Effectivity of influenza vaccination in diabetes?

Vaccination in diabetes and
morbidly obese
Sense and sensibility
C. Mathieu
Endocrinology
UZ Leuven
Advice Superior Health Council
• Diabetes Mellitus
– Children < 16 years
– Adults and adolescents > 16 years
Influenza (annually)
Influenza (annually)
• Metabolic conditions, including morbid obesity (BMI>35)
Influenza (annually)
HGR nR. 8561
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
Diabetes and infections: is there a link?
Diabetes and infections: is there a link?
Casqueiro et al. Indian Journal of Endocrinology and Metabolism 2012
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
Diabetes and influenza, not a desirable
combination
• … potential of loosing glycemic control
• … increased risk of complications of
influenza, ICU admission and death
Allard et al. Diabetes Care 2010
Diabetes and mortality in pandemic
A/H1N1
Chowell PLoS ONE 2012
Obesity and influenza, not a desirable
combination
Outcome
Event rate per 1000 person-years
ORa (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)
1.64
3.27 (0.76–14.15)
18.5–24.9 (normal weight)
0.29
1.00
25–29.9 (overweight)
0.75
2.21 (0.98–4.96)
30–34.9 (obese class I)
0.83
1.88 (0.72–4.94)
≥35 (obese class II or III)
2.78
3.23 (1.24–8.45)
Kwong et al. Clin Infect Dis 2011
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
≥ 65 y: NNT to avoid 1 hospitalisation/death
± 70
± 130
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?)
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.”
Risk for pneumococcal infections is
increased in diabetes
Kyaw et al. J Infect Dis 2005.
RRdiabetes
(adjusted): 3.4
Mortality upon pneumococcal
infection in diabetes??
Cohortstudy Denmark (Thomsen, Diab Care 2004)
After correcting for age,
gender, comorbidity:
RR mortality = 0.6 vs nondiabetics
Cost-effectiveness vaccination?
Rozenbaum et al. BMJ 2012.
3. Hepatitis B vaccination and
diabetes?
Kirkman & Schaffner. Diab Care 2012.
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).
Hepatitis B risk in residential homes
WISE Recommendations to ensure the
safety of injections in diabetes
K. Strauss, WISE Consensus Group.
Diabetes & Metabolism 2012
EU Directive Needle Sharps
(2010/32/EU)
Conclusions
• ADA:
– Influenza vaccination
– Pneumococcal vaccination
– Hepatitis vaccination
Annually
/5years
yes
• HGR:
– Influenza vaccination
= Diabetes
=BMI >35
=BMI <18.5
Annually