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P695. Efficacy of vaccination against hepatitis A and B in inflammatory bowel disease patients: preliminary results

K. Karmiris1, E. Voudoukis1, G.A. Paspatis1, 1Venizeleio General Hospital, Gastroenterology, Heraklion, Crete, Greece

Background

Inflammatory bowel disease (IBD) patients are vulnerable to viral infections. The aim of the present study was to investigate the efficacy of vaccination against hepatitis A (HAV) and B (HBV) virus in a single centre cohort of IBD patients.

Methods

153 consecutive IBD patients (females: 39.9%, Crohn's disease: 50.3%, median [IQR] age at diagnosis: 44.4[30.1–59.9] and disease duration at entry: 3.0[0.6–9.4] years) have been prospectively examined as of January 2010. Those not immunized, who were <65 years old (unless being treated with an anti-TNFalpha agent) received the respective vaccine (Havrix, 1 mL, two doses, 0 and 6–12 months and/or Engerix-B, 1 mL, three doses, 0–1-6 months). Adequate immune response was defined as an anti-HAV IgG >20 mIU/mL and an anti-HBs >10 mIU/mL. Patients who did not respond to HBV vaccination, received a second accelerated scheme (1 mL, three doses 0–1-2 months). The impact on immune response of certain epidemiological and disease specific characteristics as well as of treatment was also investigated.

Results

Eighty-one out of 153 patients (52.9%) have been vaccinated against HBV (actively: 20.3% and passively: 15% immunized before IBD diagnosis, chronic hepatitis B: 1.3%). Twenty-one out of 46 (45.7%) adequately responded. All non responders received a second accelerated scheme. Six out of 13 (46.2%) developed an adequate response. Thirty-six out of 153 (23.5%) were eligible for anti-HAV vaccination. Six out of 7 (85.7%) adequately responded. Gender, BMI, diagnosis, smoking, disease classification and activity, use of immunomodulators or anti-TNFalpha agents and CRP were not associated with the development of an adequate response to vaccination. Patients who received the accelerated scheme and responded were younger (median age at entry: 40.6 [30.4–43.9] vs 64.0 [63.2–69.9] years old, p < 0.001) and had a more recent diagnosis (disease duration at entry: 1.1 [0.9–3.9] vs 7.4 [1.8–8.2] years, p = 0.035).

Conclusion

Half of our IBD patients lack immunization against HBV at diagnosis. On the contrary about two thirds are already immunized against HAV. Response rate to HBV vaccination is low, irrespective of the use of immunomodulators. Half of non-responders will respond to a second intense course. Response rate to HAV vaccination is much higher. These results indicate the need for a proper work-up at IBD diagnosis and for establishing a modified vaccination scheme against HBV in terms of dosing schedule.