Newsgroup: it.scienza.medicina
Titolo: diabete ed epatite B

Premettendo che soffro di diabete tipo 1 da due anni, ho una relazione
con una persona affetta da epatite B. Dal momento che lui è molto
preoccupato per la mia incolumità fisica abbiamo scelto di aspettare
prima di avere rapporti fisici. Il mio medico mi ha vivamente
sconsigliato di fare il vaccino contro l'epatite perchè controindicato
in persone diabetiche. Dal momento che non è possibile smettere di
amare una persona solo perchè ha una patologia non compatibile con la
nostra, mi chiedo come ci dobbiamo comportare. Non è un problema usare
il profilattico; ma l'idea di non poter mai baciare il mio uomo,
oppure di dover essere sempre prudente quando lo vorrei accarezzare
solo perchè le prove per la glicemia lasciano dei piccoli fori nelle
mie dita.... il tutto è così triste. E' possibile che non ci sia una
soluzione?

 in persone diabetiche.
ciao,
non sapevo di questa controindicazione, anzi, siccome mi stupiva ho fatto
una veloce ricerca su Pubmed.
così ho capito che la relazione ipotizzata riguardava il possibile
innescamento di malattie autoimmuni (il diabete tipo 1 ha un'eziologia
autoimmune) in seguito alla vaccinazione.
ti dirò, ho letto molto in fretta gli abstracts, ma mi pare di aver capito
che questi dubbi siano stati sollevati nei riguardi delle vaccinazioni
contro l'epatite B per i bimbi. e cmq mi pare di capire che non ci siano
chiare prove a favore di questa teoria.
non so se questo vale anche per chi ha *già* una malattia autoimmune, come
te....
e cmq secondo me (magari adesso verrò distrutta da qualche frequentatore
del ng più aggiornato di me sull'argomento... :-) è peggio il rischio di
contrarre l'epatite B.
se vuoi puoi anche tu fare una ricerca su Pubmed, ci metti le parole chiave
hepatitis B, diabetes, vaccine.
ti riporto due abstracts.
----------------------------------------------------------------------------
--------
      Med Sci Monit 2002 Jul;8(7):CR516-9
Hepatitis B virus serologic markers and anti-hepatitis B vaccination in
patients with diabetes.
Halota W, Muszynska M, Pawlowska M.
Department of Infectious Diseases The L. Rydygier Medical University,
Bydgoszcz, Poland. 
ws...@logonet.com.pl
BACKGROUND: In Poland HBV infections are mainly the result of nosocomial
infections or risky behavior. Active prevention plays a crucial role in
limiting such infections. Patients suffering from insulin-dependent diabetes
(type 1) incur high risk of infection with hepatotropic viruses because of
frequent hospitalization and blood tests. The aim of our study was to
determine the frequency of occurrence of serological markers of HBV
infection among patients with diabetes type 1, to evaluate the humoral
response to HBV vaccine depending on dosage, and to evaluate the influence
of past HBV infections on vaccination response. MATERIAL/METHODS: 299
diabetic patients were vaccinated against hepatitis B with Engerix B in two
doses (20 mg or 40 mg), on a 0-1-6 month schedule. The humoral response to
the vaccination was evaluated in the 5th and 8th months after the first dose
of vaccine according to sex, dose and previous detection of anti-HBc in
serum. Serologic markers of HBV infection were detected with the
immunoenzymatic-fluorescent ELFA method, with bioMerieux tests using the
VIDAS system. RESULTS: 98.7% of patients achieved protective anti-HBs titer
after vaccination. Women responded better than men. There were no
differences in mean anti-HBs concentration by vaccine dose. Patients with
previous serum anti-HBc achieved anti-HBs titers (p<0.00001). CONCLUSIONS:
The frequency of anti-HBc among patients with diabetes confirms the
widespread risk of HBV infection in the Polish population. Diabetics should
be vaccinated against hepatitis B with standard doses. Diabetics with
anti-HBc in serum can be vaccinated with a single dose.
------------------------------------------------------------------------
      Pediatrics 2001 Dec;108(6):E112
Childhood vaccinations, vaccination timing, and risk of type 1 diabetes
mellitus.
DeStefano F, Mullooly JP, Okoro CA, Chen RT, Marcy SM, Ward JI, Vadheim CM,
Black SB, Shinefield HR, Davis RL, Bohlke K; Vaccine Safety Datalink Team.
National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, Georgia 30341-3724, USA. 
fdest...@cdc.gov
OBJECTIVES: To evaluate suggested associations between childhood
vaccinations, particularly against hepatitis B and Haemophilus influenzae
type b, and risk of developing type 1 diabetes; and to determine whether
