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* = Presenting author

P393 Measles, Mumps and Rubella Seronegativity Rates in IBD Patients Commencing Biologic Therapy

R. Stack*1, 2, U. Kennedy1, D. Schmidt1, 2, M. Walshe1, 2, F. MacCarthy1, 2, N. Mahmud1, 2, S. McKiernan1, 2, D. Kevans1, 2

1St James's Hospital, Gastroenterology, Dublin, Ireland, 2Trinity College Dublin, School of Medicine, Dublin, Ireland

Background

Serological testing to confirm immunity to varicella zoster and hepatitis B is established practice in Inflammatory Bowel Disease (IBD) patients where the use of immunomodulators or biological therapy is anticipated. Data, however, are few on the seronegativity rates for measles, mumps and rubella in IBD patient populations. The measles, mumps, rubella (MMR) vaccine is live and therefore cannot be administered to immunosupressed patients. Currently, there is uncertainty as to whether immunity to these viruses should be routinely tested prior to the initiation of immunomodulators or biologic therapy, particularly where individuals have been previously vaccinated.

Methods

We identified 98 IBD outpatients due to commence biologic therapy with available measles, mumps and rubella serology from an institutional database. A national immunization programme for measles, mumps and rubella was instituted in 1988. Subjects born subsequent to the year 1981 were considered to have participated in MMR immunization programme. Enzyme-linked immunosorbent assays were used to determine seronegativity to measles, mumps, rubella and varicella zoster.

Results

The study cohort comprised n=60 Crohn's Disease and n=38 Ulcerative Colitis patients [median age 42.7 years (18 - 76.9); female gender n=52 (53%)]. N=72 (73%) subjects were born prior to 1981 and therefore were not considered to have received MMR vaccination. The proportion of the study cohort seronegative for measles, mumps, rubella and varicella zoster were: 1%, 6%, 9% and 0%, respectively. Seronegativity rates for measles, mumps and rubella in the pre-MMR (n=72) versus post-MMR (n=26) cohorts were: 0% vs. 4%; 1% vs. 19%; and 8% vs. 12% respectively.

Conclusion

A significant proportion of IBD patients are seronegative for mumps and rubella viruses even where previous MMR immunization has occured. Confirmation of immunity to these viruses should be routinely performed in all IBD patients, irrespective of immunization status, prior to the initiation of immunomodulator or biologic therapies.