Why would a poorly controlled diabetic 53-year-old male receive a Hepatitis B (HBV) vaccine?

From the Guidelines

A 53-year-old male with poorly controlled diabetes should receive the hepatitis B vaccine as part of standard adult immunization recommendations, particularly because diabetes increases his risk for hepatitis B infection. The Centers for Disease Control recommends that all adults with diabetes under age 60 receive the hepatitis B vaccine series, which typically consists of three doses given over 6 months (at 0,1, and 6 months) 1. The specific vaccines available include Engerix-B or Recombivax HB, with each dose administered as an intramuscular injection in the deltoid muscle. Diabetic patients have a higher risk of hepatitis B infection due to potential exposure during blood glucose monitoring through shared devices or in healthcare settings 1. Additionally, diabetic patients who contract hepatitis B often experience worse outcomes, including higher rates of chronic infection. Poorly controlled diabetes may further compromise immune function, making protection against preventable infections particularly important. The vaccine is safe for diabetic patients and can be administered during regular healthcare visits. Side effects are generally mild and may include soreness at the injection site, low-grade fever, or fatigue lasting 1-2 days.

Key Points to Consider

• The hepatitis B vaccine series can be given safely to persons of any age, but current hepatitis B vaccines are less efficacious and less cost-effective among older adults 1.
• Decisions to vaccinate adults with diabetes who are aged ≥60 years of age should incorporate consideration of the patient’s likelihood of acquiring HBV infection, including the risk posed by an increased need for assisted blood-glucose monitoring in LTC facilities, the likelihood of experiencing chronic sequelae if infected with HBV, and the declining immunologic responses to vaccines that are associated with frailty, a geriatric syndrome characterized by decreased physiologic reserve and increased vulnerability, leading to early mortality in older adults 1.
• The proportion of adults who achieve seroprotection (≥10 mIU/mL antibody to hepatitis B surface antigen [anti-HBs]) after receipt of the 3-dose vaccine series decreases with age, obesity, smoking, immunosuppression, and comorbid conditions including diabetes 1.
• A synthesis of available literature suggests a protective response is achieved after completion of the hepatitis B vaccine series in ≥90%, 80%, 65%, and <40% of adults with diabetes lacking comorbid conditions aged ≤40 years, 41 through 59 years, 60 through 69 years, and ≥70 years, respectively 1.

Administration and Safety

• The hepatitis B vaccine series should be completed as soon as feasible after diabetes is diagnosed 1.
• Available data do not confirm an advantage to any specific hepatitis B vaccine, dosage, or approved schedule for adults with diabetes 1.
• No serologic testing or additional hepatitis B vaccination is recommended for adults who received a complete series of hepatitis B vaccinations at any time in the past 1.
• Hepatitis B vaccine may be administered during health-care visits scheduled for other purposes as long as minimum intervals between doses are observed; there is no maximum interval between doses that makes the hepatitis B vaccination series ineffective 1.

From the FDA Drug Label

Considering the serious consequences of infection, immunization should be considered for all persons at potential risk of exposure to the hepatitis B virus. The answer is:

• The patient is at risk of exposure to hepatitis B virus due to potential liver disease associated with poorly controlled diabetes.
• Immunization should be considered for all persons at potential risk of exposure to the hepatitis B virus, as stated in the drug label.
• Therefore, a poorly controlled diabetic 53-year-old male may receive the Hepatitis B (HBV) vaccine to prevent hepatitis B infection and its serious consequences, including liver cancer 2.

From the Research

Hepatitis B Vaccination in Diabetic Patients

• A 53-year-old male with poorly controlled diabetes may receive a Hepatitis B (HBV) vaccine due to the increased risk of HBV infection and its complications in diabetic patients 3, 4.
• Studies have shown that diabetic patients have a reduced immune response to HBV vaccine, with lower seroprotection rates and geometric mean concentrations (GMCs) compared to non-diabetic controls 3, 5.
• The immunogenicity of HBV vaccines in diabetic patients can be influenced by factors such as age, with older patients tend to have lower seroprotection rates 3, 6.
• Different types of HBV vaccines, including those containing pre-S2 antigen, have been compared in diabetic patients, with similar response rates and anti-HBs titers 7.
• A 2-dose HBV vaccine (HBsAg/CpG 1018) has been shown to provide a higher level of seroprotection against HBV than a 3-dose vaccine (HBsAg/alum) in patients aged 60-70 years with type 2 diabetes mellitus 6.
• Adherence to guidelines for HBV vaccination in patients with diabetes is important, but nonadherence to recommendations is common 4.