IBD patients may need more vaccination counseling

Last Updated: 2015-05-11

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Patients with inflammatory bowel disease (IBD) who lack sufficient knowledge and uptake of vaccines might benefit from more counseling from gastroenterologists and primary care providers, new research from Canada suggests.

"When we counsel our patients on their IBD, we often focus on educating patients on their disease and its medical treatments. However, because there is so much to discuss, we often overlook vaccinations, which can also be very important in providing optimal care," senior author Dr. Geoffrey C. Nguyen of the University of Toronto, Ontario told Reuters Health by email.

"There is also the uncertainty as to whether it should be the gastroenterologist or the primary care physician who should be leading the discussion with patients regarding vaccines," he added.

Dr. Nguyen and colleagues surveyed patients about their attitudes toward vaccination, knowledge of vaccine recommendations, and uptake of recommended vaccines. Between September 2013 and January 2014, 305 IBD and endoscopy patients at Mt Sinai Hospital's Center for IBD in Toronto completed the survey. Five were excluded due to incomplete data.

The respondents were about 23 years old, on average, at IBD diagnosis and about 35 on average at the time of the study. More than half were women.

The prevalence of treatment with biologics, steroids, methotrexate, and thiopurines were 37.3%, 16.0%, 5.7%, and 16.0%, respectively.

"Clinical guidelines recommend routine vaccination of IBD patients, with the exception of live-attenuated vaccines, which should be avoided in immunosuppressed patients," the researchers noted online April 23 in the Journal of Crohn's and Colitis.

Many patients did not know which vaccinations are recommended, had misconceptions about vaccination safety and efficacy, and did not accurately report their vaccination uptake.

Overall, about 45% said they had completed their vaccinations. Self-reported vaccination uptake rates were 61% for influenza, 10% for pneumococcal, 52% for hepatitis A, 61% for hepatitis B, 26% for varicella, 21% for meningococcal, 5% for herpes zoster, and 11% for human papillomavirus (in women only).

Factors that predicted vaccine completion were annual vaccination review by a family physician (odds ratio 1.82) or gastroenterologist (OR 1.72), current steroid use (OR 1.28), and current or prior treatment with biologics (OR 1.42).

Overall, about 42% of patients considered themselves responsible for ensuring vaccine completion and 32% said the family physician is responsible. Uncertainty about indications and concerns about side effects and vaccine safety were the most common reasons patients gave for not being vaccinated.

"These findings suggest that we need to develop a feasible strategy to effectively educate our IBD patients on vaccinations - perhaps through pamphlets, interactive videos, webinars, nurse educators, etc. There also needs to be more effective and consistent communication between gastroenterologists and primary care physicians so that expectations are clear as to who is assuming the role of overseeing vaccinations," Dr. Nguyen told Reuters Health.

The researchers suggest that an audit of vaccination history upon IBD diagnosis or initiation of treatment might be a way to improve vaccine knowledge and uptake.

"Many of our IBD patients are on immunosuppressant medications. So it's very important that they are up to date with their vaccinations and know which ones may not be safe for them to take. This study helped us to gauge how well informed patients are about these vaccination issues so that it can help guide educational initiatives to promote better vaccination practices," Dr. Nguyen said.

Also, the administration of certain vaccines, such as the flu vaccine or Pneumovax for pneumonia, "is considered to be a quality indicator of care. It was important to see how we were doing with respect to this metric and where we can improve," he added.

"Specialists often advise referring physicians on IBD-specific medical therapies but may not always address specific recommendations on vaccinations that are appropriate for individuals who are already on immunosuppressants or may require them in the near future," he noted.

The authors reported no study funding or conflicts of interest.

SOURCE: http://bit.ly/1dX9qYm

J Crohns Colitis 2015.