Most of those all-too-dreaded trips to the pediatrician for shots that boost the immune system culminate with the eruption of permanent teeth. But this no longer holds true; not if you’re diabetic, at least. Well into your fifties or sixties, that need for an immune system enhancer comes full circle, especially if you are diabetic.

Patients with diabetes mellitus are generally considered as having lowered immune function compared to their non-diabetic counterparts. This is especially true for diabetics who have already developed diabetes-related heart or kidney problems. Having a lowered immune function means their ability to fight infection is compromised, and their risk for fatal and non-fatal complications when an infection develops, is heightened. Putting the proverbial “ounce of prevention” into practice becomes paramount.

The Center for Disease Control Advisory Committee on Immunization Practices (CDC-ACIP) annually reviews and recommends guidelines on vaccination. Recommendations are classified based on patients’ age group and the presence of special conditions that pose greater risks of contracting certain infections.

Age does matter

For diabetics younger than 50 years and who have not received prior shots or contracted the disease, the CDC-ACIP recommends immunization against MMR (measles/mumps/rubella or German measles), and varicella (chicken pox). Under special circumstances, influenza (the flu), and pneumococcal (bacteria causing serious lung infections) vaccines are likewise needed.

The MMR vaccine is delivered subcutaneously (into the skin) in two doses spaced four weeks apart. Women capable of childbearing who have not yet contracted German measles should routinely receive MMR. These women, however, should not become pregnant within at least a month of receiving the vaccine. MMR is live attenuated vaccine, which signifies that it contains the live but weakened virus. If it is given to a pregnant woman, there is a theoretical albeit very low risk that it may cause disease in the unborn child.

Two doses administered over one to two months are necessary for the prevention of chicken pox. On the other hand, for otherwise healthy diabetics aged 50 to 64 years, routine influenza vaccination alone suffices. The best time to be vaccinated against the flu in the Northern Hemisphere is before October to November, during which time the flu season peaks.

In more senior diabetics, respiratory infections are more likely to cause greater debilitation, longer hospitalization, and a higher risk of death. Hence, both the CDC and the American Diabetes Association strongly recommend that persons aged 65 or older receive influenza and pneumococcal vaccination. Because immunity wanes a year later, the influenza vaccine is injected into muscle annually. Meanwhile, the pneumococcal polysaccharide vaccine may be injected into the muscle or skin. Though routinely administered as a single lifetime dose, a second dose is advised five years later if chronic kidney disease is present, or if the first vaccination was given before the age of 64 and five years or more have elapsed since the previous dose.

All diabetics, regardless of age, are advised to receive tetanus and diphtheria-containing vaccines. These are injected into the muscle in three doses, over a span of six months to a year. A tetanus booster dose is generally given once every ten years, but may be given earlier, after five years, if a diabetic develops an infected wound.

Special situations may require influenza and pneumococcal vaccination even for younger (age <50) diabetics. Those with long-standing lung, liver, kidney and heart conditions; those without a spleen (either from birth or removed through surgery); cancer patients, especially those with leukemia (cancer of the blood) and lymphoma (cancer of the lymph nodes); organ transplant recipients; and HIV-infected individuals benefit greatly from vaccination. Diabetics whose immune system is further compromised by certain treatments, such as steroids, dialysis, or chemotherapy are also included in this group. Lastly, healthcare workers and institutionalized individuals, such as those living in group or nursing homes, are also at higher risk of contracting the flu or pneumococcal pneumonia.

Additional immunization becomes mandatory for other medical and occupational reasons, regardless of the diabetic patient’s age. For instance, hepatitis A shots are important for those with chronic liver disease or frequent blood transfusions, and in persons who use illicit injectable drugs or have same-sex relations. Two doses are given intramuscularly 6 months apart. Hepatitis B vaccination is necessary for those who undergo dialysis or receive frequent blood transfusions, those who are in close contact with a hepatitis B-positive person or who have same-sex relations. Three shots are given, each at least a month apart from the next. Both hepatitis A and B vaccines should be given to persons such as healthcare workers and medical laboratory technicians who have work-related exposure to blood or body fluids.

Equally as important, if not more important than knowing when to be vaccinated, is knowing when NOT to be vaccinated. In general, any previous severe allergic reaction to a vaccine precludes its future use. Anaphylaxis, the most severe form of allergic reaction, is a life-threatening condition where a person experiences a dangerous drop in blood pressure and difficulty of breathing, among other symptoms. Although persons with mild illness may still be vaccinated, those who currently suffer from any moderate to severe illness should not receive any vaccine. Individuals with severe allergies to chicken eggs are cautioned against receiving the influenza vaccine. This is because the virus is grown in eggs, and the vaccine may contain egg protein to which a susceptible person may react. Lastly, pregnant women or those who are planning to conceive within the next month and those whose immune systems are severely compromised by cancer, HIV infection or chemotherapy are advised against varicella and MMR immunization. Both of these latter vaccines contain live viruses that may potentially cause disease in those with very low immunity.

Side effects to the vaccines are generally mild. The most common is a slight soreness at the injection site, which usually abates in two days time. Very infrequently, mild flu-like symptoms may be experienced. Rarely, more severe side effects such as nerve damage can occur with the influenza and pneumococcal vaccines.

Experts agree that compared to the burden of illness, complications, and deaths from these preventable infections, the cost of immunization is low and offers a substantial advantage, especially for persons with diabetes. Seen in light of suffering spared, taking that shot and enduring that overrated needle’s sting becomes worthwhile.