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Shabir MS, Arif S, Yeoh D, Grover Z. Suboptimal Vaccination Coverage and Serological Screening in Western Australian Children With Inflammatory Bowel Disease Receiving Immunosuppressive Therapy: An Opportunity for Improvement. Cureus 2024; 16:e73744. [PMID: 39677205 PMCID: PMC11646410 DOI: 10.7759/cureus.73744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2024] [Indexed: 12/17/2024] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) face an increased likelihood of severe illnesses, including those caused by vaccine-preventable diseases. Consequently, the purpose of this study was to evaluate both vaccination rates and serological screening in children with IBD in Western Australia, focusing on compliance with routine and additional vaccines, and pre-treatment screening for infections before starting immunosuppressive (IS) treatment. Method The study was conducted at Perth Children's Hospital (PCH) from June 2021 to February 2022, focusing on children aged 0-18 with confirmed IBD diagnoses. Demographic and medical data were collected and matched with immunization records from the Australian Immunisation Register (AIR) to audit compliance with routine childhood vaccinations and additional vaccines (23-valent pneumococcal, human papillomavirus (HPV), and annual influenza). Data from medical records were analyzed for compliance with serologic testing (QuantiFERON TB, Hep B and C, Varicella, and Epstein-Barr virus (EBV)) before initiating IS therapy, which included immunomodulators, biologics, or small molecules. Results Of the 243 patients, 120 (52%) were diagnosed with Crohn's disease and 106 (43%) with ulcerative colitis. A total of 181 patients (74.5%) were treated with immunomodulators, while 62 (26%) received biologic therapies. Incomplete routine vaccination coverage was identified in 71 (29.2%) patients, with no notable differences observed between the IS and non-IS groups (p=0.3). Specific vaccines with incomplete coverage included HPV in 49 (24%) patients, Varicella in 39 (16%) patients, and diphtheria-tetanus-pertussis (DTP in 16 (6.5%) patients. Pre-treatment serological screening was also suboptimal, with the lowest testing rate for EBV at 32 (13.2) patients and the highest for Varicella at 181 (74.6%) patients. Conclusion The results emphasized the importance of targeted interventions to enhance vaccination and screening practices, enhancing disease management, and reducing the possibility of preventable infections in the vulnerable populace.
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Affiliation(s)
| | - Sibgha Arif
- Family Medicine, Sonic Health Plus, Perth, AUS
| | - Dan Yeoh
- Infectious disease, Perth Children Hospital, Perth, AUS
| | - Zubin Grover
- Gastroenterology, Perth Children Hospital, Perth, AUS
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2
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García-Serrano C, Artigues-Barberà E, Mirada G, Estany P, Sol J, Ortega Bravo M. Impact of an Intervention to Promote the Vaccination of Patients with Inflammatory Bowel Disease. Vaccines (Basel) 2023; 11:1649. [PMID: 38005981 PMCID: PMC10674651 DOI: 10.3390/vaccines11111649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) have a dysregulated immune system, being at high risk of opportunistic infections. Low vaccination rates hinder the prevention of such diseases. Therefore, we implemented an intervention to increase vaccination rates, and we aimed to evaluate the effect. We determined the change in professionals and the change in the vaccination rates after the intervention. A quasi-experimental study was carried out using data from 31 December 2016 to 31 December 2021. First, healthcare professionals specializing in IBD agreed on a vaccination protocol; then, this protocol was passed on to the professionals involved in vaccination. We evaluated the perception of knowledge, capacity, and intention to vaccinate patients with IBD among the professionals before and after the intervention with a survey. We also described the effectiveness of the intervention for already diagnosed patients and compared the vaccination rates between patients diagnosed prior to the intervention and newly diagnosed patients. The intervention resulted in an improved perception of knowledge, capacity, and intention to vaccinate patients with IBD among the professionals (p < 0.05). Moreover, during the post-intervention period, in the 315 patients, the vaccination rate increased for all immune-preventable diseases (p < 0.05). The professionals positively valued the intervention, and compliance with the recommended vaccination protocol in patients with IBD improved significantly.
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Affiliation(s)
- Cristina García-Serrano
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Multidisciplinary Research Group on Therapeutics and Interventions in Primary Care (RETICAP Group), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Eva Artigues-Barberà
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Multidisciplinary Research Group on Therapeutics and Interventions in Primary Care (RETICAP Group), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
- Facultat d’Infermeria i Fisioteràpia, Universitat de Lleida, 25198 Lleida, Spain;
| | - Gloria Mirada
- Facultat d’Infermeria i Fisioteràpia, Universitat de Lleida, 25198 Lleida, Spain;
- Agència de Salut Pública de Catalunya, 08005 Lleida, Spain
| | - Pepi Estany
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
| | - Joaquim Sol
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Unitat de Suport a la Recerca de Lleida, Fundació Institut Universitari d’Investigació per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran, 44, 25007 Lleida, Spain
- Instituto de Investigación Biomédica de Lleida Fundación Dr. Pifarré (IRB Lleida), 25198 Lleida, Spain
| | - Marta Ortega Bravo
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Multidisciplinary Research Group on Therapeutics and Interventions in Primary Care (RETICAP Group), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
- Facultat de Medicina, Universitat de Lleida, Pl. de Víctor Siurana, 1, 25003 Lleida, Spain
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3
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Long MD, van Deen WK, Weisbein L, Khalil C, Appel KL, Zhang X, Chen W, Zubrod L, Maris R, Ghafari A, Dupuy T, Ha CY, Spiegel BMR, Almario CV, Melmed GY. Web-Based Video Education to Improve Uptake of Influenza Vaccination and Other Preventive Health Recommendations in Adults With Inflammatory Bowel Disease: Randomized Controlled Trial of Project PREVENT. J Med Internet Res 2023; 25:e42921. [PMID: 37610821 PMCID: PMC10483303 DOI: 10.2196/42921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of infections, bone fractures, and skin cancers. OBJECTIVE We developed preventive health videos using a patient-centered approach and tested their impact on preventive health uptake. METHODS Five animated videos explaining preventive health recommendations in IBD were iteratively developed with patient-centered focus groups and interviews. A randomized controlled trial was then conducted in a web-based IBD cohort to test the impact of video- versus text-based educational interventions. The primary outcome was receipt of the influenza vaccine. Secondary outcomes included intention to receive other preventive health services. RESULTS Five animated videos were developed with patient input. A total of 1056 patients with IBD were then randomized to receive the video (n=511) or text-only (n=545) interventions; 55% (281/511) of the video group and 57% (311/545) of the text-only group had received their influenza vaccine in the prior year. Immediately after the intervention, 73% (502/683) of patients reported their intention to receive the vaccine, with no difference by the type of intervention (75%, 231/307, for the video group and 72%, 271/376, for the text-only group). The proportion of patients who actually received the influenza vaccine after the intervention also did not differ by messaging type (P=.07). The strongest predictor of both intention to receive and actual receipt of the influenza vaccine was prior influenza vaccination. Older age was also associated with a higher likelihood of the intention to receive (age 36-75 years relative to 18-35 years; P=.006) and actual receipt (age >75 years relative to 18-35 years; P=.05) of the influenza vaccine. CONCLUSIONS The proportion of patients receiving the influenza vaccine was high in both groups, but there was no difference in receipt of or in the intention to receive preventive health recommendations by type of messaging. Notably, a portion of patients in both groups had intended to be vaccinated but did not ultimately receive the vaccine. Further evaluation of patient-education strategies is warranted to improve preventive health uptake among patients with IBD. TRIAL REGISTRATION ClinicalTrials.gov NCT05997537; https://clinicaltrials.gov/ct2/show/NCT05997537.
