Introduction Immunomodulator therapy is commonplace in the management of inflammatory bowel disease, IBD. The European Crohn’s and Colitis Organisation, ECCO, published guidelines in 2009 recommending every patient with IBD be considered for varicella, human papilloma virus, influenza, pneumococcal and hepatitis B vaccination. This study examines current immunisation practices in an IBD population at a District General Hospital.
Methods 100 consecutive patients with IBD attending general gastroenterology outpatient clinics were asked to complete a questionnaire. All subtypes of IBD were included. Information regarding IBD related medication, recent infections and immunisation status were collected. The results were analysed using the statistical package for the social sciences, SPSS software.
Results 100 questionnaires were collected; 3 were excluded, 2 due to duplication of patients, 1 was submitted blank. The patients’ median age was 52 (17–86), with a male to female ratio of 36:64%. Of IBD subtypes, 52 had Crohn’s disease, CD, 42 ulcerative colitis, UC, and 3 had colitis of undetermined type or aetiology, CUTE. 91 (94%) of patients had been on prescribed medication for IBD in the last 6 months. Of those, a majority (69%) had taken mesalazine, nearly half (42%) thiopurines, a quarter (24%) steroids and 15% anti tumour necrosis factor, anti-TNF. Of the 97 patients, 64% had been on an immunosuppressing medication in the previous 6 months, 29% of which reported having had an infection in the preceding 12 months. Chest and urinary tract infections were the most commonly reported in 33% and 22% of those reporting an infection respectively. 39% of patients on immunosuppressants reported a doctor discussing vaccinations with them. 74% of immunosuppressed patients had received an immunisation of any sort. 92% of these had received influenza vaccine, 40% Pneumovax, 21% hepatitis B vaccination, and 1 (2%) human papilloma virus. Of note, all patients who reported a chest infection had received the influenza vaccine and two thirds had received Pneumovax.
Conclusion A significant number of patients diagnosed with IBD will require immunosuppressing medications at some point during their care. Despite ECCO guidelines advising all patients with IBD be considered for a vaccination program at initial diagnosis, only three quarters had received any vaccinations whatsoever. Interestingly, in our small cohort, influenza and pneumococcal vaccinations did not seem to protect against self reported chest infections. Traditionally the role of vaccination has been seen as a function of primary care. Increasing awareness of the need for vaccination in primary care may improve adherence. Ultimately, with the increasing use of immunomodulators and their inherent infection risks, perhaps more responsibility should be taken on by the IBD clinician?
Disclosure of Interest None Declared.
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