Hepatitis B Vaccination for Type 2 Diabetes

All adults with type 2 diabetes aged 19-59 years should receive the hepatitis B vaccine series as soon as possible after diagnosis. 1

Age-Based Vaccination Recommendations

Vaccinate all unvaccinated adults with type 2 diabetes aged 19-59 years against hepatitis B immediately (ACIP Category A recommendation). 1
This is a universal recommendation that applies to all persons in this age group with diabetes, regardless of other risk factors. 1
Adults aged 23-59 years with diabetes have 2.1 times the odds of developing acute hepatitis B compared to those without diabetes. 1

For adults ≥60 years with diabetes, hepatitis B vaccination may be administered at the clinician's discretion after assessing individual risk factors and likelihood of adequate immune response (ACIP Category B recommendation). 1
The evidence for increased hepatitis B risk is less robust in this age group (odds ratio 1.5, not statistically significant). 1
Consider vaccination based on: likelihood of assisted blood glucose monitoring in long-term care facilities, risk of chronic sequelae if infected, and declining immune responses associated with frailty. 1

Adults with diabetes have 60% higher seroprevalence of hepatitis B infection compared to those without diabetes. 1
Since 1996,29 hepatitis B outbreaks in long-term care facilities were reported to CDC, with 25 involving adults with diabetes receiving assisted blood glucose monitoring. 1
The annual incidence of acute hepatitis B among adults with diabetes is 1.8 per 100,000, but this significantly underestimates true infection rates. 1

Among acute hepatitis B infections, 47% result in hospitalization and 1% are fatal. 1
Adults with diabetes who develop acute hepatitis B have a higher case-fatality rate (5%) compared to those without diabetes (2%), though this difference was not statistically significant. 1

No specific hepatitis B vaccine, dosage, or schedule is preferred for adults with diabetes—use any FDA-approved hepatitis B vaccine according to standard schedules. 1
The standard 3-dose series (0,1,6 months) is appropriate for most patients. 2

For adults aged 60-70 years with diabetes, consider the 2-dose HBsAg/CpG 1018 vaccine (HEPLISAV-B), which achieves significantly higher seroprotection rates (85.8%) compared to standard 3-dose vaccines (58.5%) in this population. 3
This enhanced vaccine addresses the reduced immunogenicity seen with standard vaccines in older adults and those with diabetes. 3

Complete the hepatitis B vaccine series as soon as feasible after diabetes diagnosis—do not delay. 1
Seroprotection rates decline with age: 88.5% (ages 20-39), 81.2% (ages 40-49), 83.2% (ages 50-59), and 58.2% (≥60 years). 2
Vaccines can be administered during visits scheduled for other purposes as long as minimum intervals between doses are observed. 1

No serologic testing or additional hepatitis B vaccination is recommended for adults who previously completed a full vaccine series at any time. 1
There is no maximum interval between doses that makes the series ineffective. 1

Don't wait to vaccinate older adults with diabetes—while the recommendation is discretionary for those ≥60 years, the median age of diabetes diagnosis is 53 years, and two-thirds of diagnoses occur before age 60. 1
Don't assume infection control measures alone are sufficient—continued hepatitis B outbreaks in long-term care facilities demonstrate that vaccination is essential despite infection control efforts. 1
Don't overlook vaccination status—baseline hepatitis B vaccination coverage among adults with diabetes is only 16.6% for ≥3 doses, far below optimal levels. 4, 5