Introduction Immunomodulators (IM) and biological agents are now used more often and earlier in Inflammatory Bowel Disease (IBD) leading to an increase in opportunistic infections (OI)1. European Crohn’s and Colitis Organization (ECCO) recommends screening and vaccinations for Varicella Zoster Virus (VZV) (if no history of chickenpox/shingles and serology negative), Human Papilloma Virus (HPV) - in women, Annual Influenza (inactivated vaccine), Pneumococcus (3- 5 yearly) and Hepatitis B (if HBV seronegative) in immunocompromised IBD patients.
Methods We retrospectively collected the data on the serology status for Hep B&C, VZV of our patients receiving biologics from pathology results reporting system and Chest X-ray (CXR) results from PACS. BCG vaccination status and previous Chicken pox exposure was obtained from the clinic letters.
The information on the vaccination status was obtained by contacting the general practioners via telephone and from patients at attendance for their infliximab infusions. Data was also taken from the clinic letters and IBD MDT proformas.
Results Of the 37 patients who are currently receiving biologics (18 males; 19 females; mean age: 37.3±2.3 years), 31 had Crohn’s disease, 5 UC and 1 indeterminate colitis. All patients received anti-TNF therapy with 33(91.7%) exposed to combination therapy with azathioprine (27) (81.8%) and (6) (18.2%) with methotrexate. Serology status on Hep B, C and Varicella was available in 26(77%), 5(13%), and 21(56%) patients respectively. A CXR was done in 65% of patients with 5 patients having their BCG status documented. IGRA was done on 2 patients with ambiguous mantoux results. Influenza, pneumococcal, HPV vaccines were administered in 6 (16.2%), 4 (10.8%) and 1 patients (2.7%) respectively.
Conclusion Relevant serology status and vaccination history was available/recorded in a minority of patients only. Non/poor-adherence to guidelines, poor documentation or limits of data collection may explain this.
To improve compliance information leaflets on the ECCO-recommended vaccines are being sent to GPs and patients. Adherence to checklists prior to biologic administration is enforced.
We believe patient education with support of our IBD nurses and empowering patients with relevant personalised information given at diagnosis and during their treatment may increase the uptake of vaccinations in these high risk patients.
The development of a dedicated IBD database ideally with GP links to allow vaccinations records to be accessed will allow us to audit our practise accurately and determine the efficacy of the current recommendations.
Disclosure of Interest None Declared.
Toruner M et al. Risk factors for opportunistic infections in patients with IBD. Gastroenterology. 2008; 134:929–36
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