SPEDM Recommendations - Vaccination Against Streptococcus pneumoniae in Adults with Diabetes Mellitus

Diabetes mellitus (DM) is a chronic disease with a high prevalence worldwide and in Portugal, with significant morbidity and mortality. Moreover, infections by Streptococcus pneumoniae (Sp - also known as pneumococcus) are very common and are responsible for a high morbidity and mortality, namely in patients with DM. Sp may cause serious infections such as pneumonia, meningitis and sepsis, being the main cause of death by pneumonia worldwide. Of particular concern in this context is invasive pneumococcal disease (IPD) which is most commonly manifested by bacteraemia. In people with DM, in addition to the significantly increased risk of pneumonia and IPD, with the consequent increase in mortality, the treatment of pneumonia is also associated to increased costs. One of the pivotal strategies to limit the impact of these diseases and their association is the use of specific vaccines, namely pneumococcal polysaccharide conjugate vaccines (PCV) such as the 13-valent PCV (PCV13) and the 23-valent PCV (PCV23). Both these vaccines have demonstrated to be effective against pneumococcal pneumonia and IPD, leading to considerable decreases in their incidence. In concordance with the norms issued by the Portuguese General Directorate of Health (DGS), SPEDM recommends the use of PCV13 and PCV23 on the adult population with DM (<< 18 years), since this group has an increased risk of IPD. The goals of this vaccination strategy are to reduce the incidence, morbidity and mortality due to IPD, preventing complications and sequelae in patients with DM. The recommended vaccination strategies are in line with the ones proposed by the Portuguese Direccao-Geral da Saude (DGS), specifically with Norma n degrees 011/2015 issued on June 23, 2015 and updated on November 6, 2015. It is of the utmost importance that the administered vaccines are registered in the national "Vacinas" information system as well as in the clinical records of the institution where they are administered. Considering the constant change of the epidemiologic context, these recommendations from SPEDM will be periodically reviewed.