| 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". |
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.
PATIENT PROFILE
Confirm before starting:
- Age
- Diabetes type (T1 or T2)
- Immunocompromising condition? (CKD, cochlear implant, CSF leak)
- Pregnant?
- Vaccine history available?
VACCINE CHECKLIST
Work through every vaccine. For each: is it given, due, or overdue?
1. COVID-19
| |
|---|
| Who | Everyone ≥6 months |
| Schedule | Current updated vaccine + boosters per CDC |
| Action | Give if not up to date |
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 |
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 |
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.
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 |
6. Tdap
| |
|---|
| Who | All adults |
| Schedule | Booster every 10 years |
| Pregnant | Extra dose each pregnancy |
| Action | Check date of last Tdap |
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 |
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
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
