Diabetes Vaccination Checker

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name: diabetes-vaccination-checker
description: Run a complete vaccination review for a person with diabetes using the ADA 2026 checklist — checks COVID-19, influenza, hepatitis B, pneumococcal, RSV, Tdap, and zoster status and gives a clear give/defer/skip decision for each. Trigger when a clinician asks about vaccines in diabetes, immunisation review, vaccination schedule for a diabetic patient, or "what vaccines does my patient with diabetes need".
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# Vaccination Checker — Diabetes
## ADA Standards of Care 2026

Ask for or confirm age, diabetes type, pregnancy status, immunocompromising conditions, and prior vaccine history before working through the checklist.

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## PATIENT PROFILE

Confirm before starting:
- **Age**
- **Diabetes type** (T1 or T2)
- **Immunocompromising condition?** (CKD, cochlear implant, CSF leak)
- **Pregnant?**
- **Vaccine history available?**

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## VACCINE CHECKLIST

Work through every vaccine. For each: is it given, due, or overdue?

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### 1. COVID-19
| | |
|---|---|
| **Who** | Everyone ≥6 months |
| **Schedule** | Current updated vaccine + boosters per CDC |
| **Action** | Give if not up to date |

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### 2. Influenza
| | |
|---|---|
| **Who** | All people with diabetes |
| **Schedule** | Every year |
| **⚠️ Important** | Inactivated or recombinant ONLY — **no live attenuated (nasal spray)** |
| **Action** | Give annually before flu season |

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### 3. Hepatitis B
| | |
|---|---|
| **<60 years** | Give routinely — complete series if not done |
| **≥60 years** | Clinician discretion based on exposure risk |
| **Action** | Check series completion; initiate if not done and age <60 |

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### 4. Pneumococcal
| Patient | Vaccine | Notes |
|---|---|---|
| Age 19–64, immunocompetent | PCV20 or PCV15 | If PCV15 used → follow with PPSV23 ≥1 year later |
| Age 19–64, immunocompromising | PCV20 or PCV15 | Per CDC schedule |
| Age ≥65 | PCV20 or PCV15 + PPSV23 if not yet given | PPSV23 not needed if PCV20 already given |

> **Simplest approach: give PCV20 (Prevnar 20)** — one shot, no PPSV23 follow-up needed.

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### 5. RSV
| | |
|---|---|
| **Age ≥75** | 1 dose routinely |
| **Age 60–74 at high risk** | 1 dose |
| **Action** | Single dose RSV vaccine; often missed — check in all ≥60 with diabetes |

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### 6. Tdap
| | |
|---|---|
| **Who** | All adults |
| **Schedule** | Booster every 10 years |
| **Pregnant** | Extra dose each pregnancy |
| **Action** | Check date of last Tdap |

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### 7. Zoster (Shingrix)
| | |
|---|---|
| **Who** | Age ≥50 |
| **Schedule** | 2-dose series, 2–6 months apart |
| **Note** | Give even if previously vaccinated with Zostavax |
| **Action** | Start at 50 — earlier than many assume |

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## GUARDRAILS

- **No live attenuated flu vaccine** in diabetes — always inactivated/recombinant
- **Hep B under 60:** don't skip — diabetes increases hepatitis B transmission risk
- **PCV20 simplifies pneumococcal** — avoids complex sequencing
- **Shingrix starts at 50**, not 60
- **RSV is frequently missed** — routine at ≥75, risk-based at 60–74
- **Don't rely on patient recall** — verify records when possible

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## SOURCE
ADA Standards of Care in Diabetes — 2026. Section 4, Recommendation 4.5, Table 4.3.
*Diabetes Care* 2026;49(Suppl. 1):S61–S88. DOI: 10.2337/dc26-S004