Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP).
Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP).
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发表时间：
2011-12
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通讯作者：
M. Sawyer;T. Hoerger;T. Murphy;S. Schillie;D. Hu;P. Spradling;Kathy K. Byrd;J. Xing;M. Reilly;R. Tohme;A. Moorman;Emily A. Smith;Bn Baack;R. Jiles;M. Klevens;J. Ward;H. Kahn;F. Zhou
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作者：
M. Sawyer;T. Hoerger;T. Murphy;S. Schillie;D. Hu;P. Spradling;Kathy K. Byrd;J. Xing;M. Reilly;R. Tohme;A. Moorman;Emily A. Smith;Bn Baack;R. Jiles;M. Klevens;J. Ward;H. Kahn;F. Zhou
B型肝炎病毒（HBV）引起肝脏的急性和慢性感染，导致大量的发病率和死亡率。在美国，自1996年以来，共有29起HBV感染暴发在一个或多个长期护理（LTC）设施，包括疗养院和辅助生活设施，报告给CDC;其中，25例涉及接受辅助血糖监测的糖尿病成人。这些疫情促使免疫实践咨询委员会（ACIP）肝炎疫苗工作组评估所有确诊糖尿病的成年人感染乙型肝炎病毒的风险。工作组审查了HBV感染相关的发病率和死亡率以及实施感染预防和控制措施的有效性。使用建议、评估、发展和评价分级（GRADE）方法评估了关于保护的科学证据的强度，* 并使用GRADE系统将安全性、价值和成本效益纳入建议中。根据工作组的研究结果，2011年10月25日，ACIP建议所有先前未接种疫苗的19至59岁糖尿病（1型和2型）成人在诊断为糖尿病后尽快接种B肝炎疫苗（建议类别A）。关于年龄≥60岁的成年人患B型肝炎风险的数据不太可靠。因此，ACIP建议，年龄≥60岁的未接种疫苗的糖尿病成人在评估其风险和疫苗接种产生充分免疫应答的可能性后，可由治疗临床医生自行决定接种疫苗（建议类别B）。本报告总结了这些建议，并提供了ACIP用于指导其决策的理由。
Hepatitis B virus (HBV) causes acute and chronic infection of the liver leading to substantial morbidity and mortality. In the United States, since 1996, a total of 29 outbreaks of HBV infection in one or multiple long-term-care (LTC) facilities, including nursing homes and assisted-living facilities, were reported to CDC; of these, 25 involved adults with diabetes receiving assisted blood glucose monitoring. These outbreaks prompted the Hepatitis Vaccines Work Group of the Advisory Committee on Immunization Practices (ACIP) to evaluate the risk for HBV infection among all adults with diagnosed diabetes. The Work Group reviewed HBV infection-related morbidity and mortality and the effectiveness of implementing infection prevention and control measures. The strength of scientific evidence regarding protection was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology,* and safety, values, and cost-effectiveness were incorporated into a recommendation using the GRADE system. Based on the Work Group findings, on October 25, 2011, ACIP recommended that all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made (recommendation category A). Data on the risk for hepatitis B among adults aged ≥60 years are less robust. Therefore, ACIP recommended that unvaccinated adults aged ≥60 years with diabetes may be vaccinated at the discretion of the treating clinician after assessing their risk and the likelihood of an adequate immune response to vaccination (recommendation category B). This report summarizes these recommendations and provides the rationale used by ACIP to inform their decision making.