Vaccinations in Patients with Inflammatory Bowel Disease and Rheumatoid Arthritis on Immunosuppressants: Primary Care Physician Awareness and Current Practices at a Tertiary Care Center

Abstract

Purpose: Patients on immunosuppressive (IS) agents are at increased risk for infections, some of which are preventable by vaccination. The use of live attenuated vaccines, however, should be avoided in these patients. In this survey, we examine the current knowledge, practices and attitudes of primary care providers (PCP) on vaccinating patients on IS agents at Penn State Hershey Medical Center. Methods: An online close-ended questionnaire was sent to primary care attending physicians and residents in the Internal Medicine, Medicine/Pediatric and Family Medicine departments at our Institution. Results: 72 primary care physicians completed the survey. 33% of the respondents were attending physicians and 67% were resident physicians. 77% of responders reported having patients on IS medications. They reported seeing this patient population and checking their vaccination status at least on a yearly basis. Close to 90% of our respondents correctly believed the injected Influenza, Pneumonia and Tetanus vaccines are safe and reported giving these vaccines routinely to this patient population. 36% incorrectly believed, however, that the live- attenuated Varicella vaccine was safe in this patient population. 32% of respondents also incorrectly believed the live-attenuated Zoster vaccine was not only safe but recommended in patients on IS therapy, and 14% recalled giving the Zoster vaccine to these patients. Other live-attenuated vaccinations, such as the MMR (Measles-Mumps-Rubella) vaccine, were incorrectly recommended by 24% of providers and administered by 4% of respondents. 22% incorrectly identified the live attenuated intranasal influenza vaccine as a safe vaccine in these patients. 57% of respondents felt that patients would prefer to receive vaccines from their PCP and 49% of responders felt that they do not have enough resources to guide them in the process of vaccinating this subset of patients. As compared to attending physicians, residents displayed greater misconceptions about the safety of vaccinations in this patient population (p=0.0001). Conclusion: Significant misconceptions, particularly in resident physicians, regarding the safety of live-attenuated vaccines were detected. Greater educational resources are necessary for all levels of primary care providers, with high emphasis on physicians in training, to improve awareness of correct and safe immunization practices among patients receiving long-term immunosuppressive therapies.