S0893 Evaluation of Interventions Intended to Increase Vaccination Rates in Inflammatory Bowel Disease: A Systematic Review

Abstract

INTRODUCTION: Vaccinations in inflammatory bowel disease (IBD) patients are important to reduce the risk of opportunistic infections. Previous studies have shown that vaccination rates in IBD patients are suboptimal, despite guidelines by ACG and ECCO. We aimed to assess the different modalities currently studied to increase vaccination rates in IBD patients. METHODS: With the assistance of a medical librarian, two independent MEDLINE searches were conducted with search words and synonyms that included: “IBD”, “UC”, “Crohns”, “vaccinations”, and “prevention” between the years 1946 and 2020. We performed a systematic review according to the PRISMA guidelines. Inclusion criteria included patients with IBD ≥18 years old, prospective trials with interventions aimed to increase vaccinations or immunizations, and full-length publications in English. Data on population, setting, study design, and outcomes were extracted and synthesized. RESULTS: The searches retrieved 1,403 articles. Six articles met our inclusion criteria. Overall 2,828 patients and 83 gastroenterologists were studied in six countries (United States, Denmark, France, Belgium, UK, and Australia). All studies were completed in GI/IBD based clinics. Five out of the six studies were pre-post test interventions and one study was a RCT. Two of the studies were physician-oriented (i.e. one was an educational intervention and the other used a scribe to allow the GI more time with the patient). One study was solely patient-oriented (i.e., a survey). One study was mixed with both a patient and physician educational interventions and two studies were barrier-oriented with either infectious disease physician (ID) or an IBD nurse acting as a navigator. Five out of the six studies found that the largest increase was in pneumococcal vaccinations (PCV), with the greatest effect occurring in the ID navigation intervention, as PCV increased from 16% to 88% (P < 0.001). CONCLUSION: In our review, many different interventions have shown some degree of benefit in increasing vaccination rates in IBD patients. Similar to other studies in preventative medicine, it is possible that barrier-oriented interventions (i.e., navigation) may have the greatest effect in increasing vaccination rates in IBD, however future high-quality RCTs are needed.