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P404 Vaccinations and immunization status in Paediatric inflammatory bowel disease: data from the VIP IBD study

Martinelli M.*1, Strisciuglio C.2, Giugliano F.P.3, Urbonas V.4, Serban D.5, Banaszkiewicz A.6, Assa A.7, Drskova T.8, Hojsak I.9, Navas Lopez V.M.10, Romano C.11, Sladek M.12, Aloi M.13, Kucinskiene R.14, Staiano A.15, Miele E.15 ESPGHAN Open IBD Interest Group16

1University of Naples “Federico II”, Translational Medical Science, Section of Pediatrics, Naples, Italy 2Second University of Naples, Naples, Italy 3University of Naples, Naples, Italy 4Vilnius University Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania 5University of Medicine and Pharmacy Iuliu Hatieganu, Cluj–Napoca, Romania, Cluj Napoca, Romania 6Medical University of Warsaw, Paediatric Gastroenterology and Nutrition, Warsaw, Poland 7Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel; and Sackler Faculty of Medicine, Tel-Aviv University,Tel Aviv, Israel 8Charles University, Prague, Czech Republic 9Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia 10Hospital Materno Infantil, Avda. Arroyo de los ángeles s/n, 29011, Pediatric Gastroenterology and Nutrition Unit, Malaga, Spain 11University of Messina, Messina, Italy 12Department of Pediatrics, Gastroenterology and Nutrition Jagiellonian University School of Medicine, Cracow, Poland 13Sapienza University, Rome, Italy 14Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania 15University of Naples “Federico II”, Naples, Italy 16University of Naples, Translational Medical Science, Section of Pediatrics, Naples, Italy

Background

The prevention of vaccine preventable diseases (VPD) in children with inflammatory bowel disease (IBD) is an increasingly recognised issue. An ESPGHAN commentary providing specific recommendations on VPD was published in June 2012 (1). The aims of this study were to describe the compliance with these recommendations and to evaluate differences among patients diagnosed before and after June 2012.

Methods

This retrospective, multicentre study included 12 pediatric IBD referral centres. The following data were collected from children with a diagnosis of IBD before and after June 2012: demographic details, diagnosis characteristics, therapies, vaccinations and immunization status at diagnosis and at the start of immunosuppressants (IM) and biologics, reasons for incomplete immunization and decision making on IM and biologics.

Results

Between May and November 2016, 394 IBD children [Crohn's Disease (CD): 55.4%; Ulcerative Colitis (UC): 41.6%; Inflammatory Bowel Disease Unclassified (IBD-U): 3%] were enrolled. Among these, 50.2% and 48.8% were respectively diagnosed before and after June 2012. At diagnosis, the percentages of completion for single vaccination were: Diphtheria (99%), Tetanus (99%), Poliomyelitis (99%), Hepatitis B (99%), Pertussis (89%), Haemophilus Influenzae (69.3%), Pneumococcus (17.3%) Meningococcus C (23.9%), Measles (86%), Mumps (79.4%), Rubella (79.4%), Chickenpox (18.4%), HPV (4.1%) and Rotavirus (2%). Complete immunisation, according to the ESPGHAN commentary, was reported in 36% of the children. Among children with incomplete immunisation, specific vaccinations, before starting IM therapy, were recommended in 54.7% patients. In the remaining children, the reasons for not vaccinating were: need for immediate IM therapies (31.3%), parental refuse (8.4%), vaccination costs (3.4%) and other (56.9%). Two-hundred-fifteen (54.4%) out of 394 children started IM [Azathioprine: 204 (94.8%), Methotrexate: 9 (4.1%), other: 0.9%]. Among the children who started AZA, EBV status was only checked in 70 patients (34.3%), with 29 (41.4%) resulting EBV immunised and 41 EBV naive (58.6%). Biologics was started in 154 (39%) children [Infliximab: 79.8%, Adalimumab: 20.1%]. Tubercolosis screening before starting biologics was practised in 94.1% of children with different methods: Tubercolin Skin Test (38.6%), Quantiferon TB Gold (65.5%), T-SPOT TB (0.6%) and chest radiography (71%). Only 29.6% of patients yearly received influenza vaccination. No significant differences were identified between patients diagnosed before and after 2012 in all the analysed variables.

Conclusion

This study suggests a poor compliance with the ESPGHAN recommendations, highlighting the need of new strategies to deal with VPD in IBD children.

References:

[1] Veereman-Wauters G, (2012), Risk of infection and prevention in pediatric patients with IBD: ESPGHAN IBD Porto Group commentary, J Pediatr Gastroenterol Nutr