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P833 Efficacy of vaccination against hepatitis A in inflammatory bowel disease patients: a single-centre cohort study

I. Dimas1, E. Voudoukis1, G. Paspatis1, K. Karmiris*1

1Venizeleio General Hospital, Gastroenterology, Heraklion, Greece

Background

Inflammatory bowel disease (IBD) patients are vulnerable to viral infections. Cases of hepatitis A infection with a fatal outcome in immunocompromised patients have been reported. The aim of the present study was to investigate the efficacy of vaccination against hepatitis A virus (HAV) in a single-centre cohort of IBD patients.

Methods

Consecutive IBD patients were screened for HAV status and those not immunised with an age < 60 years received the respective vaccine (Havrix, GlaxoSmithKline®, Brentford, UK, 1 ml, two doses, one at baseline and the second 6–12 months after the first dose). Immune response was defined as a positive anti-HAV IgG measured at least 3 months after the second dose. Anti-HAV IgG was also measured randomly 3 months after the first dose in a sub-group of patients. The impact on immune response of certain epidemiological and disease specific characteristics as well as of treatment was also investigated.

Results

356 IBD patients (females: 40.2%, Crohn’s disease [CD]: 52.2%, median [IQR] age at diagnosis: 42.2 [27.8–56.2] and age: 50.0 [33.5–63.1] and disease duration: 2.7 [0.4–9.1] years at study entry) have been prospectively examined as of January 2010. In total, 115/356 (32.3%) were eligible for anti-HAV vaccination with the rest being either actively or passively immunised before IBD diagnosis. So far, 82/90 (90.1%) have adequately responded to vaccination. Interestingly, anti-HAV IgG turned out positive in 12/21 patients (57.1%) already after the first dose. Ulcerative colitis was associated with a greater success of anti-HAV vaccination (OR: 1.8 [1.5–2.2], p = 0.01, all patients with a negative post-vaccination anti-HAV IgG titre had CD). Patients receiving anti-TNFα agents responded less to vaccination (OR: 0.04 [0.00–0.24], p < 0.0001) and those not receiving any kind of immunosuppressive therapy responded better (OR: 9.7 [1.1–81.3], p = 0.015). No other association was found with gender, BMI, smoking status, disease classification and activity, anaemia and CRP regarding development of an adequate response to vaccination.

Conclusion

Two thirds of our IBD patients are already immunised against HAV before diagnosis. Response rate to vaccination is strikingly high in the rest and especially in UC patients. One dose can provoke immunisation, a critical condition in selected cases where rapid introduction of immunosuppressant’s is warranted. Anti-TNFα agents seem to influence vaccination success rate. These results need to be verified in other cohorts.