Introduction Patients with inflammatory bowel disease are at increased risk of infection; this is especially true of the 20% on biological agents. ECCO guidelines recommend the following vaccines:
Influenza (annual), Pneumococcal, Hepatitis B, Varicella, HPV (women under 26).
The guidelines also highlight the need to exclude latent TB; local policy is to perform an interferon gamma release assay.
Within the UK vaccination services are provided by primary care.
Methods The measures taken to prevent opportunistic infection in patients prescribed anti-TNFs for IBD at Chelsea and Westminster Hospital in 2013 were audited against the ECCO OI Guidelines.
The following were retrieved from electronic records: age, sex, anti TNF prescribed, pneumococcal antibodies, hepatitis B core and surface antibodies, varicella IgG, Elispot®.
Attempts were made to retrieve vaccination history from General Practice.
Results 60 patients were prescribed infliximab and 15 patients were prescribed adalimumab. 46 GPs were able to provide vaccination history.
Influenza: 50% (23/46) patients received vaccination against influenza within the past year.
Pneumococcus: 55% (47/85) patients demonstrated immunity. 6% (5/85) were not immune and the remainder were not tested. The vaccination history of 26 patients who were not immune or not tested was retrieved. 27% (7/26) had since been vaccinated.
Hepatitis B: No patients were core Ab positive. Surface Ab levels demonstrated immunity in 7% (6/85). 53% (45/85) were not immune, and the remainder were not tested. Vaccination history of 44 patients who were not immune or not tested was retrieved. Of these, 25% (11/44) had since been vaccinated.
HPV: 4 patients were women under 26 years old. 25% (1/4) had confirmed HPV vaccination.
Varicella: 21% (18/85) patients demonstrated immunity to varicella. 2% 2/85 were not immune.
Elispot: 65% (55/85) patients had a nonreactive assay. 1% (1/85) had a positive result and the remainder were not tested.
Conclusion The standards set out by ECCO to protect patients from opportunistic infection are not being met.
Problems obtaining accurate vaccination history from GP records include incorrect surgery details, lack of availability of staff able to review records and incomplete records. HPV vaccination usually takes place at school and is not routinely recorded by primary care.
Potential service improvements include provision of vaccines at clinic, improved patient education regarding the importance of vaccination and a check list to review bloods at first anti-TNF prescription.
Rahier JF, Ben-Horin S, Chowers Y, Conlon C, De Munter P, D’Haens G, Domènech E, Eliakim R, Eser A, Frater J, et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009;3:47–91
Disclosure of Interest None Declared.
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