J Korean Diabetes.  2013 Sep;14(3):103-110. 10.4093/jkd.2013.14.3.103.

Adult Immunization in Patients with Diabetes Mellitus: Current Immunization Status and Recommended Schedule in Korea

• Joo EJ
• Yeom JS

• KMID: 2173917
• DOI: http://doi.org/10.4093/jkd.2013.14.3.103

Abstract

As the number of Korean adults with diabetes is expected to increase continuously, the health care for these patients is becoming increasingly important. In recent years, the prevention of infectious diseases through vaccination of the adult population has attracted much interest. Patients with diabetes are more vulnerable to various infectious diseases and the prevention of these diseases through adequate vaccination is especially important. With the recent introduction of newly developed vaccines throughout the country, clinicians have more options for vaccinating their patients. In 2012, the Korean Society of Infectious Diseases developed revised guidelines for adult vaccination, which include recommendations for diabetic patients. Generally, vaccines for healthy adults are also recommended for diabetic patients, and these vaccines include those for Streptococcus pneumoniae, influenza, tetanus-diphtheria-pertussis, hepatitis A and B and herpes zoster. In this review, we will focus our discussion on the pneumococcal (PSV-13 and PPSV 23), influenza and zoster vaccines.

Keyword

Immunization; Adults; Diabetes mellitus

MeSH Terms

Adult
Appointments and Schedules
Communicable Diseases
Delivery of Health Care
Diabetes Mellitus
Hepatitis A
Herpes Zoster
Humans
Immunization
Influenza, Human
Korea
Streptococcus pneumoniae
Vaccination
Vaccines
Vaccines

Figure

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  Fig. 1. Recommended adult immunization schedule, by vaccine and age group (http://www.ksid.or.kr/vaccine_eng.pdf). (A) Hepatitis A (high-risk group): persons with chronic liver disease; persons working at child-care facilities: medical personnel and laboratory workers with potential risk of exposure to the hepatitis A virus; food handlers working at restaurants; persons traveling to or working in countries where hepatitis A is endemic; persons with receive blood products frequently; men who have sex with men; IV drug users; and persons have had contact with acute hepatitis A patients within 2 weeks. (B) Hepatitis B (high-risk group): men who have sex with men; sexually active persons with more than one partner; human immunodeficiency virus (HIV) patients; sexually active persons with more than on partners; human immunodeficiency virus (HIV) patients; IV drug users; household contacts and sexual partners of persons with hepatitis B virus (HBV) carriers; patients with chronic renal failure; patients with chronic liver disease; workers who are frequently exposed to HBV; and clients and staff members of institutions for persons with developmental disabilities. (C) Measles-mumps-rubella (vaccination recommended for high-risk group): Although serological tests (especially for measles) can be done for laboratory evidence of immunity, vaccination without serological tests would be cost saving. High-risk groups: healthcare personnel (serological test required, 2 doses); persons traveling to developing countries; family members who take care of immunocompromised patients; and students who dwell in dormitories. (D) Varicella: vaccination recommended for high-risk group if serologic tests reveal no evidence of immunity. High-risk groups: healthcare workers; family contacts of immunocompromised patients; teachers and child-care employees; students; military personnel; residents of correctional institutions; non-pregnant women expecting pregnancy; adolescents and adults living in households with children; and international travelers. (E) Meningococcal (high-risk group): persons with anatomical of functional asplenia; persons with complement component deficiencies; military personnel (especially for recruits); laboratory workers exposed to meningococcus; persons who travel to or live in an endemic area, particularly if their contact with local populations will be prolonged; and college students living in dormitories. The 2-dose series is recommended for adults with anatomical or functional asplenia, complement component deficiency, and HIV infection; 2 doses should be administered at 0 and 2 months. Revaccinate with meningococcal conjugate vaccine every 5 years for adults who remain at increased risk for infection. (F) Pneumococcal (high-risk group): chronic lung disease (including asthma); chronic cardiovascular disease; diabetes; chronic liver disease; chronic renal failure; nephrotic syndrome; functional or anatomical asplenia; immunocompromised patients (congenital immunodeficiency, HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, other malignancy, solid organ transplantation). (vaccinate with 3 or 4 doses of protein conjugate vaccine for hematopoietic stem cell transplants); prolonged use of high-dose corticosteroids or immunosuppressive agents; and cochlear implants. One-time revaccination is recommended for persons aged 65 years or older if they were vaccinated 5 or more years previously and they were less than 65 years of age at the time of primary vaccination. Onetime revaccination after 5 years is recommended for patients with chronic renal failure, nephrotic syndrome, functional or anatomical asplenia, immunocompromised conditions; and prolonged use of immunosuppressive agents.

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  Fig. 2. Vaccine that might be indicated for adults, based on medical and other indications. HIV, human immunodeficiency virus; CD4, cluster of differentiation 4; MMR, measles, mumps and rubella.

Reference

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