Pneumonia Vaccine Type 1 Diabetes

Babies And The Pneumococcal Vaccine

Babies are routinely vaccinated with a type of pneumococcal vaccine known as the pneumococcal conjugate vaccine as part of their childhood vaccination programme.

Babies born on or after 1 January 2020 have 2 injections, which are usually given at:

• 12 weeks old
• 1 year old

Babies born before this date will continue to be offered 3 doses, at 8 and 16 weeks and a booster at 1 year.

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Why They Are Important And Whats Recommended

Flu and pneumonia vaccines are critical for many populations. However, the flu and pneumonia are especially risky for people with diabetes and other forms of chronic disease. In fact, people with diabetes are three times more likely to die from flu and pneumonia than non-diabetics. So, if you or a loved one has diabetes, take a look at these facts and tips regarding flu and pneumonia immunizations to stay healthy and protected.

Patients In Health Care Institutions

Residents of long-term care facilities should receive Pneu-P-23 vaccine. Refer to Recommendations for Use for information about pneumococcal vaccination of individuals at increased risk of IPD. Refer to Immunization of Patients in Health Care Institutions in Part 3 for additional information about vaccination of patients in health care institutions.

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What To Think About

In most cases pneumonia is a short-term, treatable illness. But frequent bouts of pneumonia can be a serious complication of a long-term illness, such as chronic obstructive pulmonary disease . If you have a severe long-term illness, it may be hard to treat your pneumonia, or you may choose not to treat it. You and your doctor should discuss this. This discussion may include information about how to create an advance care plan.

For more information, see:

There are a number of steps you can take to help prevent getting pneumonia.

• Stop smoking. You’re more likely to get pneumonia if you smoke.
• Avoid people who have infections that sometimes lead to pneumonia.
• Stay away from people who have colds, the flu, or other respiratory tract infections.
• If you haven’t had measles or chickenpox or if you didn’t get vaccines against these diseases, avoid people who have them.

Mechanism Of Pneumonia In Diabetic Patient Infected With Covid

Pneumonia is defined as an inflammation and consolidation of the lung because of infection . Due to lung location, anatomy, and function, this organ is more susceptible to oxidative damage . On the other hand, diabetes induces lung oxidative stress and inflammation and increases susceptibility to viral pneumonia. Not surprisingly, COVID-19 infected-diabetic patients have more severe outcome compared with non-diabetes . Rueda et al. reported that in non-diabetic cases who had bacterial pneumonia, high blood glucose related with more severity and a worse outcome, particularly when plasma glucose levels was equal or more than 180 mg/dl at the admission . Therefore, this conclusion can be drawn that monitoring of blood glucose is of immense importance in all COVID-19 infected cases .

Hyperglycemia can directly raise glucose levels in airway secretions. It has been shown that exposure of pulmonary epithelial cells to increased glucose levels markedly augments influenza virus replication and infection, suggesting that hyperglycemia may act as booster of viral replication .

Hyperglycemia reduces lung function by inducing systemic inflammation. Furthermore, hyperglycemia promotes collagen synthesis through induction of OS, increasing of nuclear factor kappa B gene expression, and enhancing of inflammatory factors, fosters cross-linkage formation through the acceleration of advanced glycation end products , and eventually disturbs lung function .

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Causes Of Low Blood Sugar

Causes of low blood sugar include:

• Taking too much insulin.
• Skipping or delaying a meal or snack.
• Exercising more than usual without eating enough food.
• Drinking too much alcohol, especially on an empty stomach.
• Taking medicines that can lower blood sugar, such as large amounts of aspirin and medicines for mental disorders.
• Starting your menstrual period, because hormonal changes may affect how well insulin works.

What Causes Type 1 Diabetes

The body makes insulin in beta cells, which are in a part of the pancreas called the islet tissue. Type 1 diabetes starts because the body destroys those beta cells. Experts don’t know why this happens.

Some people have a greater chance of getting type 1 diabetes because they have a parent, brother, or sister who has it. But most people with the illness don’t have a family history.

Having islet cell antibodies in the blood may also increase the risk of getting type 1 diabetes.

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Pneumococcal Diseases & Pneumonia Shots

There is a category of diseases called pneumococcal disease, of which pneumonia is one of the most dangerousthe other most dangerous being meningitis. People with diabetes are about three times more likely to die with flu and pneumococcal diseases, yet most dont get a simple, safe pneumonia shot.

Symptoms of pneumonia include:

Cough that can produce mucus that is gray, yellow, or streaked with blood Chest pain

What Are The Symptoms

Symptoms of pneumonia may include:

• Cough. You will likely cough up mucus from your lungs. Mucus may be rusty or green or tinged with blood.
• Fever, chills, and sweating.
• Feeling very tired or very weak.

When you have less severe symptoms, your doctor may call this “walking pneumonia.”

Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion or delirium is common. Or, if they already have a lung disease, that disease may get worse.

Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad.

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Diabetes And The Flu Shot: What To Know

Whenever a nip of cold is in the air, and coughs and sneezes ring out in public places, you know its flu season again. If you live with diabetes, youre probably being prodded to go get a flu shot and related vaccines.

