The Advisory Committee on Immunization Practices (ACIP) recommends that all adults aged 19 to 59 with diabetes mellitus type 1 or 2 who have not been vaccinated for the hepatitis B virus (HBV) do so immediately, according to a report from the Centers for Disease Control and Prevention (CDC). Adults over 60 may also be vaccinated at their doctor’s discretion. (Older adults are less likely to respond adequately to the vaccine.) Since 1982, HBV vaccination has been recommended for people receiving hemodialysis.

HBV is carried by blood, semen and vaginal fluids and can be transmitted through the use of improperly cleaned medical equipment such as finger-stick devices and blood glucose monitors. This places people with diabetes, who must make regular use of such equipment in medical settings, at special risk of acquiring hepatitis B. Since 1996, of the 29 hepatitis B outbreaks in long-term care centers reported to the CDC, 25 involved people with diabetes who received blood glucose monitoring.

An analysis of HBV infection data from 2009 to 2010 showed that people aged 23 to 59 with diabetes and no other hepatitis B risk factors—defined as “injection-drug use, male sex with a male, and sex with multiple partners”—were 2.1 times more likely to develop acute hep B compared with those without diabetes. In data for 1999-2010, people over the age of 18 living with diabetes tested positive for hep B at a rate 60% higher than did people without diabetes.

In 2009, 3,371 cases of acute hepatitis B—infection with HBV followed by short-term liver inflammation, possibly leading to chronic hep B—were reported in the U.S.  Forty-seven percent of the cases resulted in hospitalization and 1 percent in death. Cases of chronic hepatitis B are far more prevalent. The CDC estimates that 700,000 to 1.4 million Americans have hepatitis B. Chronic hep B can linger for decades and leads to long-term health problems, such as a 15 percent greater chance of liver cancer or cirrhosis.

Hepatitis B vaccines have been in use in the United States since 1982 with a firm safety record. The vaccine—a series of three injections—offers protection extending for at least 22 years among healthy recipients, though the CDC report notes that the duration of protection for people with diabetes is unknown.

“Administration of the hepatitis B vaccine series should be completed as soon as feasible after diabetes is diagnosed,” the report concludes, adding that medical facilities must maintain effective infection control practices.