Immunization and the Prevention of Influenza and Pneumococcal Disease in People With Diabetes

RATIONALE FOR IMMUNIZATION

The rationale for the use of influenza and pneumococcal vaccine in patients with diabetes is reviewed in the American Diabetes Association technical review “Use of Influenza and Pneumococcal Vaccine in People with Diabetes” (1) and can be summarized as follows:

• Patients with diabetes may have abnormalities in immune function and presumed increased morbidity and mortality from infection.

• Epidemiological studies support the fact that patients with diabetes (in particular those with end organ complications of cardiac and renal disease) are at high risk for complications, hospitalization, and death from influenza and pneumococcal disease.

• There is sufficient evidence that people with diabetes generally have appropriate humoral immune responses to vaccination.

• There are few clinical trials of vaccine efficacy specifically in patients with diabetes.

• Subgroup analysis of patients with diabetes reported in clinical narrative and case-control studies support the fact that vaccination against influenza has been effective in reducing hospital admissions during influenza epidemics.

• Although the question of the efficacy of pneumococcal vaccination in preventing nonbacteremic disease remains unresolved, many studies have shown that the vaccine is effective in reducing life-threatening bacteremic disease.

• Immunization against influenza and pneumococcal disease is an important part of preventive services for many chronic diseases such as diabetes.

According to the Advisory Committee on Immunization Practices (ACIP), the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Family Physicians, vaccinating individuals at high risk before influenza season each year is the most effective measure for reducing the impact of influenza (2). The effective implementation of immunization can reduce the cost of human suffering and health care expenditures in people with diabetes.

The recommendations that follow are based in large part on observational studies with high potential for bias. The narrative review (1) supports expert opinion that immunization intervention is low risk, is low …