SUN-139 Pneumococcal Vaccination Rates among Pediatric Diabetics

Since 1997 it has been recommended by the CDC that pediatric patients over the age of two with certain chronic illnesses, including diabetes mellitus, receive 23 valent pneumococcal polysaccharide vaccine (PPSV23) in addition to the PCV7/PCV13 primary series given to all children (1). This recommendation is attributable to the need to prevent invasive pneumococcal infection in these susceptible populations. School aged children are frequently colonized with Streptococcus pneumonia bacteria (2), and those with diabetes are at a greater risk of developing serious pneumococcal infections (3). There is some evidence in the international literature suggesting a lack of compliance with this guideline (4). Our aim was to assess the pneumococcal polysaccharide vaccination rate among a cohort of diabetic patients in our pediatric endocrinology clinic. We conducted a retrospective chart review of all diabetic patients seen at the pediatric endocrinology clinic in Staten Island, New York between the ages of 2-20. We excluded those who had no follow up for 1 year. We collected data including age of diagnosis, type of diabetes, and vaccination records. Vaccine records were obtained from the New York Citywide Immunization Registry (CIR). Out of all the diabetics in our clinic, 126 charts met eligibility criteria. Of the 126 patients, 105 had type 1 diabetes mellitus, 14 were type 2, and 7 were other (including MODY and secondary to other underlying conditions). The type 1 diabetics had the lowest mean age of diagnosis of 7 years, compared with mean age of 12 years for the other two groups. Of the 126 patients, only 3.2% (95% CI:  0.9% , 7.9%) were found to have received the PPSV23, all type 1 diabetics. Our results show a poor rate of PPSV23 vaccination among pediatric patients with diabetes. Additionally, as the age of diagnosis is lowest in type 1 diabetics, most type 1 diabetics have a longer period of exposure to potentially serious pneumococcal infections. Thus, it is imperative that all diabetics, especially type 1 diabetics, receive the vaccine as early as possible following diagnosis for optimal protection. Our findings, in combination with the limited additional pediatric literature published to date, suggest that these low vaccination rates are likely generalizable to other geographic regions as well as other chronic illnesses in which children have increased susceptibility to pneumococcal disease (5, 6). Given these results, we recommend endocrinologists and pediatricians alike take steps to ensure adherence to the PPSV23 recommendations.   References: 1) MMWRMorb MortalWkly Rep. 2010; 59 (RR-11). 2) Principi N et al. HumanVacc Imm. 2016; 12 (2): 293-300. 3) Seminog OO, Goldarce MJ. Diabetic Med. 2013; 30(12):1412-9. 4) Wolkers PCB et al. Rev EscEnferm USP. 2017; 51:e03249. 5) Harris JG et al. Pediatrics. 2015 Sep; 136(3):e681-6. 6) Sainato R et al. Clin Pediatr. 2017 Jun; 56(6):512-518.