Abstract
Vaccination of patients with immune-mediated diseases, such as inflammatory bowel diseases (IBD) and juvenile idiopathic arthritis (JIA), is an actual problem since these patients have an increased risk of developing infectious complications due to immunosuppressive therapy and features of the disease itself. The specialists’ attitude towards vaccination of patients with autoimmune inflammatory diseases has changed dramatically over the past decades: from complete refusal previously to almost complete implementation of the vaccine complex and the use of vaccines outside the national immunization schedule as of now. The purpose of this research was to assess the current attitude of pediatric gastroenterologists (PGs) and rheumatologists (PRs) towards vaccination of patients with IBD and JIA, to study their levels of knowledge and practical skills in this area using the anonymous online survey. Materials and methods used: an anonymous survey of 97 pediatric practitioners was conducted, of which 51 were PGs and 46 PRs. The questionnaire included questions about the physicians’ themselves (gender, experience, facility, academic degree) and their knowledge and approaches to vaccination of patients with IBD and JIA with live and inactivated vaccines during different stages of therapy. Results: most physicians believed that immune-inflammatory diseases are not provoked by vaccination (88% of PGs and 69.6% of PRs). A significant group of physicians (40.3% of PGs and 36.9% of PRs) consider vaccination with live vaccines safe for patients with IBD/JIA in remission while receiving immunosuppressive therapy. Most physicians consider vaccination with live vaccines unsafe in the state of active disease (80.4% of PGs and 71.8% of PRs). Outside of remission, physicians vaccinate such patients with live vaccines extremely rarely. A significant portion of physicians (32.0% of PGs and 21.7% of PRs) do not participate in vaccination considering it the responsibility of primary care pediatric practitioners/family physicians. Still, a significant portion of physicians (18.0% of PGs and 47.8% of PRs) actively discourage vaccination in general during the treatment of an immune-inflammatory disease. Determining antibodies to vaccines before starting immunosuppressive therapy/vaccination is considered appropriate by only 35.2%/47.0% of PGs and 32.5%/67.3% of PRs (р=0,885/0,110, respectively). Some physicians believe that vaccination can provoke an exacerbation of IBD/JIA (13.7%/21.6% of PGs and 21.7%/34.8% of PRs answered in affirmative or “rather yes than no,” respectively). Conclusion: the study revealed a differentiated attitude towards vaccination issues between PGs and PRs. Additional efforts needed in order to change the attitude of physicians of different specialties towards vaccination.
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