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Inflammatory bowel disease II
PTU-121 Compliance with guidelines on viral screening and vaccination of patients with inflammatory bowel disease (IBD)
  1. N Halliday,
  2. S Murray,
  3. G Parkes,
  4. V S Wong
  1. Department of Gastroenterology, Whittington Hospital, London, UK

Abstract

Introduction ECCO recommends screening IBD patients for immunity to or infection with varicella zoster virus (VZV), hepatitis B (HBV) and potentially HIV, hepatitis C virus (HCV) and tuberculosis (TB) to allow monitoring or treatment if patients require immunomodulatory therapy. Patients should be offered vaccination against VZV, HBV, human papilloma virus (HPV), pneumococcus and influenza where appropriate. We audited screening practice and the reported prevalence of prior exposure and vaccination in our IBD population.

Methods In 2010, IBD patients in our general gastroenterologyclinics completed a questionnaire regarding prior VZV disease, HBV infection or vaccination, influenza, pneumococcal and HPV vaccination. Results for screening tests were checked.

Results Patient characteristics: 91 patients returned questionnaires. 46 were male; median age was 43 years (range 19–71). 61 had a diagnosis of ulcerative colitis, 30 of Crohn's disease. Current drug therapy included none in 13 patients, 5-aminosalicylic acid (5-ASA) drugs in 42, systemic corticosteroids in 6, purine analogues, anti-metabolites or calcineurin inhibitors in 25 and biological agents in 5. Questionnaire responses: see Abstract PTU-121 table 1. Screening: 70 patients were screened for VZV immunity and 10 had complete HBV screening (surface antibody, antigen and anti-core antibody). Levels of screening for HCV, HIV were low (18 and 3 patients respectively). TB screening was more comprehensive; 47 had chest x-rays and 2 had γ interferon release assays. Those on biological agents were more likely to have been screened for TB. Four patients reporting prior VZV disease had no evidence of immunity (out of 48 who were tested). Nine of the 15 reporting HBV vaccination were tested, 5 of whom were negative. The one patient with serology consistent with previous HBV infection had no recollection of such.

Conclusion Overall compliance with ECCO guidelines was low and sporadic among our population. Other groups have reported similar low rates. Low levels of patients are taking advantage of existing immunisation programmes. Patient recall of previous vaccination may not be sufficient to imply immunity. A systematic process for assessing patients' vaccination status and active encouragement of vaccination programmes should be undertaken in the outpatient setting.

Abstract PTU-121 Table 1

Questionnaire responses

Competing interests None declared.

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