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Nisa Maruthur, M.D., M.H.S.
10-20-2010
Trinidad and Tobago Information Author: Claude Khan, BSc, MBBS, MRCGP, MSc and Nancyellen Brennan FNP, CDE
- Formal vaccination guidelines for T&T not currently available for persons with diabetes.
- Given lack of a winter period, a time when influenza cases usually spike, unlikely that vaccination would confer same benefit as in U.S.
- Unclear how often providers are currently giving pneumococcal vaccinations in T&T.
- Guidelines based on the Advisory Committee on Immunization Practices (ACIP) recommendations for the control of communicable diseases that can be prevented by vaccination.
- Patients with diabetes have co-morbid factors such as age and other chronic diseases which increase morbidity and mortality from infection.
- Influenza and pneumococcal infection associated with high death rates in those with diabetes (Smith).
- For those with diabetes, influenza vaccination associated with 54% reduction in hospitalizations and 58% reduction in deaths (Looijmans-Van den Akker). Similar clinical outcomes are unfortunately not available for the pneumococcal vaccine.
- Annual influenza vaccination may decrease cardiovascular disease morbidity and mortality (Davis).
- Prevalence of pneumococcal vaccination among patients with diabetes may be as low as 38% in the United States (Resnick), and national estimates of influenza vaccination in the general population (> 65 years of age) range from 33 to 75% (Kilmer).
- Age-specific adult immunization schedule recommended per Centers for Disease Control (for specific schedules see: http://www.cdc.gov/mmwr/PDF/wk/mm5753-Immunization.pdf)
- Two versions of the influenza vaccine: Injectable (inactivated) and inhaled (live). Either type is safe in diabetes. Both forms can cause mild symptoms, but not an influenza infection. Side effects of the inactivated injection: erythema, swelling, and pain at injection site. Both types of vaccine can cause upper respiratory infection-type symptoms (e.g., fever, myalgias). More serious (but rare) risks include life-threatening allergic reactions and Guillain-Barre Syndrome (seen with inactivated swine flu vaccine in 1970s) (http://www.cdc.gov/vaccines/vac-gen/side-effects.htm#flu).
- Annual influenza vaccine typically becomes available in October each year.
- Before age 65, single vaccination with pneumococcal polysaccharide vaccine
- After age 65 and no previous pneumococcal vaccine, single vaccination with pneumococcal polysaccharide vaccine (repeat vaccine not necessary)
- If vaccinated before age 65 and greater than 5 years since vaccination, administer second vaccination
- Primary care clinics should consider vaccine implementation strategies to ensure appropriate adherence to vaccination schedules.
- It should be noted that the vaccine for pneumonia can only prevent pneumonia caused by Streptococcus pneumoniae.
- People with diabetes should routinely receive seasonal flu vaccine and vaccine for pneumonia as stated above.
- The CDC provides destination-specific recommendations for vaccinations on its website (http://wwwnc.cdc.gov/travel/destinations/list.aspx).
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