Reducing the risk of serious infections for children with diabetes mellitus: an audit of immunisation practice

Introduction: Patients with diabetes mellitus are known to have increased mortality and morbidity from influenza and pneumococcal disease. The Department of Health recommends that these children, along with other high risk patients, receive yearly influenza vaccination and additional immunisations against invasive pneumococcal disease. We audited the uptake of these additional immunisations in our patients. Method: Retrospective audit of all patients with type 1 diabetes under the paediatric diabetes team at our district general hospital in June 2011. Patients younger than 2 years old or diagnosed within the last year were excluded. Vaccination history was obtained from their general practitioners. Results: Vaccination records were available for 84 patients. Eleven were excluded due to diagnosis within the last year. One patient had a concomitant risk factor of cystic fibrosis. 46% of patients were male, median age 14 years (IQR 10–16). Patients were distributed across 26 general practices. Forty-two patients (57%) had been vaccinated against influenza in the preceding ‘flu season. 13 patients (18%) had never received an influenza vaccination. Nineteen children (26%) received at least one vaccine against pneumococcal disease, of whom three received routine pneumococcal conjugate vaccinations but not the additional polysaccharide vaccine, and 17 received appropriate pneumococcal polysaccharide vaccinations. In total, 17 children (23%) were appropriately immunised against pneumococcal disease. Overall, 15 patients (21%) with DM were appropriately vaccinated against both influenza and pneumococcal disease. Conclusion: The vast majority of our patients are inadequately vaccinated against influenza and pneumococcal disease. Rates of pneumococcal immunisation are substantially lower than those of influenza. This may be due to increased public awareness following the recent influenza pandemic. Vaccine coverage in these high risk patients needs to be improved. This will require increased awareness of the immunisation requirements of children with diabetes within primary care, supported by specialist paediatric diabetes teams.