Recommended Vaccines for Patients with Diabetes

This article was updated to reflect recent guidance from the Advisory Committee on Immunization Practices. 

Patients with diabetes are at risk for complications from vaccine-preventable diseases, making immunization especially critical. 

Diabetes can alter the immune system, making it more difficult for individuals to fight off infections. Additionally, conditions like influenza can increase blood glucose levels leading to serious complications. According to a study by the American Diabetes Association (ADA), adult vaccination rates in patients with diabetes are low. Vaccination rates for the 846 study participants included the following: influenza (17.6%), tetanus (18.6%), hepatitis B (8.6%), and pneumococcal (5.4%).¹ Pharmacists can play an important role in administering vaccines and educating patients with diabetes on the importance of staying up-to-date on immunizations.

Recommended Vaccines

The CDC and ADA both recommend providing routine vaccinations for children and adults with diabetes. With flu season in full swing, it’s important for all patients 6 months of age and older to get an annual influenza vaccine. According to the CDC, there is elevated and even widespread flu activity across the country.² Evidence demonstrates that influenza vaccination in patients with diabetes significantly reduces flu and diabetes-related hospital admissions.³

The CDC recommends routine administration of pneumococcal conjugate vaccine (PCV13 or Prevnar13) for all children younger than 2 years of age. All adults 65 years and older should receive the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23) vaccine, and patients 19 to 64 years of age with diabetes should receive 1 dose. Individuals who received any doses of PPSV23 before age 65 should receive 1 final dose of the vaccine at 65 years or older.  Additionally, the last dose should be administered at least 5 years after the first PPSV23 dose.⁴  The Advisory Committee on Immunization Practices (ACIP) no longer recommends routine vaccination with PCV13 for all adults 65 years and older who do not have an immunocompromising condition.⁵ Instead, shared clinical decision making for PCV13 use is recommended for individuals 65 years and older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received the PCV13 vaccine.⁵ Pharmacists can download the CDC’s free PneumoRecs VaxAdvisor mobile app as a point-of-care resource for guidance on pneumococcal vaccination based upon a patient’s age, medical conditions, and immunization history.

According to a study published in Diabetes Research and Clinical Practice, individuals with diabetes have a higher risk of experiencing herpes zoster (shingles), making vaccination especially important in this population to prevent complications.⁶ Individuals 50 years of age and older should receive the recombinant zoster vaccine (RZV, Shingrix), which is recommended by ACIP as the preferred shingles vaccine. The vaccine is given as 2 doses separated by 2 to 6 months, and patients should receive RZV even if they have had shingles, previously received Zostavax, or have an unknown chickenpox history. The most common adverse effects include pain, redness, and swelling at the injection site.  Patients may also experience fever, muscle pain, and headache.

The CDC also recommends that all adults receive the tetanus, diphtheria, and pertussis (Tdap) vaccine once and a Td vaccine booster dose every 10 years. Additionally, all women should receive a Tdap vaccine during the 27th through 36th week of each pregnancy to pass on antibodies to the fetus to protect against pertussis. The CDC recommends hepatitis B vaccination for all unvaccinated adults with diabetes younger than 60 years of age as a 2- or 3-dose series. Individuals with diabetes have a higher risk of hepatitis B with transmission occurring from inappropriate use of blood glucose meters or infected needles (eg sharing lancets, improper equipment cleaning in nursing homes).⁷

References:

• Feyizoğlu G, Karsli A, Oguz A. The alarming inadequacy of adult vaccination–vaccination rates in diabetic patients. Diabetes. 2018. Doi: https://doi.org/10.2337/db18-679-P

• CDC. Weekly US Influenza Surveillance Report. CDC’s website. https://www.cdc.gov/flu/weekly/index.htm.

• American Diabetes Association. Standards of Medical Care in Diabetes–2020. Diabetes Care. January 2020. https://care.diabetesjournals.org/content/diacare/suppl/2019/12/20/43.Supplement_1.DC1/DC_43_S1_2020.pdf.

• CDC. Pneumococcal Vaccine Recommendations. CDC’s website. https://www.cdc.gov/vaccines/vpd/pneumo/hcp/recommendations.html.

• Matanock A, Lee G, Gierke R, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: Updated recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report. 2019. https://www.cdc.gov/mmwr/volumes/68/wr/mm6846a5.htm

• Saadatian-Elahi M, Bauduceau B, Del-Signore C, et al. Diabetes as a risk factor for herpes zoster in adults: A synthetic literature review. Diabetes Res Clin Pract. 2019.  Doi: 10.1016/j.diabres.2019.107983. [Epub ahead of print]

• CDC. Diabetes and Hepatitis B. CDC’s website. https://www.cdc.gov/hepatitis/populations/diabetes.htm.