Suggested use of vaccines in diabetes

Abstract

Diabetes has emerged as a disease of major public health importance in India affecting the rich and the poor alike. Conventionally, comprehensive diabetes management is aimed at preventing micro and macro vascular complications. However, morbidity and mortality due to infections are also significant. In developing countries like India, the concept of adult immunization is far from reality. Recently the H1N1 pandemic has triggered the necessity for considering immunization in all age groups for the prevention of vaccine-preventable fatal infectious diseases. Considering the economics of immunization in a developing country, providing free vaccines to all adults may not be a practical solution, although the free universal immunization program for children is in existence for several decades. There is no consensus on the use of vaccines in diabetes subjects in India. However, there are some clinics offering routine pneumococcal, influenza and other vaccinations. Patients with diabetes have a deranged immune system making them more prone for infections. Hospitalization and death due to pneumococcal disease and influenza are higher in diabetes patients. They, like other healthy individuals, have a normal humoral response to vaccination with clinically significant benefits. The American Diabetes Association, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, World Health Organization, United Kingdom Guidelines and a number of other scientific organizations have well defined guidelines for vaccination in diabetes. In this article we make some suggestions for clinicians in India, regarding use of vaccines in subjects with diabetes.

Prevalence of Diabetes in the 2009 Influenza A (H1N1) and the Middle East Respiratory Syndrome Coronavirus: A Systematic Review and Meta-Analysis

“…76 Furthermore, levels of HbA1c ≥9% were linked to a 60% increased risk of pneumonia-related complications and hospitalization due to a lower immune response. 80 Host defense to infection is largely mediated by cellular immunity and the synthesis of related cytokines, such as IFN-and interleukins, is downregulated in diabetes. 75,81 The present study has several limitations.…”

Vacunación neumocócica conjugada en adultos. Recomendaciones de las Sociedades Médicas en México

“…También se ha observado que en pacientes con diabetes con una hemoglobina glucosilada (HbA1c) mayor de 9%, tienen un 60% más de riesgo de hospitalización relacionado con la neumonía .27 La diabetes mellitus está relacionada con una alteración inmunológica, principalmente por una alteración en las defensas del huésped y es considerada un factor de riesgo independiente para desarrollar infecciones del tracto respiratorio, incluyendo la neumonía. 27,28 En los pacientes con diabetes se han reportado alteraciones en las poblaciones de neutrófilos, monocitos y linfocitos. La disminución del contenido de C4 en pacientes diabéticos puede estar asociada con neutrófilos disfuncionales y una menor respuesta de las citocinas.…”

“…La hiperglucemia crónica por sí misma influye sobre diversas funciones de defensa del huésped, reduciendo la movilización de los leucocitos polimorfonucleares, la quimiotaxis y la actividad fagocítica. 27 De tal manera, que la capacidad de activación del sistema de complemento a través de la vía clásica se encuentra disminuida en la diabetes, lo que podría contribuir al aumento en la susceptibilidad a las infecciones. La protección inmunológica contra la enfermedad neumocócica está mediada a través de anticuerpos opsonofagocíticos dirigidos contra los polisacáridos capsulares bacterianos.…”

Adult immunization: Is time ripe for its initiation

“…[1] At the outset, we must congratulate the authors for debating on a neglected issue of public health concern. The topic has in itself the potential to delve on the larger issue of “Immunization in adults and elderly.”…”

“…[1] However, morbidity and mortality due to infections are also significant. The impact assessment of immunization in diabetics may suggest that providing free vaccines to diabetics may go a long way in reducing this.…”