P679 Can we trust on patient's infectious history? A prospective study on the agreement between medical history, vaccination record and serology.
B. Moreira Gonçalves*, M. Rodrigues, F. Dália, S. Costa, R. Costa, J.B. Soares, P. Bastos, R. Gonçalves
Hospital Braga, Gastroenterology Department, Braga, Portugal
Current therapy for inflammatory bowel disease (IBD) often involves immunomodulators and with these, potential for infection increases. In Portugal there is no study concerning the immune status of IBD patients. The primary aims of this study were to assess the immune status and the agreement between recall of infection, recall of vaccination, vaccination registry and infection serology in IBD patients and to determine the risk of cervical neoplasia in female individuals.
Prospective study including patients attending the IBD clinic of a tertiary referral hospital. We evaluated the following infections: hepatitis A virus (HAV), hepatitis B virus (HBV), varicella-zoster virus (VZV), tuberculosis, human papilloma virus (HPV), influenza virus and Streptococcus pneumoniae. Patients were asked to recall past infections and/or vaccination by these agents and to bring the vaccination record in order to assess the agreement with serology. Female patients were screened for HPV infection risk factors and invited for a cervical cancer screening by liquid based cytology (LBC).
139 patients (68 ulcerative colitis and 71 Crohn´s disease), with 86 female patients, were included and 55.4% were considered immunocompromised. Regarding HAV and HBV infections, 78.4% and 33.1% were immune. For tuberculosis infection, 13% had a positive Mantoux or IGRA result. There was no (p=0.152), poor (kappa=0.18) and no (p=0.184) agreement between recall of disease and serology for HAV, HBV and tuberculosis, respectively. Concerning correlation between recall of vaccination and vaccination registry for HAV, HBV and tuberculosis, we found no (kappa=-0.118), slight (kappa=0.378) and substantial (kappa=0.765) agreement, respectively. The most prevalent risk factor for HPV infection was immunosuppression (51.2%), followed by the use of birth control pill for a period over five years (26.7%). A total of 44 patients underwent LBC: 40 (90.9%) had a normal result; 3 (6.8%) presented atypical squamous cells of undetermined significance and 1 (2.3%) had low-grade squamous intraepithelial lesions. There was no association between abnormal LBC and any risk factor for HPV infection, type or length of IBD. The rates of VZV, Influenza and Pneumococcal vaccinations were 0%, 24.5% and 5.8%.
Assessing immune status by vaccination record and serologic analysis should always be considered in IBD patients due to poor or no agreement between recall of infection or vaccination and serology. Efforts should be conducted to increase the rate of Influenza and Pneumococcal vaccinations. Conclusions about a possible connection between IBD or immunosuppression with abnormal LBC were not possible because of the small sample.