The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has previously recommended hepatitis B vaccination for all children and adolescents under the age of 18. Hepatitis B vaccination is also recommended for adult populations at high risk for hepatitis B virus infection, including healthcare workers.The ACIP recently added adults with diabetes to the list of populations at high risk for hepatitis B virus infection and recommended that all of them be vaccinated against hepatitis B. The CDC conducted a survey in 2009-2010 to determine the extent to which hepatitis B vaccination is recommended for adults with diabetes. The CDC conducted a survey of more than 800 cases of acute hepatitis B among adults who participated in the evaluation of whether they had been diagnosed with diabetes or were already at risk for hepatitis B virus infection between 2009 and 2010. The survey found that adults with diabetes under the age of 60 were twice as likely to develop hepatitis B virus infection as those of the same age without diabetes. People with diabetes who are older than or equal to 60 years of age are also at high risk for hepatitis B virus infection, although the likelihood of infection is lower than for younger adults, but no definitive data are available. The vaccine requires 3 doses, the first dose, 1 month after the first dose, and 3 months after the first dose, although other schedules apply. Longer intervals between doses are reasonable, so patients would not need additional medical visits for vaccinations. However, a series of uncompleted vaccinations and longer intervals can put adult patients with diabetes at risk for hepatitis B virus infection. For unvaccinated diabetics age 60 or older, ACIP recommends that they follow their physician’s management for vaccination. Like other vaccines, the efficacy of the hepatitis B vaccine declines with age. For older diabetics who are frail or have some reason for reduced life expectancy, the benefits of a series of vaccines may be relatively limited. However, the hepatitis B vaccine also provides partial incomplete protection in other older diabetics. Vaccine protection lasts more than 20 years in young adults, but this time is uncertain in older diabetics. Factors that support vaccinating adults with diabetes age 60 and older include temporary or permanent residents of long-term care centers such as nursing homes or assisted living facilities, recipients of home health care services who rely on glucose-assisted monitoring, and older adults who have recently been diagnosed with diabetes but have always been healthy. Adults of any age can safely receive the hepatitis B vaccine. Millions of children and adults of all ages have been immunized against hepatitis B worldwide. The safety of the vaccine was recently evaluated and reaffirmed by the Institute of Medicine. As you know, hepatitis B is a viral infection that can cause serious liver disease in adults. About 40% of adults with hepatitis B require hospitalization, and at least 4% of adult patients die from early complications of the infection. About 5 percent of adults with hepatitis B progress to chronic hepatitis B. The risk of chronic hepatitis B in adults with kidney failure is quite high. Fifteen percent of adults with chronic hepatitis B progress to cirrhosis, liver failure, or liver cancer. The hepatitis B virus is easily transmitted. Many of the easily transmitted viruses can be found in large amounts of blood or other body fluids that are too small to be seen. The virus is able to exist stably on the surface of environmental objects, maintain its infectious ability for seven or more days, and once touched, it is able to enter the body through a wound on the surface of the skin. Both the weak infectious dose and the stability of the virus make transmission easier. There have been a number of hepatitis B outbreaks among adult patients with diabetes in long-term care facilities. Disease transmission has been associated with improper cleaning of blood glucose meters, especially when adults receive glucose-assisted testing with the same instrument. Other examples of transmission include the continuous use by multiple people of finger-prick glucose meters designed for one person, or when patient-to-patient surgical tools are not properly sterilized.