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Affiliation(s)
- Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Welmoed K van Deen
- Erasmus School of Health Policy and Management, Health Technology Assessment Section, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Laura Weisbein
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Carine Khalil
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | - Keren L Appel
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Xian Zhang
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Wenli Chen
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Lori Zubrod
- IBD Partners Patient Powered Research Network, Washington, DC, United States
| | - Robbie Maris
- IBD Partners Patient Powered Research Network, Washington, DC, United States
| | - Afsoon Ghafari
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Taylor Dupuy
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | - Christina Y Ha
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Brennan M R Spiegel
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | | | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Makarova E, Khabirova A, Volkova N, Gabrusskaya T, Ulanova N, Sakhno L, Revnova M, Kostik M. Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data. World J Clin Pediatr 2023; 12:45-56. [PMID: 37034429 PMCID: PMC10075019 DOI: 10.5409/wjcp.v12.i2.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Patients with immune-mediated diseases, such as juvenile idiopathic arthritis (JIA) and inflammatory bowel disease (IBD) are at increased risk of developing infections, due to disease-related immune dysfunction and applying of immunosuppressive drugs.
AIM To evaluate vaccine coverage in patients with IBD and JIA, and compare it with healthy children.
METHODS In the cross-sectional study we included the data from a questionnaire survey of 190 Legal representatives of children with JIA (n = 81), IBD (n = 51), and healthy children (HC, n = 58). An electronic online questionnaire was created for the survey.
RESULTS There were female predominance in JIA patients and younger onset age. Parents of JIA had higher education levels. Employment level and family status were similar in the three studied groups. Patients with JIA and IBD had lower vaccine coverage, without parental rejection of vaccinations in IBD, compare to JIA and healthy controls. The main reason for incomplete vaccination was medical conditions in IBD and JIA. IBD patients had a lower rate of normal vaccine-associated reactions compared to JIA and HC. The encouraging role of physicians for vaccinations was the lowest in JIA patients. IBD patients had more possibilities to check antibodies before immune-suppressive therapy and had more supplementary vaccinations compared to JIA and HC.
CONCLUSION JIA and IBD patients had lower vaccine coverage compared to HC. Physicians' encouragement of vaccination and the impossibility of discus about future vaccinations and their outcomes seemed the main factors for patients with immune-mediated diseases, influencing vaccine coverage. Further investigations are required to understand the reasons for incomplete vaccinations and improve vaccine coverage in both groups, especially in rheumatic disease patients. The approaches that stimulate vaccination in healthy children are not always optimal in children with immune-mediated diseases. It is necessary to provide personalized vaccine-encouraging strategies for parents of chronically ill children with the following validation of these technics.
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Affiliation(s)
- Elizaveta Makarova
- Department of Polyclinic Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
| | - Aygul Khabirova
- Department of Hospital Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
| | - Natalia Volkova
- Department of Pediatric GI, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
| | - Tatiana Gabrusskaya
- Department of Pediatric GI, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
| | - Natalia Ulanova
- Department of Pediatric GI, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
| | - Larisa Sakhno
- Department of Polyclinic Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
| | - Maria Revnova
- Department of Polyclinic Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
| | - Mikhail Kostik
- Department of Hospital Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia
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Ishige T, Shimizu T, Watanabe K, Arai K, Kamei K, Kudo T, Kunisaki R, Tokuhara D, Naganuma M, Mizuochi T, Murashima A, Inoki Y, Iwata N, Iwama I, Koinuma S, Shimizu H, Jimbo K, Takaki Y, Takahashi S, Cho Y, Nambu R, Nishida D, Hagiwara SI, Hikita N, Fujikawa H, Hosoi K, Hosomi S, Mikami Y, Miyoshi J, Yagi R, Yokoyama Y, Hisamatsu T. Expert consensus on vaccination in patients with inflammatory bowel disease in Japan. J Gastroenterol 2023; 58:135-157. [PMID: 36629948 PMCID: PMC9838549 DOI: 10.1007/s00535-022-01953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Immunosuppressive therapies can affect the immune response to or safety of vaccination in patients with inflammatory bowel disease (IBD). The appropriateness of vaccination should be assessed prior to the initiation of IBD treatment because patients with IBD frequently undergo continuous treatment with immunosuppressive drugs. This consensus was developed to support the decision-making process regarding appropriate vaccination for pediatric and adult patients with IBD and physicians by providing critical information according to the published literature and expert consensus about vaccine-preventable diseases (VPDs) [excluding cervical cancer and coronavirus disease 2019 (COVID-19)] in Japan. This consensus includes 19 important clinical questions (CQs) on the following 4 topics: VPDs (6 CQs), live attenuated vaccines (2 CQs), inactivated vaccines (6 CQs), and vaccination for pregnancy, childbirth, and breastfeeding (5 CQs). These topics and CQs were selected under unified consensus by the members of a committee on intractable diseases with support by a Health and Labour Sciences Research Grant. Physicians should provide necessary information on VPDs to their patients with IBD and carefully manage these patients' IBD if various risk factors for the development or worsening of VPDs are present. This consensus will facilitate informed and shared decision-making in daily IBD clinical practice.
