Chapter 19 Nadira Husein MD FRCPC, Ashen Chetty APN MEd BScN CDE CCRA 2018 Clinical Practice Guidelines Influenza and Pneumococcal Immunization Chapter 19 Nadira Husein MD FRCPC, Ashen Chetty APN MEd BScN CDE CCRA 1

Disclaimer All Content contained on this slide deck is the property of Diabetes Canada, its content suppliers or its licensors as the case may be, and is protected by Canadian and international copyright, trademark, and other applicable laws. Diabetes Canada grants personal, limited, revocable, non-transferable and non-exclusive license to access and read content in this slide deck for personal, non-commercial and not-for-profit use only. The slide deck is made available for lawful, personal use only and not for commercial use. The unauthorized reproduction, distribution of this copyrighted work is not permitted. For permission to use this slide deck for commercial or any use other than personal, please contact guidelines@diabetes.ca

Key Changes New information on recommendations for 2018 Diabetes Canada CPG – Chapter 19. Vaccinations Key Changes 2018 New information on recommendations for Recommended types of Pneumococcal vaccination Hepatitis B vaccination Herpes Zoster vaccination

Immunization Checklist 2018 Diabetes Canada CPG – Chapter 19. Vaccinations Immunization Checklist GIVE annual influenza immunization OFFER pneumococcal immunization if >18 years of age RE-VACCINATE for pneumococcal for those >65 years of age; ensure ≥5 years between administrations Script The key messages in the chapter are that: Influenza immunization is essential yearly among patients with diabetes to reduce hospitalizations, Pneumoccoccal immunization is desired in patients with diabetes as it is a chronic disease. For those > 65, a one time revaccination is essential if original vaccine adminstered < 65 y with at least 5 years in between to ensure adequate immunity. Finally, It is important to include immunization as part of the diabetic flowsheet as a reminder. TTT:The purpose of slide is to provide the framework of key messages for the chapter 4

Annual Influenza Immunization is Beneficial for Patients with Diabetes 2018 Diabetes Canada CPG – Chapter 19. Vaccinations Annual Influenza Immunization is Beneficial for Patients with Diabetes Diabetes = ↑ risk of morbidity from influenza Influenza immunization ↓ hospitalization rates by ~ 40% Script: see above TTT: The purpose of slide is to illustrate current gap that many patients with diabetes are currently not being immunized for influenza Annual Influenza Immunization Groenwold RHH, et al. EurRespir J. 2009;34:56-62. 5

Recommend Pneumococcal Vaccine Among People with Diabetes 2018 Diabetes Canada CPG – Chapter 19. Vaccinations Recommend Pneumococcal Vaccine Among People with Diabetes People with diabetes are at similar risk of pneumococcal disease as other chronic conditions A one time revaccination is recommended if: >65 years of age + ≥5 years between administrations Script: Diabetes is considered to be a chronic condition and people with diabetes are at similar risk of developing pneumococcal disease as those with other chronic conditions – It is strongly encouraged to immunize patients for pneumococcal disease to prevent morbidity and mortality associated with pneumococcal disease. Essential to have a one time revaccination if pts > 65 or if Original vaccine administered when <65 years of age with more than 5 years between administrations TT: Slide is to illustrate the importance of pneumococcal vaccination in addition to influenza and consideration for re-vaccination. 6

Include Vaccination Status on Diabetes Flow Sheet 2018 Diabetes Canada CPG – Chapter 19. Vaccinations Include Vaccination Status on Diabetes Flow Sheet

2018 Diabetes Canada CPG – Chapter 19. Vaccinations Recommendation 1 People with diabetes should receive routine vaccination as recommended for the general population in keeping with the National Advisory Committee on Immunization guidelines [Grade D, Consensus] (available at http://www.phac-aspc.gc.ca/publicat/cig-gci/index- eng.php )

2018 Diabetes Canada CPG – Chapter 19. Vaccinations Recommendation 2 People with diabetes should receive an annual influenza vaccination during flu season to reduce the risk of influenza-related hospitalizations and death [Grade C, Level 3]

2018 Diabetes Canada CPG – Chapter 19. Vaccinations Recommendation 3 2018 Pneu-P-23 vaccination should be offered to persons with diabetes aged 19 to 64 years. A one time revaccination is recommended for those >65 years of age (if the original vaccine was given when they were <65 years of age). For people with diabetes >65 years or with an immunocompromising condition (e.g., end stage renal failure), Pneu-C-13 vaccine should be administered first, followed at least 8 weeks later by Pneu-P-23 vaccine. In people who have already received Pneu-P-23, at least one year should elapse before they are given Pneu-C-13 [Grade D, Consensus]

2018 Diabetes Canada CPG – Chapter 19. Vaccinations Key Messages Influenza vaccination can reduce hospitalization rates by approximately 40% for those individuals deemed to be at high risk Pneumococcal vaccination is desired in people with diabetes as they are considered as likely to be infected as those with other chronic diseases Adults with type 1 and type 2 diabetes are at higher risk of Hepatitis B virus infection

Key Messages for People with Diabetes 2018 Diabetes Canada CPG – Chapter 19. Vaccinations Key Messages for People with Diabetes You should receive routine vaccinations as recommended for anyone with or without diabetes. Check if you are up to date with your vaccinations. You should receive Influenza vaccination(“flu shot”) every year Pneumococcal vaccination: Initially when you are over the age of 18 years And, again, when you are over the age of 65 years (if your original vaccination was given when you were younger than 65 years and your last vaccination was over 5 years ago)

Visit guidelines.diabetes.ca

Or download the App

Diabetes Canada Clinical Practice Guidelines http://guidelines.diabetes.ca – for health-care providers 1-800-BANTING (226-8464) http://diabetes.ca – for people with diabetes