People with diabetes are more at risk of complications arising as a result of infections such as influenza and pneumonia. Elevated blood glucose levels, as a response to infection, can lead to uncontrolled diabetes and the potential danger of diabetic ketoacidosis (DKA) or Hyperglycaemic Hyperosmolar Syndrome (HSS), both of which can be fatal if left untreated.
Influenza, or 'flu', is a highly contagious acute viral infection that affects people of all ages. It starts suddenly with fever, chills, headache, aching muscles, and a cough or other respiratory symptoms. While most people recover without complications in 1-2 weeks, flu can cause serious illness and death, especially in the very young, the elderly or those at high risk because of a medical condition. Antibiotics are not effective as a treatment because antibiotics do not work on viruses.
The flu virus changes or mutates, which is why every year a vaccine is produced based on the strains of the virus expected to be circulating. All people with diabetes, including those who are pregnant, should be vaccinated against influenza regardless of age or type of diabetes management. (1)
Vaccination should start after the age of six months and be repeated each year. None of the flu vaccines is licensed for use in children before the age of six months.
The best way to protect children younger than 6 months who are in a clinical risk group such as diabetes, is to request members of their household and their caregivers be vaccinated. They may not qualify for a free flu vaccination on the NHS but the vaccination is available over the counter at most local pharmacies. (2)
Up to the age of three the dose is half that of an older child or adult, and for children under the age of 13, if they have not previously been vaccinated, the dose should be repeated after 4 – 6 weeks for the first year.
Vaccination should be postponed in patients with a feverish illness or infection and avoided in people with a known allergy to eggs, because the vaccine is grown using the protein from hens’ eggs.
The flu vaccine is not ‘live’ and therefore cannot give a person the flu, but because immunity can take up to two weeks to become effective, some people may develop the illness after being vaccinated if they are already incubating the virus in their system.
Pneumonia is an inflammation of the lung tissue affecting one or both sides of the chest that often occurs as a result of an infection.
Half of all pneumonia cases are caused by bacteria with the peak level in the winter months. The bacterium, streptococcus pneumoniae, known as pneumococcus, is the main cause of the most common type of pneumonia.
Bacterial pneumonia starts suddenly with shivering fits, fever, pains in the chest and coughing. After a day or two the person starts to cough up phlegm which can be yellow, bloodstained or rust-coloured. Breathing becomes fast and shallow with difficulty or pain on breathing deeply or coughing.
All children are offered a pneumococcal vaccination as part of their routine childhood vaccinations. The vaccine is given as three doses, at two, four and thirteen months of age. This is because the vaccines do not give long-term protection in the very young.
Children with diabetes will need a further booster after their second birthday and all people with diabetes should ask for the pneumococcal vaccination if they haven’t been offered it. (3)
Full protection is usually found about three weeks after vaccination. At the moment it is not known how long protection will last so revaccination may be necessary in the future.
Reaction to vaccinations is sometimes experienced in the form of swelling or redness around the injection area or a slight fever. This may cause a disruption of blood glucose control but this is temporary. A cold flannel on the site and simple painkillers are usually enough to relieve these symptoms.
If symptoms persist or an adverse reaction is suspected the healthcare team should be notified and a ‘Yellowcard’ completed.
References
- The influenza immunisation programme 2008/2009; DoH
- Influenza information @ DoH 2009
- Immunisation against infectious disease, The Green Book 2006; DoH
Reviewed Jan 2009