P670. Efficacy of vaccination against hepatitis A and B in inflammatory bowel disease patients
K. Karmiris1, E. Voudoukis1, M. Choustoulaki2, A. Sfiridaki2, G.A. Paspatis1, 1Venizeleio General Hospital, Gastroenterology, Heraklion, Crete, Greece, 2Venizeleio General Hospital, Blood Bank Center, Heraklion, Crete, Greece
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.
167 consecutive IBD patients (females: 38.3%, Crohn's disease: 48.5%, median [IQR] age at diagnosis: 45.4 [30.3–60.3] and disease duration at entry: 2.8 [0.7–9.2] 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, 1mL, two doses, 0 and 6–12 months and/or Engerix-B, 1mL, 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 (1mL, 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.
Eighty-three out of 167 patients (49.7%) received initally a conventional vaccination scheme against HBV (actively: 21.6% and passively: 15% immunized before IBD diagnosis, chronic hepatitis B: 1.2%). Forty out of 75 (53.3%) adequately responded. All but 5 of non responders received a second accelerated scheme. Sixteen out of 28 (57.1%) developed an adequate response (56/75, 74.6% responded in total). Patients with extensive ulcerative colitis responded less compared to those with a shorter disease extent (p = 0.015). Immunomodulatory (IMS) therapy resulted more frequently in a need for the accelerated scheme (p = 0.015). Anti-TNFalpha therapy was adversely associated with an immune response to anti-HBV vaccination (p = 0.004). Forty-three out of 162 (26.5%) were eligible for anti-HAV vaccination. Twenty-seven out of 30 (90%) adequately responded with 9/17 (52.9%) already having responded after the 1st dose. No major influence was observed on the outcome of anti-HAV vaccination.
Half of our IBD patients lack immunization against HBV at diagnosis. Response rate to HBV vaccination is low, further influenced by the use of IMS and/or anti-TNFalpha agents. More than 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 establishing a modified vaccination scheme against HBV in terms of dosing schedule and the opportunity of acquiring an effective anti-HAV response with one dose in case of a medical need for an early intervention with IMS and/or anti-TNFalpha agents.