ATLANTA – The incidence of acute hepatitis B is nearly twice as high among adults with diabetes as in those without, according to new data from the Centers for Disease Control and Prevention.
The finding, presented by Meredith Reilly, M.P.H., at a meeting of the CDC’s Advisory Committee on Immunization Practices, was based on 2009-2010 data from four sites (Connecticut, Colorado, Oregon, and New York City) that participate in the CDC’s Emerging Infection Program. Data from 2006-2008 from New York City also were included.
Those data were compared with study population denominator data from the Behavioral Risk Factor Surveillance System.
Overall, the prevalence of diabetes in 2009 was 8.4% among more than 12 million individuals at the four sites, ranging from 6.3% in Colorado to 10.0% in New York City. Diabetes prevalence ranged from 5.2% for adults aged 23-59 years, to 18.0% for those aged 60 years and older.
There were 326 reported cases of acute hepatitis B in the study population; diabetes information was available for 226. Of those patients, 15% (34) had diabetes and 85% (192) did not. Thus, the diabetes rate among the hepatitis B cases was nearly double that of the entire study population (15% vs. 8.4%), noted Ms. Reilly of the CDC’s division of viral hepatitis.
Other reported risk factors for acute hepatitis B were less common among those with hepatitis B who had diabetes than in both the nondiabetic subjects and the group of 100 for whom diabetes information was not available. Injection drug use was reported by 3% of those with diabetes, compared with 7% of those without and 27% of those with unknown diabetes status.
The estimated annual incidence of acute hepatitis B per 100,000 adults aged 23 years and older was 1.4 for those with diabetes versus 0.7 for those without, for a rate ratio of 1.9. By age, the rate ratio for acute hepatitis B between those with diabetes and those without was 2.6 for those aged 23-59 years and 2.0 for aged 60 and above. The difference was statistically significant for the younger cohort but not the older, Ms. Reilly noted.
The Advisory Committee on Immunization Practices is currently considering whether to recommend the hepatitis B vaccine for individuals with diabetes, an idea initially triggered by reports of hepatitis B outbreaks traced to improper infection-control practices associated with use of blood glucose testing and insulin injection devices in health care settings.
Next steps include results of a cost-effectiveness analysis and seroprotection studies in residents of assisted living facilities with hepatitis B outbreaks, along with estimates of current vaccination coverage. The plan is to discuss implementation strategies and address an evidence-based proposed recommendation at an upcoming meeting, said Dr. Trudy Murphy, also of the CDC’s division of viral hepatitis.
Dr. Murphy and Ms. Reilly are CDC employees with no disclosures.