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Affiliation(s)
- Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Makoto Naganuma
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center of Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Sachi Koinuma
- Japan Drug Information Institute in Pregnancy, National Center of Child Health and Development, Tokyo, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yugo Takaki
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shohei Takahashi
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuki Cho
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Daisuke Nishida
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin-Ichiro Hagiwara
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Norikatsu Hikita
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Fujikawa
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Hosoi
- Division of Gastroenterology, Tokyo Metro Children's Medical Center, Tokyo, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryusuke Yagi
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoko Yokoyama
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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6
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Bousvaros A, Lu Y. Immunizations in the Child with Inflammatory Bowel Disease. PEDIATRIC INFLAMMATORY BOWEL DISEASE 2023:765-772. [DOI: 10.1007/978-3-031-14744-9_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Martin NG, Roberts AJ, Evans HM, Bishop J, Day AS. Adherence to the New Zealand Pediatric Guideline for the Assessment and Diagnosis of Inflammatory Bowel Disease. JPGN REPORTS 2022; 3:e266. [PMID: 37168484 PMCID: PMC10158400 DOI: 10.1097/pg9.0000000000000266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/08/2022] [Indexed: 05/13/2023]
Abstract
New Zealand (NZ) guidelines for the approach to diagnosis and management of inflammatory bowel disease (IBD) in children were developed in 2014. Objectives This study aimed to assess the application of the guidelines in a group of children diagnosed with IBD in regards to baseline investigations. Methods This retrospective observational study analyzed the application of recommended baseline investigations included in the NZ guidelines in a group of children aged <16 years diagnosed consecutively with IBD at the 2 NZ tertiary pediatric gastroenterology centers. Results Fifty children were included from each center. Seventy-two were diagnosed with Crohn's disease (CD), 15 with ulcerative colitis (UC), and 13 were with IBD unclassified. The children with CD had a mean Pediatric Crohn's Disease Activity Index score of 31 and almost half had ileocolonic involvement (47%). The 15 children with UC had a mean PUCAI score of 42, and 13 had pancolonic involvement. All 100 children underwent upper and lower gastrointestinal endoscopy with biopsies, and 92% had magnetic resonance enterography at diagnosis. Iron studies, folate, and vitamin B12 were measured in >70 children. Serum zinc, magnesium, and phosphate were infrequently measured. Current anthropometry was recorded in all children but historical growth data were variably recorded. Vaccination status was also inconsistently recorded. Conclusion Most of this group of children diagnosed with IBD in 2 NZ centers underwent key recommended investigations at diagnosis including gastrointestinal endoscopy and small bowel imaging. Other baseline assessments, including measurement of micronutrient levels, were completed variably. Measures to enhance consistent baseline assessments are required.
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Affiliation(s)
- Natalie G. Martin
- From the Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Amin J. Roberts
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Helen M. Evans
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Jonathan Bishop
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Andrew S. Day
- From the Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
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8
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Ford T, Danchin M, McMinn A, Perrett K, Alex G, Crawford NW. Immunisation status of children and adolescents with a new diagnosis of inflammatory bowel disease. BMC Infect Dis 2022; 22:6. [PMID: 34983407 PMCID: PMC8725393 DOI: 10.1186/s12879-021-06976-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/08/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines. METHODS Paediatric patients (0-18 years) seen at the tertiary Royal Children's Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available. RESULTS Sixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC. CONCLUSIONS Children with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.
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Affiliation(s)
- Timothy Ford
- Perth Children's Hospital, Nedlands, WA, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute (MCRI), Parkville, Melbourne, Australia.,Immunisation services & General Medicine, RCH, Melbourne, Australia.,Department Paediatrics, University of Melbourne, Parkville, Australia
| | - Alissa McMinn
- Murdoch Children's Research Institute (MCRI), Parkville, Melbourne, Australia
| | - Kirsten Perrett
- Murdoch Children's Research Institute (MCRI), Parkville, Melbourne, Australia.,Immunisation services & General Medicine, RCH, Melbourne, Australia.,Department Paediatrics, University of Melbourne, Parkville, Australia
| | - George Alex
- Murdoch Children's Research Institute (MCRI), Parkville, Melbourne, Australia.,Department Paediatrics, University of Melbourne, Parkville, Australia.,Gastroenterology Department, RCH, Melbourne, Australia
| | - Nigel W Crawford
- Murdoch Children's Research Institute (MCRI), Parkville, Melbourne, Australia. .,Immunisation services & General Medicine, RCH, Melbourne, Australia. .,Department Paediatrics, University of Melbourne, Parkville, Australia.
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9
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deJong NA, Wofford M, Song PH, Kappelman MD. Association of Care Coordination Experience and Health Services Use with Main Provider Type for Children with Inflammatory Bowel Disease. J Pediatr 2021; 234:142-148.e1. [PMID: 33798510 PMCID: PMC8238824 DOI: 10.1016/j.jpeds.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/29/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe care coordination experience for families of children with inflammatory bowel disease (IBD) and compare use of health services between families who identified a primary care physician (PCP) vs a gastroenterologist as a child's main provider. STUDY DESIGN This is a cross-sectional survey of care coordination experiences and health services use for children 6-19 years old receiving care in the IBD program at a children's hospital during 2018. English-speaking parents completed the Family Experiences with Coordination of Care Survey about their child's main provider and reported past-year health services. Bivariate testing and multivariate logistic regression explored differences in care coordination experience and health services by main provider, adjusted for demographic and clinical variables. RESULTS A total of 113 of 270 (42%) invited patients participated. Among 101 patients with complete data, 41% identified a PCP main provider. Performance on 5 of 16 Family Experiences with Coordination of Care indicators was higher for patients reporting a gastroenterologist vs a PCP main provider. However, having a PCP vs gastroenterologist main provider was associated with greater use of any past-year primary care services (adjusted proportion 94% vs 75%; P = .01) and of mental health services when needed (95% vs 60%; P < .01). Need for IBD-related hospitalization and emergency department visits did not differ between groups. CONCLUSIONS Children with IBD may experience trade-offs in care coordination quality and important, non-disease-focused health services based on whom parents perceive as the main provider. Efforts to enhance cross-team coordination among families and primary and specialty care teams are needed to improve overall care quality.
