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Covid-19 and Diabetes
Pneumococcal and Influenza Vaccinations – Are they useful for people with diabetes?
August 23, 2020

During these times of COVID, one thought which is on everyone’s mind is WHEN THE COVID VACCINE WILL COME?  Now that’s a good question to ask because nobody is really sure of the answer. However, the good news is that they are not one, two, three, but probably over ten different companies working on the COVID vaccine. So we are confident that in the next six months to one year, we will have a COVID vaccine. But until then, what can we do? Most specifically, what can people with diabetes do?

The first thing, of course, is to look after your diabetes well and control it well because uncontrolled diabetes is definitely associated with poorer outcomes and even increased deaths and mortality due to COVID -19.

Pneumococcal and Influenza Vaccinations
Pneumococcal and Influenza Vaccinations

Diabetes and respiratory infections

Diabetes individuals are at increased risk of respiratory infections. People with diabetes are about six times more likely than non-diabetics patients to be hospitalized with a diagnosis of influenza during flu epidemics and three times more likely to die of pneumonia or flu. Also, among people with diabetes, death rates increase by 5 to 15% during flu epidemics, and the case fatality rate for influenza is about 12%, while those for pneumococcal infection range from 21 to 36%1-3.

Diabetes is associated with a higher risk of Pneumococcal Pneumonia and are reported to have an increased incidence of deaths due to pneumococcal pneumonia. Indeed even young people with diabetes are at risk. A retrospective cohort analysis data reported that the incidence of pneumococcal pneumonia in younger persons with diabetes with underlying conditions in the US, 2007–2010, has an equally higher risk of pneumococcal pneumonia as the older people with diabetes4. The risk of invasive pneumococcal disease is 3-fold more in adults with diabetes compared to healthy adults5.

Are there Vaccines a person with diabetes must take?

However there is something that you can do in the absence of the COVID vaccine. There are a couple of other vaccines that you can take, which may not prevent COVID-19, but if you get a secondary infection in the lung, then that can be avoided. The most frequent infections that affect older people are community-acquired pneumonia, and it can be prevented by taking pneumococcal vaccination. The best way to understand about the pneumococcal disease is to speak to your doctor6.

The below video explains the importance of Adult vaccinations for people with Diabetes in English.

Pneumococcal Vaccination:

The good news is that you need to take the pneumococcal vaccine only once. If you administer it once, you’re usually protected lifelong. Hence if you have been vaccinated it in the last 2 or 3 years, it’s probably not necessary to repeat that Pneumococcal vaccination.  However, if you have not had it for many years or if you’re at an older age group (over 60 years of age) and you have diabetes, it’s a good idea to take the pneumococcal vaccination. Once you take it, you are protected for many years from getting pneumococcal pneumonia, which is one of the common causes of mortality in the elders.

Influenza Vaccination:

The other vaccination which is will highly recommended for all people and especially for those with diabetes, and those who are at an older age group, is influenza vaccination. Unlike pneumococcal vaccination, the influenza vaccination has to be taken every year.  Because it is valid only for one year if you have not had in the last one year, it is recommended that you take the influenza vaccination. Now how does this help?  At least it will prevent you from getting common influenza whose symptoms are fever, cough, cold, etc.  If one develops flu now, and top of that if you get COVID 19 also, obviously the results are not going to be so good. Also, since you are going to be protected from the regular ‘flu’ if you develop the symptoms of fever, cough, and cold, etc., you know it is more likely to be COVID.

Any other Vaccinations?

covid 19 vaccine
Any other Vaccine

You may ask, is there any other vaccination that a person with diabetes should take apart from the pneumococcal vaccination and influenza vaccination? Hepatitis B vaccination also is recommended because people often get cuts or wounds, or they may have a blood transfusion, or they may be going to a laboratory where they could be some cross infection and so on. Therefore taking hepatitis B vaccination is also recommended, but the first two pneumococcal vaccination and influenza vaccination are a must for all people with diabetes. Also, people who have lower immunity (e.g., those who are at older groups) and, besides any other co-existing illnesses, it is better to take pneumococcal vaccination and influenza vaccination.