But over the years, our mailbag has filled up with questions about how those shots may mix with diabetes care.

Heres a Q& A covering all you need to know:

Why You Need The Pneumococcal Vaccine

Pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses, or fungi. When germs enter the lungs, they can overwhelm the immune system, causing inflammation, cough, fever, chills, and breathing problems.

Bacterial pneumonia, which may occur after you first have a viral infection such as a cold or the flu, is the most common type of pneumonia in adults.

Several types of bacteria can cause pneumonia, but Streptococcus pneumoniae is the type that most frequently causes pneumonia and other types of infection in adults.

Pneumococcal vaccines are designed to reduce the risk of infection from Streptococcus pneumoniae, explains Sarah B. Lieber, MD, MS, rheumatologist at Hospital for Special Surgery in New York City.

If you have a form of inflammatory arthritis, the same chronic, systemic inflammation that targets your joints can also decrease your bodys natural immune defenses. This increase your risk of serious infection like pneumonia. Plus, taking certain medications to manage your condition can also weaken or suppress the immune response, leaving you that much more susceptible to pneumonia.

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How Do You Get Pneumonia

You may get pneumonia:

• After you breathe infected air particles into your lungs.
• After you breathe certain bacteria from your nose and throat into your lungs.
• During or after a viral upper respiratory infection, such as a cold or influenza .
• As a complication of a viral illness, such as measles or chickenpox.
• If you breathe large amounts of food, gastric juices from the stomach, or vomit into the lungs . This can happen when you have had a medical condition that affects your ability to swallow, such as a seizure or a stroke.

A healthy person’s nose and throat often contain bacteria or viruses that cause pneumonia. Pneumonia can develop when these organisms spread to your lungs while your lungs are more likely to be infected. Examples of times when this can happen are during or soon after a cold or if you have a long-term illness, such as chronic obstructive pulmonary disease .

You can get pneumonia in your daily life, such as at school or work or when you are in a hospital or nursing home . Treatment may differ in healthcare-associated pneumonia, because bacteria causing the infection in hospitals may be different from those causing it in the community. This topic focuses on community-associated pneumonia.

Causes Of High Blood Sugar

Causes of high blood sugar include:

• Not getting enough insulin.
• Eating more food than usual.
• Stress and being ill or having an infection, especially if you aren’t eating or drinking enough.
• The dawn phenomenon or the Somogyi effect, which can cause early-morning high blood sugar.
• Adolescence, because of hormone changes and rapid growth.
• Pregnancy.

Diabetic ketoacidosis

Sometimes a person’s blood sugar level rises greatly before he or she knows something is wrong. Because insulin isn’t available, the cells in the body are unable to get the sugar they need for energy. The body begins to break down fat and muscle for energy.

When fat is used for energy, ketonesor fatty acidsare produced and enter the bloodstream. This causes the chemical imbalance diabetic ketoacidosis. This can be a life-threatening condition.

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Persons With Chronic Diseases

Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional information about vaccination of people with chronic diseases.

Asplenia or hyposplenia

Hyposplenic or asplenic individuals should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine, followed by a booster dose of Pneu-P-23 vaccine. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.

Chronic kidney disease and patients on dialysis

Individuals with chronic kidney disease should receive age appropriate pneumococcal vaccines. Children less than 18 years of age with chronic kidney failure or nephrotic syndrome, should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine. Adults with chronic kidney failure should receive Pneu-P-23 vaccine. Adults with nephrotic syndrome should receive Pneu-C-13 and Pneu-P-23 vaccine. Due to the decreased immunogenicity and efficacy of Pneu-P-23 vaccine in children and adults with chronic kidney failure, 1 booster dose of Pneu-P-23 vaccine is recommended. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.

Neurologic disorders

Chronic lung disease, including asthma

Chronic heart disease

Chronic liver disease

Endocrine and metabolic diseases

Non-malignant hematologic disorders

Cochlear implants

Strategies To Improve The Rate Of Vaccination

In the Indian clinic set up, the diabetologist, dietitian, diabetes educator, pharmacist, psychologist, and other members of the diabetes care team may take over the responsibility of counseling the patients on the availability and requirement of routine vaccinations. Use of educational material in local language, discussion on vaccination during diabetes education and the use of vaccination cards will boost confidence among the patients. Some of the strategies that may improve the rate and outcomes of vaccination include:

• Identification of eligible candidates for vaccination.

• Informing the patients and caregivers regarding the benefits and risks of the vaccination and documenting the delivery of that information.

• Documenting refusal to take vaccination or presence of a contraindication like allergy to egg, a recent episode of GuillainâBarre syndrome, etc.

• Recording the administration of a vaccine and records of revaccination or postvaccination adverse events.

• Providing a documentation of vaccine administration to subjects like vaccination card with full information regarding the vaccines.

The standing order protocols should be implemented such that the health care professionals should be trained to:

• screen patients who are most likely to benefit from and identifying those with contraindications to vaccinations

• administer vaccines

• monitor patients for adverse events.

