You may have heard that older people and people with diabetes have greater risk of death from COVID-19. Diabetes and aging slow down the immune system and make it harder to fight infections like COVID and the flu. We want to prevent such infections, and vaccines are an important way to do that.
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There is no vaccine for COVID-19, but there are good ones for many other diseases that commonly affect older people. For people with diabetes, vaccination is considered an important part of self-management, but which vaccines, if any, should we take? What is the best way to take them, and what are the side effects and risks?
What is a vaccine?
Like all animals, people rely on our immune systems to keep us safe from disease-causing germs in the environment. Immune systems find and attack invading germs (bacteria, viruses, fungi and protozoa). But immune cells have to recognize invaders before they will attack them. This process takes time, and people can get very sick before the immune defense kicks in. A vaccine works by training the immune system to recognize a particular bacteria or virus. Vaccines use certain molecules called “antigens” from the surface of the germs. When these molecules are injected into the body, the immune system learns to recognize them as invaders. The body will then produce antibodies, which are cells that remember those specific antigens. If the bacteria or virus appears, the antibodies will recognize the antigens and attack the invaders before they can spread and cause sickness.
Why get vaccinated?
The Centers for Disease Control (CDC) note that “diabetes, even if well managed, can make it harder for our immune system to fight infections.” The system works slower because of higher-than-normal blood sugars, which is why doctors recommend giving the immune system a head start with vaccines.
Vaccinations that most people with diabetes should receive include:
Influenza (flu) vaccine
The flu is one of the most dangerous infections in modern society, with more than 79,000 flu-related deaths recorded in the United States in the 2017 to 2018 flu season. For most people, the flu means seven to 10 days of misery, but for some, it’s far worse. The CDC warns that complications can include pneumonia, organ failure and death. They also caution that “Influenza can raise your blood glucose to dangerously high levels.”
There are four major strains of flu virus and several substrains. More than one strain can come around in the same year. Large pharmaceutical companies have created a number of different vaccines focused on different strains, and scientists try to guess each year which ones will work best. They do this by analyzing which strains are showing up in samples from patients around the world. Two versions of the vaccine are available specifically to people 65 and older: Fluzone High-Dose and Fluad, which use a higher dose of antigen. Writing about vaccinations here, Amy Campbell MS, RD, LDN, CDCES, notes that, “There is no guarantee that getting a flu shot will protect you from getting the flu. You may get infected by a strain of flu virus that isn’t ‘covered’ by the flu vaccine, and for some people, the flu vaccine doesn’t work that well.” But Dr. David Kim, MD, MPH, director of the division of vaccines and immunization at the Department of Health and Human Service, advises that, even if the flu shot doesn’t completely protect you, you will probably get a milder case of flu than you would without the vaccine.
Pneumonia can be deadly in older people. The CDC recommends that all adults 65 years of age or older get vaccinated against it. There are two kinds of pneumonia vaccine. Prevnar 13 protects against 13 of the most common strains, and Pneumovax protects against 23 more strains. Younger adults should get one of them if they have diabetes, HIV, cancer or smoke cigarettes.
Your doctor might recommend one or both vaccinations. WebMD says, “People who need a pneumonia vaccine should get both shots: first, the PCV13 shot and then the Pneumovax shot a year or more later.” In most people, these shots will give lifetime protection against pneumonia and meningitis.
Shingles is not life-threatening, but it is an extremely painful rash. It’s a miserable experience that can leave a patient with chronic pain (called post-herpetic neuralgia, or HPN). Shingles is caused by the virus varicella-zoster, which causes chicken pox in children and stays dormant in the nerves for life.
Ninety-five percent of Americans have had chickenpox and so are at risk for shingles when their immune system weakens with age. There are two brands of shingles vaccine. Zostavax is a single shot that is over 50% effective in preventing shingles and needs to be taken every five years or so. Shingrix is a series of two shots. It is over 90% effective for at least four years, according to manufacturer GlaxoSmithKlein.
“People with diabetes have higher rates of hepatitis B than the rest of the population,” according to the CDC. This might be in part because hep B “can be spread by sharing needles, syringes, glucose meters, lancets or other injection equipment,” as might happen in a nursing home or assisted living.
The CDC recommends that all unvaccinated adults under the age of 60 years of age get a hepatitis B vaccination. If you’re older than age 60, ask your doctor if you should get the vaccine. The hepatitis B vaccine is given as a series of three shots over a period of six months. You must get the three shots to acquire long-term protection. Discuss whether to get this vaccine with your healthcare provider.
TDAP stands for tetanus/diptheria/pertussis. The CDC recommends that all adults get the TDAP vaccine once, and then a booster every ten years. Discuss whether to get this vaccine with your healthcare provider.
Concerns about vaccines
Vaccines are drugs, and the benefits and risks should be weighed before taking any drug. Vaccines can have side effects, including soreness at the injection site and mild flu-like symptoms for a day or two. More serious side effects are extremely rare. If you have allergies to eggs or have had allergic response to vaccines before, you should be cautious about using a vaccine. But don’t rule them out, according to the American College of Allergy, Asthma and Immunology.
According to the CDC, vaccines are widely available. “Most health insurance plans cover recommended vaccines,” they say. “Check with your insurance provider for details and for a list of vaccine providers covered by your plan.” If you don’t have insurance, though, cost may be a major factor in your decision. Programs like this one can help you pay.
Per the CDC, “People have concerns over the use of formaldehyde, mercury or aluminum in vaccines. It’s true that these chemicals are toxic to the human body in certain levels, but only trace amounts are used in FDA-approved vaccines.” For people with diabetes, the benefits of the flu, pneumonia and shingles vaccines seem to far outweigh the downsides. For other vaccines, please talk with your healthcare provider.
Want to learn more about vaccines in people with diabetes? Read “Type 1 Diabetes: Five Vaccines That You May Need” and “Three Vaccines That You Need…Now!”