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Affiliation(s)
- Neal A. deJong
- Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine
| | - Marie Wofford
- Department of Emergency Medicine, Carolinas Medical Center
| | - Paula H. Song
- Department of Health Administration, VCU College of Health Professions
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10
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Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, Albuquerque A, Allocca M, Esteve M, Farraye FA, Gordon H, Karmiris K, Kopylov U, Kirchgesner J, MacMahon E, Magro F, Maaser C, de Ridder L, Taxonera C, Toruner M, Tremblay L, Scharl M, Viget N, Zabana Y, Vavricka S. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:879-913. [PMID: 33730753 DOI: 10.1093/ecco-jcc/jjab052] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- T Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - P Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - T Greuter
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland, and Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois CHUV, University Hospital Lausanne, Lausanne, Switzerland
| | - J F Rahier
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Yvoir, Belgium
| | - B Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and Department of Chronic Diseases, Metabolism and Ageing, TARGID-IBD, KU Leuven, Leuven, Belgium
| | - C Abreu
- Infectious Diseases Service, Centro Hospitalar Universitário São João, Porto, Portugal
- Instituto de Inovação e Investigação em Saúde [I3s], Faculty of Medicine, Department of Medicine, University of Porto, Portugal
| | - A Albuquerque
- Gastroenterology Department, St James University Hospital, Leeds, UK
| | - M Allocca
- Humanitas Clinical and Research Center - IRCCS -, Rozzano [Mi], Italy
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - M Esteve
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - F A Farraye
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - H Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - U Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Kirchgesner
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal
| | - C Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - L de Ridder
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Taxonera
- IBD Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - M Toruner
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - L Tremblay
- Centre Hospitalier de l'Université de Montréal [CHUM] Pharmacy Department and Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - M Scharl
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
| | - N Viget
- Department of Infectious Diseases, Tourcoing Hospital, Tourcoing, France
| | - Y Zabana
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - S Vavricka
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
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11
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Vaccines in Children with Inflammatory Bowel Disease: Brief Review. Vaccines (Basel) 2021; 9:vaccines9050487. [PMID: 34064576 PMCID: PMC8151471 DOI: 10.3390/vaccines9050487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022] Open
Abstract
Incidence of inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), is increasing worldwide. Children with IBDs have a dysfunctional immune system and they are frequently treated with immunomodulating drugs and biological therapy, which significantly impair immune system functions and lead to an increased risk of infections. Vaccines are essential to prevent at least part of these infections and this explains why strict compliance to the immunization guidelines specifically prepared for IBD patients is strongly recommended. However, several factors might lead to insufficient immunization. In this paper, present knowledge on the use of vaccines in children with IBDs is discussed. Literature review showed that despite a lack of detailed quantification of the risk of infections in children with IBDs, these children might have infections more frequently than age-matched healthy subjects, and at least in some cases, these infections might be even more severe. Fortunately, most of these infections could be prevented when recommended schedules of immunization are carefully followed. Vaccines given to children with IBDs generally have adequate immunogenicity and safety. Attention must be paid to live attenuated vaccines that can be administered only to children without or with mild immune system function impairment. Vaccination of their caregivers is also recommended. Unfortunately, compliance to these recommendations is generally low and multidisciplinary educational programs to improve vaccination coverage must be planned, in order to protect children with IBD from vaccine-preventable diseases.
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12
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Kabir A, Newall AT, Randall D, Menzies R, Sheridan S, Jayasinghe S, Fathima P, Liu B, Moore H, McIntyre P, Gidding HF. Estimating pneumococcal vaccine coverage among Australian Indigenous children and children with medically at-risk conditions using record linkage. Vaccine 2021; 39:1727-1735. [PMID: 33622589 DOI: 10.1016/j.vaccine.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Risk-based recommendations are common for pneumococcal vaccines but little is known about their uptake. In Australia, pneumococcal conjugate vaccine (PCV) was funded only for Aboriginal or Torres Strait Islander (Indigenous) children and those with underlying medical conditions in 2001, and then there were different booster dose recommendations depending on risk after the introduction of universal PCV vaccination in 2005. METHODS We measured coverage of PCV dose 3 and additional PCV and 23-valent pneumococcal polysaccharide vaccine (PPV23) doses by risk group among children born in July 2001-December 2012 in two Australian states using linked immunisation and hospitalisation data (available until December 2013). We ascertained medical risk conditions using hospitalisation diagnosis codes and Indigenous status using an established algorithm, comparing coverage for children born pre (2001-2004) and post (2005-2012) universal PCV funding. RESULTS Among 1.3 million children, 63,897 (4.9%) were Indigenous and 32,934 (2.5%) had at least one medically at-risk condition identified by age 6 months. For births in 2001-2004, coverage for PCV dose 3 by 1 year of age was 37% for Indigenous, 15% for medically at-risk and 11% in other children, increasing to 83%, 91% and 92%, respectively for births in 2005-2012. In children with medically at-risk conditions, PCV dose 4 coverage by 2 years was 1% for 2001-2004 births, increasing to 9% for 2005-2012 births, with PPV23 coverage by 6 years 3% in both cohorts. Among eligible Indigenous children, PPV23 coverage by 3 years was 45% for 2001-2004 births and 51% for 2005-2012 births. CONCLUSIONS Coverage with additional recommended booster doses was very low among children with medical conditions, and only modest among Indigenous children. If additional PCV doses are recommended for some risk groups, especially in the context of routine schedules with reduced doses (e.g. 2 + 1 and 1 + 1), measures to improve implementation will be required.
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Affiliation(s)
- Alamgir Kabir
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia.
