Diabetes Patients Have Double the Risk for Hepatitis B Infection

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices on Oct. 25 held a hearing on a recommendation that patients with diabetes receive immunization with the hepatitis B vaccine, following findings that U.S. adult diabetes patients face a roughly twofold increased risk for hepatitis B infection.*

Results from CDC investigations identified inadequately cleaned blood glucose monitors as a major route of hepatitis B virus transmission among patients with diabetes.

Meredith L. Reilly, a CDC epidemiologist, said while presenting a poster at the meeting, "Over the past several years, we've observed outbreaks of hepatitis B among patients with diabetes in places where they undergo assisted blood glucose monitoring, with more than one person using the monitor," such as assisted-living facilities, physician offices, and at pharmacies, said Dr. Trudy V. Murphy, head of the vaccine unit in the Division of Viral Hepatitis at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta. A total of 24 of 28 outbreaks at long-term care facilities identified different aspects of blood glucose monitoring as the source of the infection."

Dr. Murphy was scheduled to propose new recommendations on the use of hepatitis B vaccination before the Advisory Committee on Immunization Practices of the CDC at the ACIP's meeting on Oct. 25, and her recommendations will include targeting the vaccine to patients with diabetes, both types 1 and 2, she said in an interview.

Although the CDC will also promote other steps to prevent hepatitis B transmission among patients with diabetes, such as greater attention to cleaning blood glucose monitors and avoiding the sharing of lancets or insulin needles, "Vaccination is an additional measure to ensure protection," she said.

Diabetes patients must also take other steps to avoid blood exposures because they also face infection threats from other blood-borne pathogens. However, hepatitis B poses a particular risk because it is highly infectious in residual blood and is relatively stable. An invisible drop of blood can contain enough virus to infect an exposed person, and the virus in that drop will remain infectious on a surface for 7 days, Dr. Murphy noted. In addition, blood glucose monitors can be very hard to completely clean of residual blood because of their design and because more thorough cleaning can damage the equipment.

Hepatitis B is the first blood-borne pathogen that has been proven to transmit among patients with diabetes through blood-contaminated equipment used in monitoring and treating diabetes, she added.

Following the outbreak investigations, the CDC reviewed acute hepatitis cases reported during 2009 and 2010 at eight U.S. sites in the CDC's Emerging Infections Program. The review included 865 people with acute hepatitis B infections, including 95 with diabetes. In an analysis that controlled for gender, age, race and ethnicity, and other hepatitis B risk factors, the patients with diabetes who were 23-59 years old had a statistically significant, 2.1-fold higher risk of being infected with hepatitis B, compared with the people studied who did not have diabetes, Ms. Reilly reported in her poster. Among those aged 22 years or younger, the patients with diabetes had a significant, 1.9-fold increased risk for hepatitis B infection. Among those aged 60 years or older, the risk of hepatitis B infection was 50% higher in patients with diabetes, a difference that did not achieve statistical significance, reported Ms. Reilly, who also works in the CDC's Division of Viral Hepatitis.

The Centers for Disease Control and Prevention, Oct. 25, 2011