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Diabetes Standards of Care & Clinical Practice Resources

Immunizations

People with diabetes are at increased risk of contracting several vaccine-preventable infections and/or for experiencing more severe complications of the infection.

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Immunizations Sections

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Clinical Practice Recommendations

Recommendations for Immunizations

Assessment

  • Conduct an immunization status review at diabetes diagnosis and as a routine part of diabetes care.

Provide the following immunizations to patients with diabetes after screening for contraindications:

Immunizations Frequency/Which Patients
Hepatitis B Hepatitis B vaccination for adults, complete 3-dose series or 2-dose series depending on vaccine type: (3 dose series includes: Engerix-B®, Recombivax HB®, and Twinrix® vaccines and 2 dose series includes: Heplisav-B® vaccine)

  • Administer to unvaccinated adults <60 years of age as soon as feasible after diabetes diagnosis.
  • Consider administering to adults ≥60 years of age based on provider discretion and/or patient's likelihood of:
    • Acquiring hepatitis B virus infection (e.g., anticipated need for assisted blood-glucose monitoring in long term care facilities)
  • Revaccination (i.e., booster dose, challenge dose, or complete series) is not generally recommended for persons with normal immune status who were previously vaccinated as infants, children, adolescents, or adults.
  • Serologic testing or additional hepatitis B vaccination is not recommended for adults who have received a complete series of hepatitis B vaccination at any time in the past.

Source: Centers for Disease Control and Prevention

Influenza
  • Administer annual influenza immunization to all patients ≥6 months of age.
Pneumococcal
The figure is a box illustrating sequential administration and recommended intervals for 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults aged ≥65 years in the United States.
Source: Centers for Disease Control and Prevention
Tetanus and Diphtheria (Td)
  • Provide every 10 years; tetanus, diphtheria, and acellular pertussis (Tdap) should replace a single dose of Td for anyone who has not previously received a dose of Tdap.
Zoster Zoster vaccination for unvaccinated patients:

  • Administer recombinant zoster vaccine (RZV-Shingrix®) to adults ≥50 years of age in 2 doses 2-6 months apart regardless of past episode of herpes zoster (shingles) or receipt of live herpes zoster vaccine (ZVL-Zostavax®)

Alternately:

  • Administer live herpes zoster vaccine (ZVL-Zostavax®) to adults ≥60 years of age as a single dose, regardless of reported history of prior herpes zoster episode.