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Trial Proves Safety And Efficacy Of Artificial Pancreas

To evaluate the safety and efficacy of the artificial pancreas, Professor Hovorka and an international team of researchers conducted a trail including 74 children with type 1 diabetes, aged one to seven years, from across seven centres in the UK and Europe. First, the children used the CamAPS FX hybrid closed-loop system for 16 weeks, and then the sensor-augmented pump therapy for 16 weeks.

When using CamAPS FX, the children spent around three-quarters of their day in the target range for their glucose levels and spent less than a quarter of their time with raised blood sugar levels hyperglycemia. The differences compared to the control period was almost nine percent. However, no difference was found between the two groups in the time spent in hypoglycemia.

CamAPS FX led to improvements in several measures, including hyperglycaemia and average blood sugar levels, without increasing the risk of hypos, said Dr Julia Ware, the study’s first author, also from the Wellcome-MRC Institute of Metabolic Science.

With artificial pancreas, parents were able to relax and spend less time worrying about their child’s blood sugar levels, particularly at night time. Hence, parents have described it as ‘life-changing’, Dr Ware added.

Currently, CamAPS FX can be availed through NHS trusts across the UK, including Cambridge University Hospitals NHS Foundation Trust. The team is hoping that it will soon be available even more widely.

Adults At High Risk Of Ipd

Adults with immunocompromising conditions resulting in high risk of IPD, except HSCT, should receive 1 dose of Pneu-C-13 vaccine followed at least 8 weeks later by 1 dose of Pneu-P-23 vaccine, if not previously received. The dose of Pneu-C-13 vaccine should be administered at least 1 year after any previous dose of Pneu-P-23 vaccine. Refer to Immunocompromised persons for information about immunization of HSCT recipients.

Immunocompetent adults with conditions or lifestyle factors resulting in high risk of IPD should receive 1 dose of Pneu-P-23 vaccine, if not previously received. One dose of Pneu-P-23 vaccine is also recommended for all adults who are residents of long-term care facilities and should be considered for individuals who use illicit drugs.

Some experts also suggest a dose of Pneu-C-13 vaccine, followed by Pneu-P-23 vaccine, for immunocompetent adults with conditions resulting in high risk of IPD as this may theoretically improve antibody response and immunologic memory. However, Pneu-P-23 vaccine is the vaccine of choice for these individuals, and if only one vaccine can be provided, it should be Pneu-P-23 vaccine, because of the greater number of serotypes included in the vaccine.

Adults at highest risk of IPD should also receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization.

Table 4 – provides recommended schedules for adult immunization with pneumococcal vaccines.

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Persons New To Canada

Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals, as necessary. Review of pneumococcal vaccination status is particularly important for persons from areas of the world where sickle cell disease is present, as persons with sickle cell disease are at risk of serious pneumococcal infections. In many countries outside of Canada, pneumococcal conjugate vaccine is in limited use. Refer to Immunization of Persons New to Canada in Part 3 for additional information about vaccination of people who are new to Canada.

When Should You Call Your Doctor

The faster you get treatment, the faster you will get over pneumonia. This is especially true for the very young, for people older than 65, and for anyone with other long-lasting health problems, such as asthma.

911 or other emergency services immediately if you:

• Have chest pain that is crushing or squeezing, is increasing in intensity, or occurs with any other symptoms of a heart attack.
• Have such bad trouble breathing that you are worried you will not have the strength or ability to keep breathing.
• Cough up large amounts of blood.
• Feel that you may faint when you sit up or stand.

if you have:

• A cough that produces blood-tinged or rust-coloured mucus from the lungs.
• A fever with shaking chills.
• Difficult, shallow, fast breathing with shortness of breath or wheezing.

• Frequently brings up yellow or green mucus from the lungs and lasts longer than 2 days. Do not confuse mucus from your lungs with mucus running down the back of your throat from your nasal passages . Post-nasal drainage is not a worry.
• Occurs with a fever of 38.3°C or higher and brings up yellow or green mucus from the lungs .
• Causes you to vomit a lot.
• Continues longer than 4 weeks.

Also call your doctor if you have new chest pain that gets worse with deep breathing and if you have other symptoms of pneumonia, such as shortness of breath, cough, and fever.

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Who Needs A Pneumococcal Vaccination

The pneumococcal vaccine is available in Scotland for all people aged 65 years and over.

It may also be available if youre under 65 and fall under one of the following risk groups, or have one of the following serious medical conditions:

• problems with the spleen, either because the spleen has been removed or doesnt work properly
• chronic respiratory diseases, including chronic obstructive pulmonary disease , chronic bronchitis, and emphysema
• serious heart conditions

Dtap And Tdap Immunization Schedules

The first DTaP immunizations start when children are very young. DTaP shots for young children are typically given at:

• 6 weeks to 2 months
• 4 months
• 4 to 6 years

Thereafter, Tdap booster shots are given to ensure lasting protection against tetanus, diphtheria, and pertussis.

Adolescents are advised to get a booster Tdap shot at around 11 to 12 years. If they miss this, it is OK for them to get a Tdap between 13 and 18 years.

It is recommended that adults get a Tdap shot for one of their tetanus boosters. If youre 65 and over, Tdap vaccination is also recommended.

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