Disease Control and Prevention or CDC, here below are the vaccines that all adults especially diabetics should receive:

a. Influenza vaccine or flu vaccine is given every year. This is usually given before the rainy season, which is between April to May. A trivalent influenza vaccine protects against the two Influenza A viruses and against one Influenza B virus. Under trivalent influenza vaccine, there is a standard trivalent vaccine that is injected intramuscularly and given to adults 18 years old and above, and high dose trivalent vaccine, which is given to people 65 years and above. The CDC doesn’t recommend one vaccine over the other, what is recommended is to get a flu vaccine once a year.

b. Tetanus-diphtheria (Td) vaccine is given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 and older should receive a single dose of Tdap. Women should receive Tdap during each of their pregnancies (preferably in the third trimester between the 27th and 36th week)

c. Pneumococcal vaccine: Pneumococcal infections are responsible for pneumonia, meningitis, blood infection, and ear infection. Pneumococcal vaccines are very effective at preventing severe infections that necessitate hospitalization. However, having received them does not give a hundred percent guarantee that the above infections cannot occur. Pneumococcal conjugate vaccine (PCV 13 or Prevnar 13 protects against 13 types of pneumococcal bacteria. Another type of pneumococcal vaccine is called PPSV or pneumococcal polysaccharide vaccine or PPSV23, this vaccine protects against 23 types of pneumococcal bacteria. PCV 13 or Prevnar 13 is recommended for all adults 65 years or older. Patients who received PCV 13 or Prevnar vaccine should receive PPSV23 12 months after. The two vaccines should not be co-administered together. For patients who received PPSV23 when aged less than 65 years and for whom an additional PPSV23 is indicated when aged>65 years, this subsequent dose should still be given one year after PCV13 and more than or equal to 5 years after the most recent dose of PPSV23.

d. Hepatitis B vaccine: Patients with diabetes more often get pricked for blood sugar monitoring or poked for blood extractions for laboratory tests. That is why; they are at a higher risk of having hepatitis B infection, a blood borne infection. Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus can cause lifelong infection, cirrhosis or scarring of the liver, liver cancer, liver failure and death.

e. Shingles vaccine reduces the risk of developing shingles or herpes zoster and the long-term pain from post herpetic neuralgia. Patients are advised to receive the vaccine if they are aged 60 years and older. Even patients who have had shingles can receive the vaccine to help prevent future occurrence of the disease.

These are some of the vaccines that are necessary for diabetic patients. In general, all diabetic patients unless contraindicated should receive all the vaccines that are for general population. Remember, an ounce of prevention is worth a pound of cure.