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P270. Program of vaccination of patients with inflammatory bowel disease

M. Rivero, A. Diaz, M. Bautista, M. Arias, M. Cal, B. Castro

Hospital Universitario Marques de Valdecilla, Santander, Spain

Because of the increasing use of immunosuppressive and biological drugs, the occurrence of opportunistic infections has become a key safety issue for patients with inflammatory bowel disease (IBD). Prevention is far the first and most important step, and many of which infections are preventable by prior vaccination. For this reason, our center has developed an standardized vaccination program for patients with IBD.

Material and Methods: We present a first descriptive study to identify the population that is being vaccinated. Patient demographics, IBD medications and duration of therapy details were colleted. A data base was elaborated and registered the previous vaccination status (herpes virus, measles, rubella and viral hepatitis) serology and the vaccines that recieves each one of the patients.

Results: A total of 173 IBD patients have been included in this program. Of these 52 (30%) have Ulcerative Colitis and 121 (70%) have Crohn's disease. The median age was 40.8 years (range 15–74). At the moment that the vaccination started, 141 patients were receiving immunosuppressive drugs, being the azathioprine the drug most commonly used (63%), both in monotherapy (39.8%) or in combination with corticosteroids or anti-TNF therapy (60.2%). 27 Patients received antiTNF therapy: Infliximab (7.5%) or Adalimumab (8.09%). The remaining 32 patients were in treatment with aminosalicylates.

The 95.9% of the patients recieved vaccines against pneumococcus, the 100% of the patients were vaccinated against H. Influenza and 97.6% was vaccinated against Meningococo. The MMR (measles, mumps and rubella) was only necessary in 4% of the patients whose serology was negative. The 35.8% required vaccine against diphtheria-tetanus. The 5.2% required vaccination against varicella because their serology was negative.

116 (67%) has been vaccinated against hepatitis A virus. The 134 (77.4%) of the patients recieved the vaccine against hepatitis B virus in different doses depending on the therapy received at the time. In a preliminary analysis we have noticed that the serological response against hepatitis B surface antigen is lower than normal population.

Conclusions:

  1. Despite an adequate compliance of the vaccination calendar, an important percentage of our patients required new vaccination against different agents. So we emphasize the importance of checking the immunization state and the convenience of developing specific program of vaccination of IBD patients to prevent the increasing risk of opportunistic infections.
  2. The 77.4% required vaccination against hepatitis B virus, with a poor response specially in those in treatment with biological drugs. Thus we considerer necessary future studies regarding immunological response to this measure, specially in patients with biological therapy.