Abstract
BackgroundPatients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines.MethodsPaediatric patients (0–18 years) seen at the tertiary Royal Children’s Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available.ResultsSixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC.ConclusionsChildren with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.
Highlights
Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases
Immunisation status was determined by history and reviewing the Australian Children’s Immunisation Register (ACIR), Australian Immunisation Register (AIR, which replaced the ACIR on 30 September 2016), Royal Children’s Hospital (RCH) Immunisation Program Service (ImPS) database and the RCH electronic medical record
The median age at diagnosis of IBD was 11.25 years (IQR 4.64) and the median age at first Specialist Immunisation Clinic (SIC) review was 13.12 years (IQR 4.61 years). 68.1% patients resided in a major city according to the Australian Statistical Geography Standard (ASGS) system [18]
Summary
Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. 1970 to 2000) [1, 2] Patients with IBD are at increased risk of serious infections, including vaccine preventable diseases (VPD) [3] This increased infection risk stems from a number of factors including the immunomodulatory effects of the disease process, immunosuppressive therapy, suboptimal nutrition and nosocomial infections associated with surgery, parenteral nutrition and hospital attendances [4]. Immunosuppressive agents such as biologics are increasingly being used early in the disease course and have been associated with severe infections [5]. High rates of cervical dysplasia have been described in adult female patients with IBD, highlighting the importance of timely Human Papillomavirus (HPV) vaccination [11, 12]
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