| | - Anthony T Newall
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia
| | - Rob Menzies
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Sheridan
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia
| | - Bette Liu
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
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13
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Martinelli M, Giugliano FP, Strisciuglio C, Urbonas V, Serban DE, Banaszkiewicz A, Assa A, Hojsak I, Lerchova T, Navas-López VM, Romano C, Sladek M, Veres G, Aloi M, Kucinskiene R, Miele E. Vaccinations and Immunization Status in Pediatric Inflammatory Bowel Disease: A Multicenter Study From the Pediatric IBD Porto Group of the ESPGHAN. Inflamm Bowel Dis 2020; 26:1407-1414. [PMID: 31689349 DOI: 10.1093/ibd/izz264] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vaccine-preventable diseases and opportunistic infections in pediatric inflammatory bowel disease (IBD) are increasingly recognized issues. The aims of this study were to evaluate vaccinations, immunization status, and consequent therapeutic management in children with IBD and to analyze the differences among patients diagnosed before (Group 1) and after June 2012 (Group 2). METHODS This was a multicenter, retrospective cohort investigation. Between July 2016 and July 2017, 430 children with IBD were enrolled in 13 centers. Diagnosis, therapeutic history, vaccinations, and immunization status screening at diagnosis and at immunosuppressant (IM)/biologic initiation and reasons for incomplete immunization were retrieved. RESULTS Vaccination rates at diagnosis were unsatisfactory for measles, mumps, and rubella (89.3%), Haemophilus influenzae (81.9%), meningococcus C (23.5%), chickenpox (18.4%), pneumococcus (18.6%), papillomavirus (5.9%), and rotavirus (1.9%). Complete immunization was recorded in 38/430 (8.8%) children, but specific vaccines were recommended in 79/430 patients (18.6%), without differences between the 2 groups. At IM start, 22% of children were tested for Epstein-Barr virus (EBV) status, with 96.2% of EBV-naïve patients starting azathioprine, without differences between Groups 1 and 2. Screening for latent tuberculosis (TB) before start of biologics was performed in 175/190 (92.1%), with up to 9 different screening strategies and numerous inconsistencies. CONCLUSIONS We demonstrated a poor immunization status at diagnosis in children with IBD, which was not followed by proper vaccination catch-up. EBV status before IM initiation and latent TB before biologics were not adequately assessed. Thus, the overall impact of the current guidelines seems unsatisfactory.
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Affiliation(s)
- Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II," Napoli, Italy; Napoli, Italy
| | - Francesca Paola Giugliano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II," Napoli, Italy; Napoli, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Napoli, Italy
| | - Vaidotas Urbonas
- Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania
| | - Daniela Elena Serban
- 2nd Department of Pediatrics, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Amit Assa
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach-Tikva, affiliated with the Sackler faculty of Medicine, Tel-Aviv University, Israel
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, University J.J. Strossmayer, Osijek, Croatia
| | - Tereza Lerchova
- Pediatric Department of 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | | | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Małgorzata Sladek
- Department of Pediatrics, Gastroenterology and Nutrition Jagiellonian University Medical College, Kracow, Poland
| | - Gabor Veres
- Pediatric Institute, AOK, University of Debrecen, Debrecen, Hungary
| | - Marina Aloi
- Department of Pediatrics, Sapienza University, Rome, Italy
| | - Ruta Kucinskiene
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II," Napoli, Italy; Napoli, Italy
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14
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Holland KJ, Wilkinson TA, Phipps E, Slaven JE, Bennett WE. Vaccination Rates and Family Barriers Among Children with Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2020; 2:otaa056. [PMID: 33817638 PMCID: PMC8015385 DOI: 10.1093/crocol/otaa056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Many children with inflammatory bowel disease (IBD) are taking immunosuppressant medications that place them at risk for vaccine preventable diseases. Despite national guidelines, children with IBD have low vaccination rates. Adult data suggest that there is concern about the safety of vaccines. There are no current studies addressing perceived safety about vaccinations among families of children with IBD. METHODS A total of 108 caregivers of children (ages 10-25 years) were surveyed during their outpatient visit, with approximately half having a diagnosis of IBD. The survey consisted of validated questions regarding vaccine safety and opinions. After enrollment, state-wide vaccine registry data was collected. Demographics between the two groups were compared using Ch-square and the Wilcoxon rank-sum tests to analyze Likert scale questions. RESULTS The majority of children followed for IBD were Caucasian males, had Crohn's disease (68%) and were immunosuppressed. Results from the survey revealed a concern about vaccine safety (40% vs. 16%, p=0.03) and overall effectiveness (34% vs. 12%, p<0.01) in the IBD group compared to the non-IBD. Furthermore, more IBD families were worried that vaccines would worsen their child's symptoms (36% vs. 10%, p=<0.01). The majority of children were missing the flu and/or HPV vaccine. Finally, 96% of the children on a biologic for their IBD were missing the PPSV23 booster. CONCLUSIONS Caregivers of children with IBD are more concerned about vaccine safety and effectiveness than those with non-IBD diagnosis. Despite being on immunosuppressant medications, many patients were missing recommended vaccines.
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Affiliation(s)
- Kathleen J Holland
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tracey A Wilkinson
- Department of Pediatrics, Indiana University School of Medicine, Children’s Health Services Research, Indianapolis, Indiana, USA
| | - Erin Phipps
- Department of Pediatrics, Indiana University School of Medicine, Developmental Pediatrics and Pediatric Gastroenterology, Hepatology and Nutrition, Indianapolis, Indiana, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William E Bennett
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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García-Serrano C, Mirada G, Marsal JR, Ortega M, Sol J, Solano R, Artigues EM, Estany P. Compliance with the guidelines on recommended immunization schedule in patients with inflammatory bowel disease: implications on public health policies. BMC Public Health 2020; 20:713. [PMID: 32429900 PMCID: PMC7236120 DOI: 10.1186/s12889-020-08850-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) have a higher risk of developing opportunistic infections due to either the disease itself or to treatment with immunosuppressants. This risk can be reduced through vaccination. The aim of this study was to determine the prevalence of compliance with the guidelines on recommended immunization schedule in patients with IBD in the health district of Lleida, Spain. METHODS Descriptive, cross-sectional, retrospective study of data at December 31, 2016. The reference population was formed by adults with a clinical diagnosis of IBD. The dependent variable was "compliance with the guidelines on recommended immunization schedule". Variables were sex, age, residence, diagnosis, vaccination against measles, mumps, rubella, varicella, tetanus-diphtheria, influenza, pneumococcus, meningococcus C, hepatitis B, and hepatitis A. Data were obtained from electronic medical records. For the data analysis, mean (standard deviation), prevalence with 95% confidence intervals, χ2 test and Mann-Whitney test were used. RESULTS Compliance did not exceed 65% for any of vaccines analysed in the 1722 studied patients with ulcerative colitis or Crohn's disease. Significant differences across age groups were found in compliance for measles, mumps, rubella, varicella, tetanus, diphtheria and influenza in both ulcerative colitis and Crohn's disease and for meningococcus C and hepatitis A exclusively in ulcerative colitis. CONCLUSIONS Compliance in patients with IBD is low. Thus, prevention of immunopreventable diseases or their complications is not maximized in this kind of patients. Greater awareness of how vaccines can reduce the risk of vaccine-preventable infections is needed among both patients and healthcare professionals.
