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



Adult Vaccinations Copyright © by Stacy C. Kramer, MD. All Rights Reserved.

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