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P371. Vaccination against opportunistic infections in patients with inflammatory bowel disease on immunomodulator therapy

S.T.C. Peake, C.T. Tee, J. Landy, N. Arebi

St Mark's Hospital, Middlesex, United Kingdom

Background: The treatment paradigms for Inflammatory Bowel Disease (IBD) have changed. Immunomodulators (IM), including biological agents, are being used more often and earlier in the course of the disease, with an increase in the risk of opportunistic infections (OI). The relative risk of OI is reported as Odds Ratio (OR) of 2.9 with one IM increasing to an OR of 14.5 with ≥2 concomitant IMs. Age (>50 years) is also an independent risk factor for OI. A consensus report on the prevention, diagnosis and management of OI in IBD was devised by the European Crohn's and Colitis Organisation (ECCO) with the aim of minimising OI in immunocompromised individuals. The following vaccinations are recommended: Varicella Zoster Virus (VZV) (if no history of chickenpox/shingles and VZV serology is negative), Human Papilloma Virus (HPV), annual Influenza (trivalent inactivated vaccine), Pneumococcal polysaccharide and Hepatitis B (if HBV seronegative). In addition, following the Influenza A virus outbreak (H1N1) in 2009, Swine Flu vaccination was recommended.

Aims: To investigate the vaccination status of IBD patients on one or more IM drugs.

Methods: We identified a cohort of 200 patients on IM or biological therapy from our IBD database seen in the outpatient clinic between September 2009 and June 2010. Questionnaires were posted to the General Practitioners to report on vaccination status for Influenza (within 1 year), Pneumococcal (within previous 5 years), VZV, HPV and Swine Flu. Demographical information was recorded for each patient. Fisher's exact test was used to examine for differences in higher risk groups.

Results: The response rate was 51.5% (103/200). The median age of patients was 42 years (range 16–74); 54 were female (52.4%). 82 were tertiary referrals (79.6%). 75.7% had Crohn's disease (n = 78). IMs included Azathioprine (35.9%, n = 37), 6-Mercaptopurine (9.7%, n = 10), corticosteroids (5.8%, n = 6), Methotrexate (3.8%, n = 4) and Tacrolimus (1.9%, n = 2). Biological agents included Infliximab (36.9%, n = 38) and Adalimumab (25.2%, n = 26). Administered vaccinations are shown in Table 1.

Table 1
VaccineAdministeredNot administered n (%)Unknown statusNot eligible
 n (%)Not invitedPatient refusedn (%)n (%)
Infleunza38 (36.9)56 (54.4)9 (8.7)0 (0)0 (0)
H1N133 (32.0)60 (58.3)9 (8.7)0 (0)1 (0.9)*
Pneumococcal7 (6.8)91 (88.3)4 (3.4)1 (0.9)0 (0)
HPV0 (0)14 (13.6)0 (0)1 (0.9)88 (85.4)
VZV0 (0)72 (70.0)0 (0)7 (6.7)24 (23.3)*
*Patient previously contracted illness and therefore not eligible for vaccination.

Within the cohort, 21 patients were ≥50 years old. Within this group, 47.6% (10/21) had received the Influenza and/or Swine Flu vaccination compared to 40.2% (33/82) in the younger age group (p = 0.6). Of the 10 patients receiving dual IM and biological therapy, 9 (90%) received both the annual Influenza and Swine Flu vaccinations (p < 0.001).

Conclusion: The majority of patients at risk of OI in our cohort are on biological therapy. Very few are receiving the recommended vaccinations. Patients on dual immunosuppression were the only high risk group to have significantly higher vaccine uptake. These findings may be due to lack of awareness of the risks associated with immunosuppression. Information leaflets on the ECCO-recommended vaccines directed at GPs and patients may improve compliance.