Current Recommendation on Adult Pneumococcal immunization from Scientific bodies during COVID

  1. Even though vaccines such as Haemophilus influenza type B vaccine or pneumococcal vaccine cannot prevent the new Coronavirus, they should be recommended to protect against respective respiratory illnesses7.
  2. Although there is no vaccine available to prevent COVID-19 at this time, ensure that other vaccinations are up to date, including influenza and pneumococcal vaccines. This will help reduce the pressure on the healthcare system by lowering vaccine-preventable diseases8.
  3. Patients with CVD need to remain vaccinated, including the pneumococcal vaccine given the increased risk of secondary bacterial infection with COVID-19; CVD patients should be vaccinated against influenza by current ACC/AHA guidelines9.
  4. Recommendations by Research Society for the Study of Diabetes in India (RSSDI)10
  • All diabetes subjects should be educated about administering at least pneumococcal and the influenza vaccine.
  • Vaccination against pneumococcal disease, including pneumococcal pneumonia, with 13‑valent pneumococcal conjugate vaccines (PCV13) is recommended for children before age two years.
  • People with diabetes aged 2 through 64 years should receive 23‑valent pneumococcal polysaccharide vaccine (PPSV23). At age ≥65 years, regardless of vaccination history, additional PPSV23 vaccination is necessary.
  • Annual vaccination against influenza is recommended for all people ≥six months of age, especially those with diabetes.

▫ A quadrivalent influenza vaccine should be preferred.

Kindly note

  • Vaccination is contraindicated/postponed in patients with:

▫ hypersensitivity to the active substances or to any of the excipients of the vaccine ▫ history of chicken egg allergy particularly when considering flu shot

▫ recent history of Guillain‑Barre syndrome within six weeks of previous influenza vaccination in the case of a flu shot

▫ febrile illness or any acute infection

Improving Adult Immunization Coverage 11,12

Improving adult vaccination coverage could have positive consequences for individuals, families, and communities. Adult vaccination could also help to reduce healthcare costs, which is particularly crucial among more deprived communities. Improving adult vaccination coverage in India could help break the chain of infection, reduce the burden of disease among patients with chronic conditions, and prevent full community spread. Specifically, better coverage will result in reduced incidence rates, reduced hospital admissions, reduced health costs, and improved quality of life.

Intensive efforts are needed for the provision of vaccines in the national immunization schedule, that could help alleviate adult suffering from infectious diseases. Adult vaccination must become part of routine immunization because these vaccines can save millions of lives 8.

The below video explains the importance of Adult vaccinations for people with Diabetes in Tamil.

DR.V. MOHAN, M.D., FRCP, Ph.D., D.Sc., FNASc, FASc, FNA, FACE, FACP, FTWAS, MACP, FRSE

Awarded Padma Shri by Govt. of India
Chairman & Chief of Diabetology


Dr. A. AMUTHA,M.Sc.,R.D.,PGDDE.,Ph.D,
Scientist -YDR Projects,
Dept. of Epidemiology
Dr. Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India

References:

  1. Bouter P. et al., Effect of epidemic influenza on ketoacidosis, pneumonia and death in diabetes mellitus: a hospital register survey of 1976-1979 in the Netherlands, Diabetes Research and Clinical Practice 1991, 12: 61-68
  2. CDC. If you have diabetes, a flu shot could save your life. [Online] 2007 [2 page]; Available from URL http://www.cdc.gov/diabetes/projects/pdfs/eng_brochure.pdf,
  3. National Coalition for Adult Immunization roundtable panelists. A call to action: Improving influenza and pneumococcal immunization rates among high-risk adults. (May 1998) [Online], 2004. Available from URL http://www.nfid.org/ncai/publications/roundtable/
  4. Froes F, Roche N, Blasi F. Pneumococcal vaccination and chronic respiratory diseases. Int J Chron Obstruct Pulmon Dis. 2017;12:3457-3468. Published 2017 Dec 5. doi:10.2147/COPD.S140378
  1. Moe H. Kyaw, Charles E. Rose, Jr, Alicia M. Fry et.al.; The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults; J Infect Dis. 2005 Aug 1; 192(3): 377–386. Published online 2005 Jun 23. doi: 10.1086/431521
  2. Centre of Disease Control and Prevention, Pneumococcal Disease; Prevention; https://www.cdc.gov/pneumococcal/about/prevention.html ; Accessed on 9th Nov 2019.
  1. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
  2. NIFD. Common Questions and Answers About COVID-19 for Older Adults and People with Chronic Health Conditions [Internet]. National Foundation for Infectious Diseases; 2020 Mar 19 [cited 30 Mar 2020]. Available from: https://www.nfid.org/infectious-diseases/common-questions-and-answers-about-covid-19-for-older-adults-and-people-with-chronic-health-conditions/
  3. ACC CLINICAL BULLETIN COVID-19 Clinical Guidance For the CV Care Team.
  4. Chawla R, Madhu SV, Makkar BM, et al. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab. 2020;24(1):1-122. doi:10.4103/ijem.IJEM_225_20
  5. Verma R, Khanna P, Chawla S. Adult immunization in India: importance and recommendations. Hum Vaccin Immunother. 2015;11:2180–82. doi:10.4161/hv.29342.
  6. Tan L. Adult vaccination: now is the time to realize an unfulfilled potential. Hum Vaccin Immunother. 2015;11:2158–66. doi:10.4161/21645515.2014.982998.

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