Hepatitis B virus (HBV) vaccination should be administered to all previously unvaccinated persons aged 19 through 59 years who have diabetes, and to those aged 60 years and older at the discretion of their clinicians. 

The CDC’s Advisory Committee on Immunization Practices (ACIP) issued these recommendations (MMWR. 2011;60:1709-1711) after a subcommittee found that diabetes patients aged 23 through 59 years had 2.1 times the odds of developing acute hepatitis B as those without diabetes. Diabetes patients aged 60 years and older were 1.5 times more likely than persons without diabetes to develop acute hepatitis B. 

The ACIP put forth a category-A recommendation advising younger adults to be vaccinated against HBV as soon as possible after being diagnosed with diabetes. For the patients aged 60 years and older, however, data on the risk of hepatitis B were less robust, prompting a category-B recommendation that treating clinicians make decisions to vaccinate based on individual patient risk assessment and the likelihood of adequate immune response to vaccination. 

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HBV infection severity among adults ranges from asymptomatic to fulminant hepatitis. A total of 3,371 acute HBV infections were reported in 2009. Of the 2,126 infections for which information was available, nearly half (47%) resulted in hospitalization, and 1% of the 1,900 infections for which information was available were fatal.

Data from the nationwide Emerging Infections Program for the period of 2009-2010 indicated a higher case-fatality rate among acute-HBV-infected persons with diagnosed diabetes compared with those without diabetes (5% vs 2%), although the difference was not statistically significant.