39 - Survey of Hepatitis B Vaccination Rates in Adult Patients with Diabetes at a Large Internal Medicine/Geriatrics Clinic

Background: The Advisory Committee on Immunization Practices (ACIP) recommends immunization with hepatitis B vaccine (HBV) for diabetic adults aged 19-59 years and advises HBV at the discretion of the treating clinician for those 60 years or older. Current HBV rates are suboptimal. In one 2015 survey, only 24.4% of diabetic adults aged 19-59 years were immunized.

Methods: This is a single center, retrospective cohort of patients seen in an internal medicine/geriatrics clinic at Cleveland Clinic Main Campus between January 1, 2017 and December 31, 2017. Patients included were at least 19 years of age and had a diagnosis of diabetes mellitus (type I or type II) as determined by ICD-10 code. Patients with acute or chronic hepatitis B infection were excluded from the primary analysis. Data collected included demographics, HBV status, pneumococcal vaccination status, and risk factors for hepatitis B virus infection (chronic liver disease, end stage renal disease (ESRD)). Primary objective evaluated rate of HBV, defined as documented completion of 3-dose series or positive qualitative anti-HBs. Descriptive statistics included number (percentage) or mean + standard deviation.

Results: A total of 3104 patients, aged 65 + 1.5 years, male (50.2%) or white (72.6%) with Type II diabetes (88.9%) were enrolled. Of these, 171 (5.5%) received one dose of HBV, with 62 (2.0%) completing the immunization series. There were 806 (26%) patients with hepatitis B screening, of those 10 (0.3%) and 177 (5.7%) were HbsAg positive or anti-HBs seropositive, respectively. Overall, 221 (7.1%) patients received the 3-dose series or were anti-HBs positive. In comparison, 1719 (55.4%) patients received at least one dose of either pneumococcal vaccine. Comorbid liver disease or ESRD yielded higher rates of HBV immunity (3-dose series completion or anti-HBs positive) at 28.8% (46/160) and 57.8% (52/90) respectively.

Conclusion: We found low HBV rates for adults with diabetes despite ACIP recommendations, indicating that efforts are needed to improve vaccination coverage. Patients were more likely to have received immunization if comorbid conditions were present that conferred a higher risk of hepatitis B acquisition, however rates were still suboptimal.