timing of vaccination influences risk. METHODS: We conducted a case-control
study within 4 health maintenance organizations (HMOs) that participate in
the Vaccine Safety Datalink project of the Centers for Disease Control and
Prevention. Study eligibility was restricted to children who met the
following criteria: 1) born during 1988 through 1997; 2) HMO member since
birth; 3) continuously enrolled for first 6 months of life; and 4) at least
12 months of HMO membership before diabetes incidence date (or index date
for controls) unless incidence date was before 12 months of age. All 4 HMOs
maintain registries of their members who have diabetes, and we used the
registries to identify potential cases of diabetes. We conducted chart
reviews to verify that potential cases met the World Health Organization
epidemiologic case definition for type 1 diabetes mellitus (ie, a
physician's diagnosis of diabetes plus treatment with daily insulin
injections). We defined the incidence date of diabetes as the first date
that the child received a diagnosis of diabetes. We attempted to match 3
controls to each case. Controls had the same eligibility criteria as cases
and were matched to individual cases on HMO, sex, date of birth (within 7
days), and length of health plan enrollment (up to the incidence or index
date). The index date for controls was defined as the incidence date of the
case to which the control was matched. Chart abstraction was performed by
trained chart abstractors using standardized forms. In addition to complete
vaccination histories, the chart abstraction forms for both cases and
controls included information on sociodemographic characteristics, selected
medical conditions, history of breastfeeding, and family medical history. We
used conditional logistic regression to estimate the odds ratio (OR) of
diabetes associated with vaccination, with vaccine exposure defined as
before the diabetes incidence date (or index date for controls). RESULTS:
Two hundred fifty-two confirmed cases of diabetes and 768 matched controls
met the study eligibility criteria. The OR (95% confidence interval) for the
association with type 1 diabetes was 0.28 (0.07-1.06) for whole cell
pertussis vaccine (predominantly in combination as diphtheria, tetanus
toxoids and pertussis vaccine), 1.36 (0.70-2.63) for measles-mumps-rubella,
1.14 (0.51-2.57) for Haemophilus influenzae type b, 0.81 (0.52-1.27) for
hepatitis B vaccine, 1.16 (0.72-1.89) for varicella vaccine, and 0.92
(0.53-1.57) for acellular pertussis-containing vaccines. Compared with
children who had not received hepatitis B vaccine, the OR of diabetes was
0.51 (0.23-1.15) for children vaccinated at birth and 0.86 (0.54-1.35) for
those first vaccinated against hepatitis B at 2 months of age or later. Race
and ethnicity and family history of diabetes were independently associated
with risk of type 1 diabetes, but adjustment for these factors did not
materially alter the ORs for any of the vaccines. CONCLUSIONS: In this
large, population-based, case-control study, we did not find an increased
risk of type 1 diabetes associated with any of the routinely recommended
childhood vaccines. Our study adds to previous research by providing data on
newer vaccines, including hepatitis B, acellular pertussis, and varicella
vaccines. For the older vaccines, our results are generally in agreement
with previous studies in not finding any increased risks. Ours is the first
epidemiologic study to evaluate the possibility that timing of vaccination
is related to risk of clinical diabetes in children. Our results on
hepatitis B vaccine do not support the hypothesis; risk of type 1 diabetes
was not different between infants vaccinated at birth and those who received
their first vaccination later in life. The results of our study and the
preponderance of epidemiologic evidence do not support an association
between any of the recommended childhood vaccines and an increased risk of
type 1 diabetes. Suggestions that diabetes risk in humans may be altered by
changes in the timing of vaccinations also are unfounded.
--
ciao,
Laura

 Il mio medico mi ha vivamente  sconsigliato di fare il vaccino contro
l'epatite perchè controindicato in persone diabetiche.
Non c'è alcuna controindicazione alla vaccinazione antiepatite B nei
diabetici.
Senza voler togliere nulla al tuo medico curante, rivolgiti al Dipartimento
di Prevenzione della tua ASL e chiedi del Servizio Igiene e Sanità Pubblica
dove verrai vaccinata (gratuitamente), naturalmente dopo aver fugato i tuoi
dubbi.
Ciao Dem