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Affiliation(s)
- Cristina García-Serrano
- Catalan Health Institute (ICS), Primary Care, Lleida, Spain.,Lleida Institute for Biomedical Research (IRBLleida), Lleida, Spain
| | - Glòria Mirada
- Faculty of Nursery and Physiotherapy, University of Lleida, Lleida, Spain.,Catalan Agency of Public Health, Lleida, Spain
| | - Josep R Marsal
- Cardiovascular Epidemiology Unit, Cardiology Department, Vall d'Hebron University Hospital, CIBERESP, Lleida, Spain
| | - Marta Ortega
- Catalan Health Institute (ICS), Primary Care, Lleida, Spain.,Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain.,Faculty of Medicine, University of Lleida, Lleida, Spain.,Research Group in Therapies in Primary Care (GRETAPS), Lleida, Spain
| | - Joaquim Sol
- Catalan Health Institute (ICS), Primary Care, Lleida, Spain. .,Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain. .,Metabolic Physiopathology Group, Department of Experimental Medicine, University of Lleida-IRBLleida, Lleida, Spain.
| | - Rubén Solano
- Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
| | - Eva M Artigues
- Catalan Health Institute (ICS), Primary Care, Lleida, Spain.,Faculty of Nursery and Physiotherapy, University of Lleida, Lleida, Spain.,Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain.,Research Group in Therapies in Primary Care (GRETAPS), Lleida, Spain.,Research Group in Health Education (GREpS), Department of Nursery and Physiotherapy, University of Lleida, Lleida, Spain
| | - Pepi Estany
- Catalan Health Institute (ICS), Primary Care, Lleida, Spain
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16
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Cagol L, Seitel T, Ehrenberg S, Frivolt K, Krahl A, Lainka E, Gerner P, Lenhartz H, Vermehren J, Radke M, Trenkel S, Mayer B, Koletzko S, Debatin KM, Mertens T, Posovszky C. Vaccination rate and immunity of children and adolescents with inflammatory bowel disease or autoimmune hepatitis in Germany. Vaccine 2020; 38:1810-1817. [DOI: 10.1016/j.vaccine.2019.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023]
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17
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Carlson SJ, Scanlan C, Marshall HS, Blyth CC, Macartney K, Leask J. Attitudes about and access to influenza vaccination experienced by parents of children hospitalised for influenza in Australia. Vaccine 2019; 37:5994-6001. [PMID: 31471153 DOI: 10.1016/j.vaccine.2019.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/23/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In Australia, influenza hospitalises more children than any other vaccine preventable disease does. Children aged six months or older are recommended to receive annual influenza vaccines, and pregnant women are recommended vaccination to protect infants aged up to six months. However, vaccine uptake is low. This study explored influenza vaccination knowledge and behaviours of parents of children who were hospitalised for influenza, in order to inform strategies that target barriers to uptake. METHODS We conducted 27 semi-structured interviews with parents/caregivers during or shortly after their child's hospitalisation for laboratory-confirmed influenza in 2017. Questions were guided by the Social Ecological Model exploring all levels of influence on vaccination uptake from the intrapersonal through to policy, via the parents' perspective. Transcripts were inductively analysed. Themes were categorised into the components of the Capability-Opportunity-Motivation-Behaviour (COM-B) model. RESULTS 20/27 children were aged six months or older; 16/20 had not received an influenza vaccine in 2017. Mothers of 4/7 infants aged less than six months were not vaccinated in pregnancy. The themes regarding barriers to influenza vaccination were: (1) Limited Capability - misinterpretations and knowledge gaps, (2) Lack of Opportunity - inconvenient vaccination pathway, missing recommendations, absence of promotion to all, and the social norm, and (3) Missing Motivation - hierarchy of perceived seriousness, safety concerns, a preference for 'natural' ways. Though most parents, now aware of the severity of influenza, intended to vaccinate their child in future seasons, some harboured reservations about necessity and safety. When parents were asked how to help them vaccinate their children, SMS reminders and information campaigns delivered through social media, schools and childcare were suggested. CONCLUSION Improving parents' and providers' knowledge and confidence in influenza vaccination safety, efficacy, and benefits should be prioritised. This, together with making influenza vaccination more convenient for parents, would likely raise vaccine coverage.
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Affiliation(s)
- Samantha J Carlson
- The University of Sydney, School of Public Health, Sydney, New South Wales 2006, Australia.
| | - Camilla Scanlan
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales 2145, Australia; The University of Sydney, Sydney Health Ethics, Sydney, NSW 2006, Australia.
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, University of Adelaide and Women's and Children's Health Network, Adelaide, South Australia 5006, Australia.
| | - Christopher C Blyth
- Discipline of Paediatrics, School of Medicine and Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, GPO Box D184, Perth, Western Australia 6840, Australia; Perth Children's Hospital, Hospital Avenue, Nedlands, Western Australia 6009, Australia.
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales 2145, Australia; The University of Sydney, Discipline of Child and Adolescent Health, Sydney, New South Wales 2006, Australia.
| | - Julie Leask
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, 88 Mallett St, Camperdown, New South Wales 2006, Australia.
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Kowalska-Duplaga K, Baranowska-Nowak M, Nescioruk M, Banasiuk M, Karolewska-Bochenek K, Łazowska-Przeorek I, Radzikowski A, Banaszkiewicz A. Immunization Coverage in Children with Inflammatory Bowel Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1113:83-88. [PMID: 29429027 DOI: 10.1007/5584_2018_163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Patients suffering from inflammatory bowel diseases (IBD) are at increased risk of infections, mainly due to immunosuppressive treatment. Moreover, infections may cause flares of IBD. Vaccination is the most effective way of preventing many infections. The aim of this study was to evaluate the vaccination status of Polish children with IBD. Individual immunization cards of children with IBD and healthy controls were reviewed. Demographic data such as age, sex, and IBD history, including therapy type, were collected. We enrolled 267 children into the study, including 214 children with IBD and 53 controls. None of the children had completed the full up-to-date routine childhood immunization schedule recommended in Poland. Controls were more than 4 times more likely to be vaccinated than the IBD patients, with the vaccines that enjoy the insurance reimbursed (OR 4.1, 95% CI 2.2-7.9). In conclusion, the study demonstrates a poor vaccination status in children suffering from IBD.
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Affiliation(s)
- K Kowalska-Duplaga
- Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Cracow, Poland
| | - M Baranowska-Nowak
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland
| | - M Nescioruk
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland
| | - M Banasiuk
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland
| | - K Karolewska-Bochenek
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland
| | - I Łazowska-Przeorek
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland
| | - A Radzikowski
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland
| | - A Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland.
