Selective Vaccines
Hepatitis B
In October of 2011 the ACIP began recommending Hepatitis B vaccine in non-immunized diabetic patients under the age of 60.6 Patients with diabetes have greater than two fold increased risk of developing acute HBV when compared to non-diabetic patients. Diabetics are also more likely to develop NASH which increases morbidity and mortality associated with HBV. Despite these guidelines, screening for Hepatitis B is often missed in the primary care setting. Therefore physicians need to make a practice of screening for Hepatitis B vaccination especially in diabetic patients.
What to know in clinic:
Administer missing doses to complete a 3 dose series (0, 2, 4 months)
If the series is delayed, complete the series from prior dose
Check a titer 1 month after a 3 dose series, repeat series if <10 IU
Anyone can be vaccinated but specific indications include the following:
- sexually active patients not in long-term monogamous relationship
- patients seeking evaluation for STDs
- current or recent injection drug users
- men who have sex with men
- health care personnel potentially exposed to blood or body fluids
- diabetics <60 (under physician discretion when over age 60)
- ESRD, chronic hemodialysis patients
- chronic liver disease
- HIV
- household contacts and sexual partners of Hep B surface Ag positive persons
- travelers to regions of high endemic HBV infection
- adults in the following settings: STD treatment, HIV testing/treatment, drug abuse treatment/prevention, correctional facilities, ESRD programs, developmental
disability facilities