2008 Clinical Practice Guidelines - Canadian Diabetes Association

More documents

Recommendations

Info

2008 CLINICAL PRACTICE GUIDELINES S86 Influenza and Pneumococcal Immunization Canadian Diabetes Association Clinical Practice Guidelines Expert Committee The initial draft of this chapter was prepared by Vincent Woo MD FRCPC KEY MESSAGES • Studies in high-risk individuals, which included people with diabetes, have shown that influenza vaccination can reduce hospitalizations by approximately 40%. • As people with diabetes are at least as susceptible to pneumococcal infection as other people with chronic diseases, the use of the pneumococcal vaccine is encouraged. • A one-time pheumococcal revaccination is recommended for individuals >65 years of age if the original vaccine was administered when they were 5 years earlier. INTRODUCTION People with diabetes, especially those with renal and cardiac complications, are at high risk for morbidity and mortality from influenza and pneumococcal disease (1). Studies in high-risk individuals, which included people with diabetes, have shown that influenza vaccination can reduce hospitalizations by about 40% (2). However, there are few randomized controlled trials that have specifically evaluated the use and benefit of influenza or pneumococcal immunization in people with diabetes (1). Clinical practice recommendations for people with diabetes must therefore be extrapolated from recommendations for individuals at high risk of complications associated with these infectious diseases (3-5). INFLUENZA IMMUNIZATION IN ADULTS The majority of studies on influenza immunization rely on observational reports of increased death rates in people with diabetes during influenza epidemics (6-9). One case-control study of people with diabetes showed a 6-fold increased risk of hospitalization during influenza outbreaks compared to nonepidemic years (9). A retrospective case-control study demonstrated the effectiveness of influenza vaccination in reducing rates of hospitalization of people with diabetes for influenza, pneumonia or diabetes-related events during 2 influenza epidemics in Leicestershire, England, United Kingdom (10). The study detected a 79% reduction in hospitalization rates during the 2 epidemics in people with diabetes who had been immunized against influenza during the period immediately preceding the epidemic. Another nested case-control study in the Netherlands demonstrated that vaccination was associated with a 56% reduction in any complication, a 54% reduction in hospitalizations and a 58% reduction in deaths in people with type 2 diabetes (11). PNEUMOCOCCAL IMMUNIZATION IN ADULTS Numerous studies have demonstrated the efficacy of immunization in reducing pneumococcal bacteremia in the general population (12-15).There is widespread acceptance that people with diabetes are at least as susceptible to pneumococcal infection as other people with chronic diseases (1), and therefore the use of the pneumococcal vaccine is encouraged in this population. A one-time revaccination is recommended for individuals >65 years of age if the original vaccine was administered when they were 5 years earlier. RECOMMENDATIONS 1. People with diabetes should receive an annual influenza vaccine to reduce the risk of complications associated with influenza epidemics [Grade D, Consensus]. 2. People with diabetes should be considered for vaccination against pneumococcus [Grade D, Consensus]. RELATED WEBSITES National Advisory Committee on Immunization. Canadian Immunization Guide. 7th ed. Ottawa, ON: Canadian Medical Association; 2006. Available at: http://www.phac-aspc.gc. ca/publicat/cig-gci/index.html.Accessed September 1, 2008. REFERENCES 1. Smith SA, Poland GA. Use of influenza and pneumococcal vaccines in people with diabetes. Diabetes Care. 2000;23:95-108. 2. Nichol KL, Nordin J, Mullooly J, et al. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med. 2003;348:1322-1332. 3. Casey JI. Host defense abnormalities in diabetic patients. In: Rifkin H, Raskin P, eds. Diabetes Mellitus. Vol 5. Bowie, MD: Robert J. Brady Company; 1981:219-223. 4. Heymann AD, Shapiro Y, Chodick G, et al. Reduced hospitalizations and death associated with influenza vaccination among patients with and without diabetes. Diabetes Care. 2004;27: 2581-2584.
5. Smith SA, Poland GA, American Diabetes Association. Influenza and pneumococcal immunization in diabetes. Diabetes Care. 2004;27:S111-S113. 6. Eickhoff TC, Sherman IL, Serfing RE. Observations on excess mortality associated with epidemic influenza. JAMA. 1961;176: 104-110. 7. Martin WJ. Recent changes in the death rate from influenza. Br Med J. 1950;1:267-268. 8. Stocks P, Camb MD. Influenza epidemics on the certified causes of death. Lancet. 1935:ii;386-395. 9. Bouter KP, Diepersloot RJA, van Romunde LKJ, 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 Res Clin Pract. 1991;12:61-68. 10. Colquhoun AJ, Nicholson KG, Botha JL, et al. Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes. Epidemiol Infect. 1997;119:335-341. 11. Looijmans-Van den Akker I, Verheij TJ, Buskens E, et al. Clinical effectiveness of first and repeat influenza vaccination in adult and elderly diabetic patients. Diabetes Care. 2006;29: 1771-1776. 12. Bolan G, Broome CV, Facklam RR, et al. Pneumococcal vaccine efficacy in selected populations in the United States. Ann Intern Med. 1986;104:1-6. 13. Forrester HL, Jahnigen DW, LaForce FM. Inefficacy of pneumococcal vaccine in a high-risk population. Am J Med. 1987; 83:425-430. 14. Schwartz JS. Pneumococcal vaccine: clinical efficacy and effectiveness. Ann Intern Med. 1982;96:208-220. 15. Shapiro ED, Clemens JD. A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. Ann Intern Med. 1984; 101:325-330. S87 MANAGEMENT
Page 1:
Canadian Publication Mail Agreement
Page 4 and 5:
2008 CLINICAL PRACTICE GUIDELINES i
Page 6 and 7:
2008 CLINICAL PRACTICE GUIDELINES i
Page 8 and 9:
2008 CLINICAL PRACTICE GUIDELINES v
Page 10 and 11:
2008 CLINICAL PRACTICE GUIDELINES v
Page 12:
2008 CLINICAL PRACTICE GUIDELINES x
Page 16 and 17:
2008 CLINICAL PRACTICE GUIDELINES S
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51: 2008 CLINICAL PRACTICE GUIDELINES S
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 176 and 177:
Page 178 and 179:
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
show all

2008 Clinical Practice Guidelines - Canadian Diabetes Association

Create successful ePaper yourself

Delete template?

Save as template?