The principal cause of illness and death all over the world are due to the infectious diseases. There is a continuous rise in the challenge of improving the efforts to encounter the health threats caused by the microbes. The challenge to prevent and control the disease is due to the ability of the microbes to evolve and adapt to the changing environment, populations, technologies, and practices. The impact of infectious diseases in developing countries reduced survival rates in children, and diminished economic growth and development. There were concerns in health and economic areas of developed countries due to the infectious diseases. The endemic, resurgent, and new diseases result in enormous suffering and death. They also cause huge financial losses in the country. To protect the country from infectious diseases, it is necessary to develop and implement comprehensive health policies that are evidence-based, and the health of the vulnerable populations should be taken care. The country has to develop collaboration with the global partners to control further outbreaks inside the country and spread of the disease across the borders (CDC framework for preventing infectious diseases, 2011).
Among the evidence-based resources for the health promotion issue, ‘immunization and infectious diseases, and global health’, an outline of 2011 morbidity and mortality weekly report is discussed here. The report focuses on the risk of Hepatitis B infection in people with diabetes mellitus. The report also talks about mortality rate, control measures of the infection, the efficiency of the vaccine, and the method of administering the vaccine (Evidence-based resource summary, 2011). A chronic or acute infection of the liver by hepatitis B virus (HBV) leads to mortality. Since 1996, 29 outbreaks of HBV infection occurred in more than one long-term medical care facilities of United States. The long-term medical care (LTC) facilities included nursing homes and assisted living areas. The above information was reported to the Center for disease control and prevention (CDC). Among 29, 25 were associated with adults suffering from diabetes (MMWR, 2011).
Infection and its Control
The group of people with diabetes at higher risk for Hepatitis B infection was reported to consist of 865 cases in the year 2009-2010. This number was estimated from eight infection programs and it occupies 17 percent of the US population. The risk analysis was evaluated for those above 23 years of age. The guidelines for infection control mainly conveyed safe blood glucose monitoring and these were available since 1990. The guidelines for HBV control targeting the LTC atmosphere were published in 2005 (MMWR, 2005).
Evaluation of the HBV vaccine intervention
Two recombinant Hepatitis B vaccines were generated from a single antigen. They were Recombivax HB and Engerix-B. A combination of hepatitis A and B vaccine called Twinrix was made available in the United States. Vaccine for hepatitis B virus is available in US since 1982. Evaluation is associated with checking the efficiency of the intervention program. Evaluation can be done in formative and summative methods. Formative evaluation is conducted during the development and implementation of the intervention program while summative is done when the program is established and giving its results. The former method helps in improving the intervention and the latter helps in identifying the extent of the outcome achieved by the intervention (CDC’s healthy communities program, nd).
Hepatitis B Vaccine – Intervention
Formative evaluation –
Intramuscular administration of three doses of this vaccine is done at 0, 1 and 6 months. The adults getting seroprotection from hepatitis B surface antigen, after receiving three doses gradually decrease with age, smoking, immunosuppression, obesity, comorbid conditions like diabetes (MMWR, 2011). The antibody responses for the diabetics were found to be reduced than the non-diabetics. The research studies have revealed that greater than 90 percent of adults (<40 years age) with diabetes could receive a protective response from hepatitis B vaccine series. Good response was observed in 80 percent of adults aged 40-60 years, 65 percent in those aged 60 to 69 years and less than 40 percent in people aged greater than 70 percent (CDC, unpublished data, 2011). It was observed that revaccination using one to three additional doses of hepatitis B vaccine enhanced the adults achieving a protective level of anti-HBs (MMWR, 2006). The protection duration against chronic and symptomatic HBV infection extends to greater than 22 years in healthy vaccine responders (Leuridan & Vandamm, 2011). The information about the immunity duration of diabetics is not known. Adults and children receiving vaccine should have anti-HepB levels greater than 10 mIU/mL for one to two months after receiving HepB vaccine serial dosage of greater than three. These people are considered as seroprotected and are vaccine responders (MMWR, 2006).
Summative evaluation –
Hepatitis B vaccine (dosage >1) administered to 70 million people in United States between 1982 and 2004 had common side effects of pain at the injection site and mild increase in the body temperature. In some of the placebo-controlled studies, people receiving the vaccine were not frequently getting the side effects than people taking a placebo. This vaccine is contraindicated for people with the history of hypersensitivity to yeast and other vaccine components. It is not contraindicated in those suffering from autoimmune diseases, multiple sclerosis, pregnant or lactating women and other chronic diseases. Additional dosages of the vaccine are not given to those who had serious side effects like anaphylaxis after taking the first series of doses. A rapid protective immunity against significant infection is provided by the booster dose of HepB vaccine which is administered after the primary vaccination series. The number of people with vaccine-induced seroprotection increased when revaccination of greater than one dose of HepB vaccine was administered for the nonresponses (MMWR, 2006).
Hepatitis B vaccine can be given to any individual of any age. But, recently these vaccines are not considered as efficient and cost effective for older adults. According to the approvals of the committee on immunization practices, HepB vaccine should be administered to unvaccinated adults having diabetes mellitus, aged between 19 and 59 years. However, evidence has shown that increased risk of acute HBV infection in diabetic adults aged more than 60 years was not so strong than in young people with diabetes (Evidence-based resource summary, 2011).
Building our understanding: Key concepts of evaluation, what is it and how do you do it? Creating a culture of healthy living. CDC’s healthy communities program. Retrieved from
CDC. (2006). 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) part II: immunization of adults. MMWR, 55(No. RR-16). Retrieved from
CDC. (2005). Transmission of Hepatitis B virus among persons undergoing blood glucose monitoring in long-term facilities – Mississippi, North Carolina, and Los Angeles county, California, 2003-2004. MMWR, 54, 220-3.
Leuridan, E., & Van Damme, P. (2011). Hepatitis B and the need for a booster dose. Clinical Infectious Diseases, 53, 68–75.
Mark H. Sawyer et.al, (December, 2011). Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report (MMWR). Center for Disease Control and Prevention. 60(50), 1709-1711. Retrieved from
Thomas, R. F., Rima, F. K., deputy director for infectious diseases, Center for disease control and prevention; Kevin M. De Cock, F.R.C.P Director, Center for global health. (October 2011). A CDC Framework for preventing infectious diseases. Sustaining the essentials and Innovating for the future. Retrieved from
Use of Hepatitis B Vaccination for adults with diabetes mellitus: recommendations of the advisory committee on immunization practices (ACIP). (2011). Evidence-based resource summary. HealthyPeople.gov. Retrieved from