Introduction Evolving definitions of disease control over the last decade have translated into earlier and often combined use of immunomodulatory (IM) therapy with the aim of achieving deep remission. The potential for immunosuppression to increase the risk of opportunistic infection was recognised early with the publication of ECCO Consensus guidelines on prevention diagnosis and management of opportunistic infections in IBD. Has this permeated to the grass roots of clinical care or are we still “top-heavy”? We reviewed vaccination practices in a large primary care cohort.
Methods Data was obtained from primary care in the Fylde and Wyre CCG from electronic patient records maintained on EMIS Web. Patients were considered immunosuppressed if they were on doses of prednisolone >20 mg/day or equivalent for 2 weeks or more, ongoing treatment with effective doses of Thiopurines, Methotrexate, Infliximab and Adalimumab or had these agents discontinued within 3 months. We identified patients treated with these drugs between September 2012 and August 2013. Vaccination practices were reviewed in line with ECCO consensus. Data on biologic therapy and steroids was not available.
Results A total patient population of 93,240 (adult population of 75,952) from 13 practices was thus audited. A total of 594 patients were prescribed IM therapy [Azathioprine (AZA) 135, Methotrexate (MTX) 446, 6MP 13]. The data on vaccinations is shown in Table 1. Vaccination rates were significantly higher in the non IBD cohort as compared to the IBD cohort, for influenza vaccine p < 0.001, 95% CI (–0.17 ± 0.1) and pneumococcal vaccine P < 0.001 95% CI (–0.177 ± 0.103).
Conclusion The practice of immunisation was poor and probably reflective of disparate practices elsewhere. Mere existence of guidelines is insufficient for quality improvement, which must take into account and remedy barriers to implementation. These include clinician awareness, concerns regarding safety and side effects and ambiguity regarding responsibility. Gastroenterologists must provide a clear line of communication to primary care physicians. We are taking necessary steps through a dedicated proforma to ensure vaccination uptake.
Disclosure of Interest None Declared.