Influenza

Vaccine in
Diabetes
Mellitus

Tri Juli Edi T

Divisi Metabolik Endokrin RSCM

Overview
 Immune disturbance in Diabetes Mellitus

 The needs of certain vaccines in Diabetes Mellitus

 Influenza vaccine in Diabetes Mellitus

 What the guidelines say?

 Summary
Phatophysiology of Infections associated with DM
 The components of the innate immune system.

John C. Pickup Dia Care 2004;27:813-823

©2004 by American Diabetes Association

 Several factors such as altered nutrition, inactivity, age, fetal metabolic programming, and
genetic propensity are known activators of the innate immune system.

John C. Pickup Dia Care 2004;27:813-823

©2004 by American Diabetes Association

Major Infections associated with
DM
Urinary Tract Gastrointestinal &
Respiratory Infection
Infection Liver Infection
• Influenza • Asymptomatic • H.pylori infection
• Streptococcus bacteriuria • Oral & esophageal
pneumoniae • Fungal cystitis candidiasis
• H1N1 • Emphysematous
• Tuberculosis cystitis
• Bacterial
pyelonephritis
• Perinephric abscess
Immunization Recommendations
Provide routine vaccinations for children and adults with Diabetes according to
age-related recommendations

• Annualy in all patients with Diabetes aged > 6

Influenza Vaccine months

• All patients with Diabetes aged > 2 years

Pneumococcal polysaccharide • Routinely in patients with Diabetes aged > 65
Vaccine 23 (PPSV23) years

• Routinely in patients with Diabetes aged > 65 years

Pneumococcal conjugate
Vaccine 13 (PCV 13)

• All adults with Diabetes

Hepatitis B Vaccine

Source: American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1-S106.
Influenza Vaccination in
Patients with DM
Age Group Dosage (ml) Number of Doses Route
6-35 months 0,25 2 doses at the first time* IM
1 dose annually
3-8 years 0,5 2 doses at the first time* IM
1 dose annually
> 9 years 0,5 1 dose annually IM

* Children 6 months through 8 years of age receiving influenza vaccine for the first time should
receive two doses administered at least 1 month apart
Pneumococcal Vaccination in
Patients with DM
Age at first dose Primary scheme Boosters
(months) Pnc7 Pnc7 Pn23
2-6 3 doses (2/4/6 12-15 months of age After 2 years of age
month)
7-11 2 doses (0/2 month) 12-15 months of age First dose : at least 6-
8 weeks after the last
dose of Pnc7
12-23 2 doses (0/2 month) None Second dose : 5 years
after the first Pn23
dose
> 24 2 doses (0/2 month) None
Summary
– Persons with diabetes often have co-morbid factors which increase morbidity
and mortality from infections
– Vaccines are among the most cost-effective clinical preventive services
– People with diabetes should routinely receive routine vaccines as
recommended
Reference
– http://care.diabetesjournals.org/content/33/7/1491
– http://care.diabetesjournals.org/content/27/3/813.full
– http://care.diabetesjournals.org/content/36/7/e94
– http://clinical.diabetesjournals.org/content/25/4/145
– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354930/
– https://www.cdc.gov/mmwr/volumes/65/rr/rr6505a1.htm
– https://www.cdc.gov/diabetes/managing/flu/index.html
– http://www.ndei.org/ADA-diabetes-management-guidelines-immunization-
recommendations-influenza-hepatitis.aspx.html