Are there differences in hepatitis-B immunization status between diabetes and non-diabetes subjects in Korea?

Article information

Kosin Med J. 2018;33(1):41-50
Publication date (electronic) : 2018 January 21
doi : https://doi.org/10.7180/kmj.2018.33.1.41
1Department of Internal Medicine, Division of Infection, College of Medicine, Kosin University, Busan, Korea
2Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Kosin University, Busan, Korea
Corresponding Author: Su Kyoung Kwon, Department of Internal Medicine, College of Medicine, Kosin University, 262, Gamchen-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6712 Fax: +82-51-990-6712 E-mail: mir316@naver.com
Received 2016 October 21; 2016 November 14; Accepted 2016 December 26.

Abstract

Objectives

The American Diabetes Association (ADA) recommends hepatitis-B virusVIruS vaccination for unvaccinated adults with diabetes. However, the Korean Diabetes Association (KDA) did not recommend hepatitis-B vaccination for unvaccinated adults with diabetes. This study was performed to assess the differences in hepatitis-B virus antigen and antibody status between Korean patients with diabetes and those without by using national survey data.

Methods

We analyzed hepatitis-B virus antigen and antibody status in 9,771 South Korean people from the general population based on the Korean National Health and Nutrition Examination Survey. Diabetes patients were defined as those with a measured fasting plasma glucose over 126 mg/dL or those who had been previously diagnosed with diabetes by other health care centers.

Results

Subjects with diabetes accounted for 812 (8.3%) among the 9771 study subjects. The prevalence ofhepatitis-B (HBsAg) seropositive subjects was not significantly different (3.9% vs. 4.6%, P = 0.09) between subjects with diabetes and those without. The prevalence of hepatitis-B antibody (HBsAb) positive subjects and unimmunized subjects was not significantly different (55.2% vs. 58.2%, P = 0.09, 40.9% vs. 37.2%, P = 0.09) between the two groups. The prevalence of unimmunized subjects decreased by age (< 20 years 33.3 % vs. 33.0%, 20~29 years 49.1% vs. 41.2%, 30~39 years 41.9% vs. 37.7%, 40~49 years 35.1% vs. 33.5%, 50~59 years 39.0% vs. 38.0%, 60~69 years 41.2% vs. 39.8%, > 70 years 48.5% vs. 42.8%) but was not significantly different between the 2 groups.

Conclusions

From this study, we conclude that there are not sufficient grounds to recommend routine hepatitis-B virus vaccination for unvaccinated Korean subjects with diabetes at this point in time in Korea. Further prospective studies will be needed.

Fig. 1.

Distribution of hepatitis-B immunization status among diabetes and non-diabetes subjects.

Baseline characteristics of study subjects

Age and Obesity adjusted means of liver function

Distribution of hepatitis-B immunization status according to different age groups by diabetes status

References

1. Emerging Risk Factors Collaboration. Seshasai SR, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011;364:829–41.
2. American Diabetes Association. 3. Foundations of Care and Comprehensive Medical Evaluation. Diabetes Care 2016;39:S23–35.
3. Treatment Guidelines for Diabetes (5th edition) [Internet] Korean Diabetes Association. Available from: http://www.diabetes.or.kr/pro/pub-lishlguide.php?mode=list.
4. Bender TJ, Wise ME, Utah O, Moorman AC, Sharapov U, Drobeniuc J, et al. Outbreak of hepatitis B virus infections associated with assisted monitoring of blood glucose in an assisted living facility-Virginia, 2010. PLoS One 2012;7:e50012.
5. Centers for Disease Control and Prevention (CDC). Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2011;60:1709–11.
6. Jeong S, Yim HW, Bae SH, Lee WC. Changes of Hepatitis B Surface Antigen Seroprevalence in Korea, 1998-2005. Korean J Epidemiol 2008;30:119–27. Korean.
7. Thompson ND, Perz JF. Eliminating the blood: ongoing outbreaks of hepatitis B virus infection and the need for innovative glucose monitoring technologies. J Diabetes Sci TechnoI 2009;3:283–8.
8. Centers for Disease Control and Prevention(CDC). Transmission of hepatitis B VIruS among persons undergoing blood glucose monitoring in long-term--care facilities- Mississippi, North Carolina, and Los Angeles County, California, 2003-2004. MMWR Morb Mortal Wkly Rep 2005;54:220–3.
9. Reilly ML, Poissant T, Vonderwahl CW, Gerard K, Murphy TV. Incidence of acute hepatitis B among adults with and without diabetes, 2009-2010. 49th Annual Meeting of the Infectious Disease Society of America and the HIV Medicine Association; Boston, MA, October 2011.
10. Younossi ZM, Gramlich T, Matteoni CA, Boparai N, McCullough AI. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol 2004;2:262–5.
11. Mehta SH, Brancati FL, Sulkowski MS, Strathdee SA, Szklo M, Thomas DL. Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med 2000;133:592–9.
12. Antonelli A, Ferri C, Fallahi P, Pampana A, Ferrari SM, Goglia F, et al. Hepatitis C virus infection: evidence for an association with type 2 diabetes. Diabetes Care 2005;28:2548–50.
13. Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis 1995;20:992–1000.
14. El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 2004;126:460–8.
15. Klonoff DC, Perz JF. Assisted monitoring of blood glucose: special safety needs for a new paradigm in testing glucose. J Diabetes Sci TechnoI 2010;4:1027–31.
16. Samandari T, Malakmadze N, Balter S, Perz IF, Khristova M, Swetnam L, et al. A large outbreak of hepatitis B virus infections associated with frequent injections at a physician's office. Infect Control Hosp Epidemiol 2005;26:745–50.
17. Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) partII: immunization of adults. MMWR Recomm Rep 2006;55(No.RR-16):1–13.

