Human Papillomavirus Vaccine Compliance in Inflammatory Bowel Disease Patients in Clinical Practice

Abstract

Immunomodulators and biologics are commonly used to treat patients with Inflammatory Bowel Disease (IBD) and immunosuppression may lead to an increased risk of infection, including vaccine-preventable infections. Despite this, IBD patients are often under-vaccinated, as compared to the general population. The are many reasons, including inadequate knowledge regarding which immunizations can be administered to immunosuppressed IBD patients and ambiguity as to whether the primary care physician or the gastroenterologist should be administering vaccinations. One of the recommended vaccinations for female IBD patients between the ages of 9 and 26 is the Human Papillomavirus (HPV) vaccine, Gardasil®. This vaccine is particularly important given the evidence showing increased risk of cervical dysplasia, and possibly cervical cancer, among female IBD patients. The aim of this study was to assess how many female patients in the IBD Clinic at Wake Forest Baptist Health have a primary care physician and have been compliant with HPV vaccination. Consecutive female IBD patients, between the ages of 18-27, who were seen at the Wake Forest Baptist Health IBD Clinic, were prospectively enrolled in a quality improvement project beginning January 2012. Charts were reviewed to assess whether or not the subjects have a primary care physician, whether they have been offered the HPV vaccine, and if they have received the HPV vaccine. Twenty women were enrolled. Of these, 95% (19 out of 20) reported having a primary care physician, 80% (16 out of 20) reported being offered the HPV vaccine, and 65% (13 out of 20) reported receiving the HPV vaccine. In the Wake Forest Baptist Health IBD Clinic, 95% of young women have primary care doctors, 80% have been offered the HPV vaccine, and 65% report that they have received the HPV vaccine. This is higher compliance with the HPV vaccine than reported in a national sample or in other IBD clinics. The difference in compliance may be explained by socioeconomic factors, insurance status, and availability of primary care physicians. Further research is warranted to understand the barriers to vaccination in IBD patients in different populations.