Categories
CDE Diabetes

Study Guide: Immunization in Diabetes (Updated 2025)

1. Overview & Principles

People with diabetes are at higher risk for complications from vaccine-preventable diseases. The new 2025 guidance emphasizes a broader range of vaccines and simplified protocols for pneumococcal protection.

  • Advocacy: Clinicians should discuss ALL age-appropriate vaccines regardless of public/private coverage.
  • Timing: Routine childhood immunizations should be up to date (refer to provincial schedules).
  • Timing: Routine childhood immunizations should be up to date (refer to provincial schedules).

2. Routine & Annual Vaccinations

These are “Ongoing Immunizations” recommended for adults with diabetes.

  • COVID-19:
    • Frequency: Annual.
    • High-Risk: Some high-risk individuals may require 2 doses/year.
    • Timing: Minimum 3 months from the last dose or 3 months post-infection.
  • Influenza (Flu Shot):
    • Frequency: Annual.
    • Target: All adults with diabetes.
  • Tetanus-Diphtheria-Pertussis (Tdap):
    • Frequency: Booster every 10 years.

3. One-Time / Series Vaccinations (Major Updates)

The protocols for Pneumococcal and Shingles have been significantly updated from the 2018 guidelines.

A. Invasive Pneumococcal Disease

  • New Recommendation: One dose of Pneu-C-21 OR Pneu-C-20.
  • History: This single dose is recommended regardless of previous vaccination status with Pneu-C-13 (Prevnar-13) or Pneu-P-23 (Pneumovax-23).
  • Age: Recommended for adults age 18+.

B. Herpes Zoster (Shingles)

  • Vaccine Type: Recombinant Zoster Vaccine (RZV) is recommended.
  • Age: Recommended for adults age 50 years.
  • Previous History:
    • If the patient had a previous episode of Shingles: Wait at least 1 year before vaccinating.
    • If the patient received the live vaccine (LZV) previously: Wait at least 1 year before vaccinating with RZV.

C. Respiratory Syncytial Virus (RSV)

  • Strategy: Individualized assessment.
  • Risk Factors: High-risk populations include diabetes, chronic kidney disease (CKD), and obesity.
  • Age: The tool highlights consideration starting at age 60. (Note: Recent NACI guidance also discusses ages 50-59 ).

D. Hepatitis B

  • Indication: Recommended if not vaccinated in childhood or if medical conditions change.
  • Specific Risk: Chronic Kidney Disease (CKD) with or without dialysis.
  • Vaccine: Most people should be immunized with the combined Hepatitis A + B vaccine.

4. Additional Lifetime Recommendations

These are not specific only to diabetes but are part of comprehensive care.

  • Human Papillomavirus (HPV): Recommended if not previously vaccinated with a complete series (up to age ~44 in chart).
  • Meningococcal-ACYW: Booster at 12–24 years old (even if vaccinated as an infant).
  • Measles-Mumps-Rubella (MMR): Adults born in or after 1970 should receive one dose.

References:

Husein N, Chetty A. Influenza, Pneumococcal, Hepatitis B and Herpes Zoster Vaccinations. Canadian Journal of Diabetes. 2018;42:S142-S144. doi:10.1016/j.jcjd.2017.10.016
 
Diabetes Canada. Immunizations Recommended for Adults Living with Diabetes. Accessed August 23, 2025. https://guidelines.diabetes.ca/getmedia/5365a51d-a34b-4176-bb1f-beed55239ebb/Immunization-Tool_Ver_3.pdf