Objective : The incidence of Pneumococcal and viral infections is higher amongst diabetic patients. The availability and efficacy of Pneumococcal and Inflluenza vaccine in reducing morbidity and mortality is well accepted. The acceptability pattern in this susceptible population especially in the vulnerable periods, was studied in the outpatients of a tertiary hospital.
Methods : 746 patients with Type II diabetes were observed in the outpatient department of tertiary hospital from 1st August to 10th November 2018 for immunization status. Since the polluted winter brings with it the spike in respiratory and systemic infections from October to February in Mumbai, the pattern of acceptance of preventive Pneumococcal and Influenza vaccine in specifi, was documented.After informed consent, a predefined questionnaire regarding knowledge, beliefs and practices regarding vaccination, was recorded. 392 females and 354 males within the age range of 52 to 90 years having a history of diabetes duration from 1 to 25 years were included Patients with all HbA1cs were included.
Results : 42 patients had taken Pneumococcal vaccine in the last 24 months and 69 subjects had taken intermittent influenza vaccination. Following counselling and inter-patient meetings, 79 (11.2%)more patients were vaccinated for Pneumococcal vaccine, 46 (58.2%) were males and 33 (41.7%) were females.144 (19.3%) patients were given influenza vaccine and of these 88 were first timers and the rest regulars. Again 81(56.2%) were males and 63 (44%) were females.Alll the vaccinated patients, were interestingly on two or more drugs for diabetes and had one or more comorbidities (Hypertension, CVD,COPD,CKD etc). The average A1c was 8.8 in this recently vacinated group of patients.
Discussion : With growing awareness of the need to protect susceptible diabetic patients from preventable infections, the acceptance of vaccines is gradually increasing. Clinically the success rate was more amongst those with uncontrolled diabetes and those on multiple medication.The presence of associated comorbidities seemed to be a driving factor in acceptance. Just 100 days of intensive OPD counselling produced the success rate of 11.2% for Pneumococcal and 19.3% for Influenza. The ratio was skewed in favour of males in both segments of the study.
Conclusion : Type II diabetics, if enlightened appropriately and regularly of the hazards of cultivating infections especially in susceptible periods, take well to utilizing vaccine prevention on an OPD basis.The impact of counselling is most in the uncontrolled population and those with comorbidities.The need for OPD staff to be more proactive is thus the need of the hour.
Hemant Thacker– Consultant Physician and CardioMetabolic Speicialist, Breach Candy, Jaslok, Bhatia and H.N. Reliance Hospital, Mumbai, India
Rupal Shrimanker– Clinical Coordinator, Bhatia Hospital, Mumbai, India
Tarka Malgundkar– Reasearch Coordinator, Bhatia Hospital, Mumbai, India
Consultant Physician and CardioMetabolic Speicialist
Breach Candy, Jaslok, Bhatia and H.N. Reliance Hospital
Dr. Hemant P. Thacker is an M.D. in Internal Medicine from Mumbai – attached to Breach Candy, Jaslok, Bhatia & Reliance H. N. hospitals. He is a Specialist in Cardio-Metabolic disorders and a Fellow of the American College of Physicians and Clinical Endocrinology.
Besides being a teacher for post graduate Medicine(DNB), he has been the Principal Investigator for numerous International and National Clinical trials and runs his own Research site which is audited and approved. He is a pioneer for antibiotic stewardship and under his guidance the first policy was designed in 2009 and released at Bhatia Hospital.
He is the founder member of the Preemptive Disease International Forum and the founding Chairman of the South Bombay Physician’s Club (academic body which has been active for over 12 years and MCI accredited).
He has presented cases and numerous posters at world conferences ( ADA, AACE, World Conference of Hypertension, etc) and has delivered orations and lectures in CardioMetabolics on diverse platforms for multiple organizations, across the globe.
He has innumerable publications in indexed journals and has contributed many chapters to the API textbook of post-graduate medicine. In 2014 he was awarded the Giants International award for his outstanding contribution in the field of medicine.
Sr. Clinical Research Coordinator and Diabetic educator with Bhatia Hospital since 2004. She has worked has a coordinator in more than 30 trials for Diabetes, , Dyslipidemia, Heart failure, Cardiology and many more studies.