Introduction There is evidence-based guidance, including from the Department of Health, supporting vaccination of patients with susceptible gastroenterological conditions. The recent pandemic flu has also raised the profile of vaccination programmes for at-risk patients. Anecdotally, Gastroenterologists rarely advise vaccinations for these patients.
Methods We aimed to assess current uptake of vaccination in at-risk Gastroenterology patients. We prospectively audited vaccination uptake in the preceding 12 months, against influenza and pneumococcal disease among 100 consecutive eligible gastroenterology patients on immunomodulators or with chronic liver disease (CLD) seen in clinics or wards. Hepatitis A and B vaccination uptake were also assessed in CLD patients. The underlying diagnoses, type of immunomodulators and Child-Pugh scores were recorded. Patients who received vaccinations were also asked who advised their vaccination.
Results We identified 57 males and 43 females with a mean age of 51 (range 19–83). 52% were on immunomodulators (31 Azathioprine, 9 Infliximab, 1 Adalimumab, 1 6-Mercaptopurine, 10 Combination) while 48% had CLD. Indications for immunomodulators include Crohn's disease (56%), UC (25%), autoimmune hepatitis (15%) and post-liver transplant (4%). Diagnoses for CLD patients include ALD (59%), HCV infection (13%), PBC (6%), NAFLD (4%), autoimmune hepatitis (4%), haemochromatosis (4%), HBV infection (2%) and mixed aetiologies (8%). Only 10% of patients had both influenza and pneumococcal vaccines, while 27% had influenza vaccination alone. Of the eligible CLD patients, only 2/46 (4%) patients had both HAV and HBV vaccinations while 1/46 (2%) had HBV vaccination only. Of the 38 patients who had at least one vaccination, 73% were advised to by their general practitioner, 11% by the gastroenterology team, 11% via self-referral and 5% via other secondary care teams.
Conclusion Despite national guidance, only about one third of our susceptible gastroenterology patients are receiving all or some of the appropriate vaccinations. Of the patients receiving vaccination, most do not receive all the recommended vaccinations. This suggests a failure to disseminate guidance rather than a lack of patients' willingness to receive them. Most patients receiving vaccination were advised by their GPs. Few patients were advised by the Gastroenterology department, despite Gastroenterologists initiating immunomodulators and caring for susceptible patients. A departmental guideline is being created to ensure recommendations to receive all appropriate vaccinations are made to patients and their GPs. These findings may be similar in many UK hospitals and our findings may be more widely applicable.
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