Advisory Committee On Immunization Practices (ACIP) Recommendation for Hepatitis B Vaccination for Adults with Diabetes

Background:  Hepatitis B virus (HBV) causes acute and chronic infection of the liver, leading to substantial morbidity and mortality.  Since 1996, a total of 29 outbreaks of HBV infection in U.S. long-term-care (LTC) facilities were reported to CDC; of these, 25 involved adults with diabetes receiving assisted blood glucose monitoring.   

Setting:  U.S. (not limited to LTC or institutional settings)

Population:  Adults with diabetes aged 19 years or older

Project Description:  Outbreaks prompted the Hepatitis Vaccines Work Group of the Advisory Committee on Immunization Practices (ACIP) to evaluate the risk for HBV infection among all adults with diagnosed diabetes.  The strength of scientific evidence regarding protection was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and safety, values, and cost-effectiveness were incorporated into a recommendation. 

Results/Lessons Learned:  2009-2010 Emerging Infections Program (EIP) data for adults without hepatitis B-related risk behaviors indicated that those with diabetes aged 23-59 years and  ≥60 years had 2.1 (95% CI: 1.6, 2.8) and 1.5 (95% CI: 0.9, 2.5) times the adjusted odds of acute hepatitis B, respectively, as those without diabetes.  Strength of evidence for seroprotection was type 2 (randomized trials with important limitations, or exceptionally strong evidence from observational studies), benefits outweighed harms, and higher values were placed on preventable outcomes for adults aged <60 years.  The incremental cost per quality-adjusted life-year (QALY) saved was $75,100 for adults aged 20-59 years but increased substantially with increasing age.  On the basis of available information, ACIP recommended on October 25, 2011 that all previously unvaccinated adults aged 19-59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B (recommendation category A) and that unvaccinated adults aged ≥60 years with diabetes may be vaccinated at the discretion of the treating clinician (recommendation category B).