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19
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deBruyn JCC, Soon IS, Fonseca K, Feng S, Purtzki M, Goedhart C, Kuhn S, Vanderkooi OG, Wrobel I. Serologic Status of Routine Childhood Vaccines, Cytomegalovirus, and Epstein-Barr Virus in Children With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1218-1226. [PMID: 30551205 DOI: 10.1093/ibd/izy366] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on the serologic status of childhood vaccines, cytomegalovirus (CMV) and Epstein-Barr virus (EBV), are limited in inflammatory bowel disease (IBD). Therefore, we evaluated vaccine coverage and seroprotection, along with CMV and EBV seropositivity, in pediatric IBD. METHODS In a cross-sectional study, demographic data, IBD history, vaccine records, and serum for antibodies against measles, mumps, rubella, diphtheria, tetanus, varicella, hepatitis B (HBV), CMV, and EBV were collected from children with IBD. We evaluated potential factors associated with serologic status. RESULTS Of 156 subjects, vaccine coverage was up to date for age in 93.5% for measles, mumps, rubella, 95.6% for diphtheria, tetanus, pertussis, polio, hemophilus influenza B, 75.8% for HBV, and 93.5% for varicella, including past infection and vaccination. Seroprotection was present in 65.8% for measles, 60.5% for mumps, 79.1% for rubella, 79.5% for diphtheria, 80.8% for tetanus, 70.5% for varicella, and 62.8% for HBV of subjects. Older age at diagnosis was associated with seroprotection among subjects with complete HBV (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.03-1.39) and rubella series (OR, 1.18; 95% CI, 1.02-1.37). Older age at serum collection was associated with seroprotection among subjects with prior varicella vaccination or infection (OR, 1.69; 95% CI, 1.33-2.15). Only 25.2% and 37.8% demonstrated seropositivity to CMV and EBV, respectively. Among subjects on immunosuppressive medications, 75.3% and 62.4% were seronegative for CMV and EBV, respectively. CONCLUSIONS Children with IBD have low serologic protection to childhood vaccines in spite of high vaccine coverage and universal vaccinations. Children with IBD, including a large proportion on immunosuppressive medications, have low seropositivity to CMV and EBV.
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Affiliation(s)
- Jennifer C C deBruyn
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ing Shian Soon
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Fonseca
- Virology, Provincial Laboratory for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Feng
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Purtzki
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Caitlin Goedhart
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Susan Kuhn
- Section of Infectious Diseases, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Iwona Wrobel
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
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20
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Abstract
Many of the therapeutic options for patients with inflammatory bowel disease (IBD) suppress the immune system, which increases the risk of certain infections in these patients. Effective vaccines exist and offer protection against a number of infectious diseases. However, data has shown that IBD patients are inadequately vaccinated and, as a result, are at risk of developing certain preventable infections. Furthermore, gastroenterologists' knowledge regarding the appropriate immunizations to administer to their IBD patients is suboptimal. Areas covered: Over the past several years, there has been a considerable amount of research contributing to our knowledge regarding vaccination of patients with IBD. Expert opinion: This updated review article focuses on the current immunization schedule for the IBD patient and stresses the important role of the gastroenterologist as an active participant in the health maintenance of their IBD patients.
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Affiliation(s)
- Samantha Zullow
- a Department of Medicine, Division of Gastroenterology and Hepatology , New York University School of Medicine , New York , NY , USA
| | - Francis A Farraye
- b Department of Medicine, Section of Gastroenterology , Boston University School of Medicine , Boston , MA , USA
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21
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ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease. Am J Gastroenterol 2017; 112:241-258. [PMID: 28071656 DOI: 10.1038/ajg.2016.537] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 10/01/2016] [Indexed: 02/06/2023]
Abstract
Recent data suggest that inflammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identification, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identification of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary.
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22
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Marín AC, Gisbert JP, Chaparro M. Immunogenicity and mechanisms impairing the response to vaccines in inflammatory bowel disease. World J Gastroenterol 2015; 21:11273-11281. [PMID: 26527572 PMCID: PMC4616204 DOI: 10.3748/wjg.v21.i40.11273] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is an immunological disorder that is usually treated with immunosuppressive therapy, potentially leading to increases in vulnerability to infections. Although many infections can be prevented by vaccination, vaccination coverage in these patients in clinical practice is insufficient. Therefore, the seroprotection condition should be verified, even for routine vaccines, such as hepatitis B or pneumococcus. Response to vaccines in IBD patients is thought to be impaired due to the immunological alterations generated by the disease and to the immunomodulatory treatments. The immunogenicity of hepatitis B, influenza, and pneumococcal vaccines is impaired in IBD patients, whereas the response to papillomavirus vaccine seems similar to that observed in the healthy population. On the other hand, data on the immunogenicity of tetanus vaccine in IBD patients are conflicting. Studies assessing the response to measles-mumps-rubella, varicella, and herpes zoster vaccines in IBD patients are scarce. The cellular and molecular mechanisms responsible for the impairment of the response to vaccination in IBD patients are poorly understood. Studies aiming to assess the response to vaccines in IBD patients and to identify the mechanisms involved in their immunogenicity are warranted. A better understanding of the immune response, specifically to vaccines, in patients with immune-mediated diseases (such as IBD), is crucial when developing vaccines that trigger more potent immunologic responses.
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23
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Banaszkiewicz A, Radzikowski A, Albrecht P. Immunisation in children and adolescents with inflammatory bowel disease. Adv Med Sci 2015; 60:144-7. [PMID: 25689276 DOI: 10.1016/j.advms.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 11/27/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
Inflammatory bowel disease (IBD) patients may be at a higher risk for developing infections due to underlying disease, malnutrition, surgery, or immunosuppressive therapy. Therefore, protecting this group against infections is of particular importance. Immunisation against vaccine-preventable diseases is strongly recommended. This article for the first time summarises data on immunogenicity and safety of vaccines in IBD children and provides an update on some important issues regarding immunisation in these group of children.
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24
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Abstract
Current therapeutic options for patients with inflammatory bowel disease (IBD) include several agents that can alter their immune response to infections. Effective vaccines exist and offer protection against a number of infectious diseases. However, recent data has shown that IBD patients are inadequately vaccinated and, as a result, at risk to develop certain preventable infections. Furthermore, gastroenterologists' knowledge regarding the appropriate immunizations to administer to their IBD patients is suboptimal. This review article focuses on the current immunization schedule for the IBD patient and stresses the important role of the gastroenterologist as an active participant in the management of vaccination in their IBD patients.
