Use of influenza and pneumococcal vaccines in people with diabetes.

Abstract

R e v i e w s / C o m m e n t a r i e s / P o s i t i o n S t a t e m e n t s 96DIABETES CARE, VOLUME 23, NUMBER 1, JANUARY 2000 Technical Review that results from bacterial and viral infections such as influenza and pneumococcus.Poor antibody response has been shown to be a marker of immunologic susceptibility to infection and its sequelae (17). Immunity (as measured by in vitro opsonic activity of serum from vaccinated patients), howe v e r, has not always been correlated with level of antibody measured by radioimmunoassay (18,19). Antibody responses to the pneumococcal vaccine in people with diabetes have been examined and have been shown to be no diff e rent than in people without diabetes (20)(21)(22). Observations of i m p a i red antibody response to the influenza vaccine, in particular when there is poor metabolic control, has led some to question the value of the influenza vaccination in people with diabetes (23)(24)(25)(26).Cell-mediated abnormalities (and related humoral responses), such as d e c reased CD4/CD8 lymphocyte ratios, changes in natural killer cell function, reduced lymphocyte blastogenesis, acquire d defects in interleukin-2 production, and a reduced phagocytic function of monocytes, have all been re p o rted in people with diabetes (27-30) and could account for an i n c reased risk of infection (both bacterial and viral) and poor antibody response to vaccination. It has also been proposed that cell-mediated immunity may be a more re l iable predictor of adequate immune re s p o n s e as it relates to viral infections such as influenza infection (25).Leukocyte function is important in the p r i m a ry immune response to bacterial infections (both primary and secondary infections complicating viral infections). Poorly c o n t rolled diabetes has been associated with a l t e red granulocyte function (31-33). It appears from these studies that the complex cellular processes of bacteria engulfment and killing could be influenced by glycemic cont rol independent of active infection. Bacterial colonization, if significant, could contribute to patients' risks for complicating nosocomial infection from primary infections. Patients with diabetes have been shown to have a higher incidence of positive s u rveillance cultures (and carrier rates) for coagulase-positive S t a p h y l o c o c c u s and Gro u p B streptococci (34), whereas others have re p o rted a colonization rate for people with diabetes that is no higher than that expected for other individuals (35). Carrier status appears to be associated with glycemic cont rol (34,36). While it is tempting to speculate how colonization may have contributed to Leonard Thompson' s complicating s t a p h ylococcal pneumonia (1), it is difficult to assess colonization' s specific impact on the morbidity and mortality of disease for people with diabetes. Epidemiological evidenceT h e re are limited studies re p o rting the incidence, morbidity, and mortality of viral and bacterial infections specifically in patients with diabetes. Tables 1 and 2 summ...

Working-age adults with diabetes experience greater susceptibility to seasonal influenza: a population-based cohort study

“…Of course, the unit cost of a diabetes-specific vaccination programme may be much higher, and the actual effectiveness of influenza vaccinations in high-risk populations is not well established. While observational studies suggest that vaccination against influenza reduces hospitalisations in working-age adults with diabetes [10,50], these benefits may be attributable to healthy user bias [15]. Our observation that workingage adults with diabetes experience a greater burden of influenza than similar non-diabetic adults provides a clinical justification for targeted anti-influenza interventions; identifying particular interventions and evaluating their effectiveness in this population are questions for further research.…”

“…However, the evidence for this premise is limited [6,7,10]. To our knowledge, only three studies have compared the burden of seasonal influenza in adults with and without diabetes.…”

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

“…Data are sparse concerning the outcome of invasive pneumococcal infection in patients with diabetes (10). Previous case series of pneumococcal bacteremia (1,2,(11)(12)(13)(14) have been hampered by small numbers of diabetic patients, cohorts from specialized hospitals, or lack of follow-up after hospital discharge.…”

Immunogenicity of influenza A(H1N1)pdm09 vaccine in patients with diabetes mellitus

“…4 Annual influenza vaccination has therefore long been recommended for these individuals. 1,5 In June 2009, the World Health Organization (WHO) declared a global pandemic of the influenza A(H1N1)pdm09 and identified chronic medical conditions as being specific risks for infection. 6 As a result, many diabetic patients received H1N1 vaccination according to the recommendations of the WHO.…”

“…[1][2][3] According to the Advisory Committee on Immunization Practices (ACIP) in the United States, vaccinating high-risk individuals before influenza season each year is the most effective measure for reducing the impact of influenza. 4 Annual influenza vaccination has therefore long been recommended for these individuals.…”