Article information Continued

Fig. 1.

Distribution of hepatitis-B immunization status among diabetes and non-diabetes subjects.

Table 1.

Baseline characteristics of study subjects

Variables Diabetes (n = 812) Non diabetes (n = 8959) P-value
Male : Female 415:397 4095:4864 0.021
Age, years 51.66 ± 15.67 37.91 ± 18.07 < 0.001
Weight, Kg 62.07 ± 10.81 58.8 ± 11.34 < 0.001
BMI, kg/m2 24.02 ± 3.41 22.47 ± 3.38 < 0.001
Waistcircumference(WC) 84.87 ± 9.34 77.75 ± 10.14 < 0.001
SBP, mmHg 134 ± 20.76 122.74 ± 18.75 < 0.001
DBP, mmHg 80.75 ± 12.44 75.99 ± 12.53 < 0.001
Pulserate, bpm 76.13 ± 10.88 74.02 ± 10.40 < 0.001
AST, U/L 51.66 ± 15.67 26.91 ± 18.52 < 0.001
ALT, U/L 33.84 ± 29.725 25.59 ± 21.30 < 0.001
Fastingbloodglucose, mg/dL 163.25 ± 62.04 93.65 ± 12.82 < 0.001
WBC, × 103/μL 6.15 ± 1.83 6.20 ± 18.28 0.947

Data are presented by mean ± standard deviation.

N, number; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; bpm, beats per minuite; AST, aspartate aminotransferase; ALT, alanine aminotransferase; WBC, white blood cell.

Table 2.

Age and Obesity adjusted means of liver function

Variables Diabetes (n = 812) Non diabetes (n = 8959) P-value
Aspartate aminotransferase, AST, SGOT* 30.71 ± 0.69 27.07 ± 0.21 < 0.001
Alanine aminotransferase, ALT, SGPT* 31.35 ± 0.75 25.83 ± 0.23 < 0.001
AST** 30.12 ± 0.69 27.13 ± 0.21 < 0.001
ALT** 30.17 ± 0.75 25.95 ± 0.23 < 0.001

Data are presented by mean ± standard error

*

Adujusted by age and body mass index.

**

Adjusted by age, body mass index and waist circumference.

Table 3.

Distribution of hepatitis-B immunization status according to different age groups by diabetes status

Age Groups Non-diabetes Diabetes P-value
HBV carrier Immunized Non-immunized HBV carrier Immunized Non-immunized
Total(%) 408 (4.6%) 5189(58.2%) 3313 (37.2%) 36 (3.9%) 477 (55.2%) 348 (40.9%) 0.169
<20 42 (2.4%) 1152 (64.6%) 588 (33.0%) 1 (3.7%) 17 (63%) 9 (33.3%) 0.898
20-30 81 (5.6%) 764 (53.1%) 593 (41.2%) 0 (0.0%) 28 (50.9%) 27 (49.1%) 0.140
30-40 115 (6.2%) 1033 (56.0%) 696 (37.7%) 8 (6.5%) 64 (51.6%) 52 (41.9%) 0.622
40-50 77 (5.1%) 918 (61.4%) 501 (33.5%) 5 (3.7%) 82 (61.2%) 47 (35.1%) 0.747
50-60 63 (6.0%) 588 (56.0%) 396 (38.0%) 6 (2.9%) 122 (58.1%) 82 (39.0%) 0.188
60-70 21 (2.5%) 486 (57.7%) 335 (39.8%) 10 (6.1%) 87 (52.7%) 68 (41.2%) 0.078
70-80 10 (2.5%) 218 (54.1%) 175 (43.4%) 1 (1.1%) 45 (51.1%) 42 (47.7%) 0.605
≥ 80 3 (3.2%) 54 (57.4%) 37 (39.4%) 1 (5.3%) 8 (42.1%) 10 (52.6%) 0.463

HBV, hepatitis B virus; Immunozed, HBsAg (-) and HBsAb (+); Non-immunized, HBsAg (-) and HBsAb (-)