I live with diabetes, which vaccinations should I get? 

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Whether or not you live with diabetes, vaccination concerns us all. It is part of a process to prevent disease in a population, so that a certain number of infections can be avoided. Vaccination coverage corresponds to the proportion of people vaccinated in a population at a given time (targets set: at least 95% for all vaccinations, 75% for the flu ). Infections in people living with diabetes can lead to complications. Should they get more vaccinations? What’s the benefit of getting vaccinated? What are the vaccination procedures? 

Is there a risk of infection if I live with diabetes?

A medical study has shown that people with diabetes have a higher risk of serious infection than those without diabetes. This is especially true for bone and joint infections, septicemia, skin and heart infections (endocarditis) and pneumonia.1

In addition, people with diabetes are more likely to be hospitalized for an infection. Factors contributing to hospitalization for infection include: advanced age, male gender, recent history of hospitalization, obesity, and microvascular disease (one of the potential complications of diabetes).2

It is also reported that the presence of other diseases, in addition to diabetes, such as cardiovascular disease, chronic obstructive pulmonary disease (COPD) or chronic kidney failure, increases the risk of infection, particularly pneumonia.3

Does diabetes weaken the immune defense system? 

Diabetes falls within the scope of what is known as “acquired immune deficiency”, which is a weakening of the immune defense system.4

Is it absolutely necessary for people with diabetes to have the flu vaccine?

If you live with diabetes, it is strongly recommended that you get a flu shot. This is because the risk of getting seasonal flu seems to go up with diabetes. This increases the risk of hospitalization, especially due to complications of the flu (such as pneumonia), particularly if the diabetes is unbalanced.

The flu vaccine is given in a single intramuscular injection at the beginning of each season. Vaccinated people are protected two weeks after the injection. The flu shot can be administered by doctors, nurses, pharmacists or midwives. 

The only contraindication is an allergy to a component of the vaccine.

What about pneumococcal respiratory infections? Should I get the pneumococcal vaccine?

Pneumococcal superinfection is common after the flu. The influenza virus “sets the stage” for pneumococcus.

The risk of being hospitalized and having a severe infection is even greater for people living with diabetes and other associated conditions.

The vaccine is given in two stages: a first dose and then a second dose of the vaccine eight weeks later. The main side effects are local side effects at the injection site.

Therefore, pneumococcal vaccination is recommended for those with diabetes.

Could I have shingles?

The risk of shingles increases with diabetes. Vaccination against shingles can reduce their occurrence and the associated pain. Therefore, it is recommended for people over 65 years of age living with diabetes. It consists of a single dose administered by a subcutaneous or intramuscular injection. 

What about tetanus, hepatitis B and their vaccines?

In case of open wounds, there is a risk of tetanus. 

This can be the case, for example, with the chronic wounds associated with diabetes. 

The main side effects are minor local side effects at the injection site.

The recommendation regarding vaccination for tetanus is the same as for someone who does not have diabetes.  

The same applies to hepatitis B (HBV). Vaccination recommendations are the same as for the general population, whether or not one is living with diabetes. 

Should children and adolescents with diabetes get more vaccinations? 

Children and adolescents with controlled diabetes do not develop more diseases or infections than those without diabetes.5

However, it is best to have them vaccinated against the seasonal flu, starting at 6 months of age, to prevent a diabetes imbalance in the event of an infection. 

For the other vaccines, it is simply a matter of following the vaccination schedule.

Are vaccines dangerous for your health?

Sometimes there are obstacles, fears, or even misunderstandings about vaccinations that hold people back. 

In the general population, the injection can cause mild and short-lived undesirable reactions: pain and redness at the injection site (10 to 40% of cases), flu-like syndrome (5 to 10% of cases), etc.6

Apart from possible allergic reactions, the scientific data available to date have not demonstrated any proven health risks related to vaccination. 

Key points to remember 

Vaccines provide individual and collective protection against disease and epidemics.

It is recommended for people living with diabetes to: 

  • get vaccinated against the seasonal flu; 
  • get the pneumococcal vaccine to prevent respiratory infections; 
  • get the shingles vaccine for people over the age of 65 with diabetes. 

Sources

Référentiel de la Société francophone du diabète (SFD) : vaccination chez la personne diabétique.

  1. Carey IM, Critchley JA, DeWilde S, et al. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care 2018;41:513–21.
  2. Hamilton EJ, Martin N, Makepeace A, et al. Incidence and predictors of hospitalization for bacterial infection in community-based patients with type 2 diabetes: the Fremantle diabetes study. PLoS One 2013;8:e60502.
  3. Shea K, Edelsberg J, Weycker D, et al. Rates of pneumococcal disease in adults with chronic medical conditions. Open Forum Infect Dis 2014;1:ofu024. 
  4. Weintrob AC, Sexton DJ. Susceptibilty to infections in persons with diabetes mellitus.UpToDate®; 2019, https://www.uptodate.com/contents/susceptibility-to-infectionsin-persons-with-diabetes-mellitus
  5. Laffel LM, Limbert C, Phelan H, et al. ISPAD Clinical Practice Consensus Guidelines 2018: sick day management in children and adolescents with diabetes. Pediatr Diabetes 2018;19(Suppl. 27):193–204.
  6. Vaccines against influenza WHO position paper – November 2012. Wkly Epidemiol Rec 2012;87:461–76. 

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