2904 Influenza and Pneumococcal Vaccination in Patients With Inflammatory Bowel Disease: Findings From a Large Safety Net Hospital

Abstract

INTRODUCTION: Inflammatory Bowel Disease (IBD) inherently predisposes to infections due to a lack of appropriate innate and adaptive immune responses to infectious agents. Immunomodulators and biological therapies further increase the risk of infections in IBD patients by dampening the immune response of an already dysregulated intestinal immunity. Many of these infections are preventable with vaccinations. Advisory committee on immunization practices recommends pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23) and annual influenza vaccine for all IBD patients. Despite these recommendations, vaccination rates continue to be suboptimal. We present our findings on the vaccination rate at a large safety net hospital. METHODS: We hypothesized that vaccination rate are low at most outpatient centers. In order to test this, we retrieved electronic medical records (EMR) from one of the outpatient departments of a large safety net hospital between November 2017 and March 2018. Patients with a diagnosis of IBD were identified and EMR were reviewed. Data regarding influenza vaccine, PCV13, PPSV23, immunosuppressive medications and comorbidities were obtained. Microsoft Excel and SPSS software version 21 were used for data management and analyses. Two-sided P-value < 0.05 was considered statistically significant. RESULTS: 181 patients were included in the study, 51.9% female and 48.1% male. Majority were African American (86.7%). The mean age was 45 years with 56.9% of patients being ≤49 years, 38.7% were between 50-69 years and 4.4% were over 70 years. 59.1% of patients were on immunosuppressive therapy. Overall, only 54.1% received an annual influenza vaccine. 24.9%, received PPSV23 alone, 4.4% received PCV13 alone and 13.8% patients received both P13 and PPSV23. Patients within the ages of 50-69 years were more likely to receive influenza vaccine (r = 0.358, P < 0.001). 43.1% of our patient populations were uninsured and 53.5% were unemployed. CONCLUSION: Our study revealed suboptimal implementation of national recommendation on influenza and pneumococcal vaccination among IBD patients at the selected institution, consistent with previous studies. We also found that older age predicts vaccination uptake. We propose that continuous education on the vaccination guidelines should be consistently provided to physicians involved in the care of IBD patients. Incorporating reminder alerts and patient education materials on vaccination guidelines in the EMR might improve its uptake and rate.