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Affiliation(s)
- Athanasios P Desalermos
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02118, USA
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25
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Lu Y, Bousvaros A. Immunizations in children with inflammatory bowel disease treated with immunosuppressive therapy. Gastroenterol Hepatol (N Y) 2014; 10:355-63. [PMID: 25013388 PMCID: PMC4080872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The vast majority of patients with inflammatory bowel disease (IBD) will receive immunosuppressive therapy at some point for their disease, whether for the short term (such as a course of corticosteroids) or long term (such as maintenance therapy with immunomodulators or biologics). The systemic immunosuppression places patients at increased risk for infections. Therefore, it is important that patients are up-to-date with immunizations to minimize vaccine-preventable infections. However, the literature shows that the rate of immunization in patients with IBD is low. Ideally, the vaccination status is checked at diagnosis, and patients are immunized with the vaccines they need. Drawing titers is helpful in cases in which vaccination history is unclear or to confirm that titers are at an adequate level in cases in which patients have been vaccinated. Current guidelines recommend that patients with IBD follow the same routine immunization schedule as healthy children, but patients should not be administered live vaccines if they are receiving immunosuppressive therapy. Therefore, it is ideal to administer any necessary vaccinations as early as possible, prior to starting immunosuppressive therapy. Patients may receive inactivated vaccines regardless of immunosuppressive status. The IBD literature suggests that inactivated vaccines are safe and do not worsen disease activity. In general, patients with IBD mount an immune response to vaccines, but the response may be lower if patients are receiving immunosuppressive therapy, especially tumor necrosis factor inhibitors.
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Affiliation(s)
- Ying Lu
- Dr Lu is an assistant professor in the Division of Pediatric Gastroenterology at Cohen Children's Medical Center of New York at Hofstra North Shore-Long Island Jewish School of Medicine in Lake Success, New York. Dr Bousvaros is a pediatric gastroenterologist in the Division of Pediatric Gastroenterology, Hepatology, and Nutrition and the associate director of the Inflammatory Bowel Disease Center at Boston Children's Hospital in Boston, Massachusetts. He is also an associate professor of medicine at Harvard University in Boston, Massachusetts
| | - Athos Bousvaros
- Dr Lu is an assistant professor in the Division of Pediatric Gastroenterology at Cohen Children's Medical Center of New York at Hofstra North Shore-Long Island Jewish School of Medicine in Lake Success, New York. Dr Bousvaros is a pediatric gastroenterologist in the Division of Pediatric Gastroenterology, Hepatology, and Nutrition and the associate director of the Inflammatory Bowel Disease Center at Boston Children's Hospital in Boston, Massachusetts. He is also an associate professor of medicine at Harvard University in Boston, Massachusetts
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26
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Immunization status in children with inflammatory bowel disease. Eur J Pediatr 2014; 173:603-8. [PMID: 24305728 DOI: 10.1007/s00431-013-2207-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/24/2013] [Indexed: 02/01/2023]
Abstract
Inflammatory bowel diseases have an increased risk of infections due to immunosuppressive therapies. To report the immunization status according to previous recommendations and the reasons explaining a delay, a questionnaire was filled in by the pediatric gastroenterologist, concerning outpatients, in six tertiary centers and five local hospitals, in a study, from May to November 2011. One hundred and sixty-five questionnaires were collected, of which 106 Crohn's diseases, 41 ulcerative colitis, and 17 indeterminate colitis. Sex ratio was 87:78 M/F. Median age was 14.4 years old (4.2-20.0). One hundred and nine patients (66 %) were receiving or had received an immunosuppressive therapy (azathioprine, infliximab, methotrexate, or prednisone). Vaccines were up to date according to the vaccine schedule of French recommendations in 24 % of cases and according to the recommendations for inflammatory bowel disease in 4 % of cases. Coverage by vaccine was the following: diphtheria-tetanus-poliomyelitis 87 %, hepatitis B 38 %, pneumococcus 32 %, and influenza 22 %. Immunization delay causes were as follows: absence of proposal 58 %, patient refusal 41 %, fear of side effects 33 %, and fear of disease activation 5 %. Therefore, immunization coverage is insufficient in children with inflammatory bowel disease, due to simple omission or to refusal. A collaboration with the attending physicians and a targeted information are necessary.
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27
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Crawford NW, Barfield C, Hunt RW, Pitcher H, Buttery JP. Improving preterm infants' immunisation status: a follow-up audit. J Paediatr Child Health 2014; 50:314-8. [PMID: 24372963 DOI: 10.1111/jpc.12481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 11/29/2022]
Abstract
AIM Preterm infants are at increased risk of vaccine preventable diseases. An audit in 2007 identified suboptimal immunisation status of preterm infants. The aim of this study was to complete the 'audit loop', reviewing preterm infants' immunisation status at a single tertiary paediatric hospital. METHODS A retrospective follow-up immunisation audit was conducted at The Royal Children's Hospital, Melbourne, neonatal unit. The 'audit loop' included a preterm infants' reminder sticker and feedback of the original audit findings to Royal Children's Hospital health-care professionals. Immunisation status was determined using the Australian Childhood Immunisation Register record for all admitted preterm infants born <32 weeks gestation (July 2008-June 2009). RESULTS Conducted in March 2011, the median age of participants (n = 57) was 2.5 years (range 1.7-3.1 years). Forty-four per cent (25/57) had a history of chronic lung disease, 86% (49/57) were <1500 g and 42% (24/57) <28 weeks gestation. The majority (96% (55/57)) were up to date with routine immunisations at 12 months of age. There was a 2.4-fold increase, compared with the original audit, for receipt of the additional recommended hepatitis B vaccine at 12 months of age, as well as influenza vaccine in infants with chronic lung disease. CONCLUSION This study showed that a simple reminder combined with education strategies can improve vaccine delivery in special risk groups such as preterm infants.
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Affiliation(s)
- Nigel W Crawford
- SAEFVIC, Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia; Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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28
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Banaszkiewicz A, Klincewicz B, Łazowska-Przeorek I, Grzybowska-Chlebowczyk U, Kąkol P, Mytyk A, Kofla A, Radzikowski A. Influenza vaccination coverage in children with inflammatory bowel disease. Influenza Other Respir Viruses 2014; 8:431-5. [PMID: 24490714 PMCID: PMC4181802 DOI: 10.1111/irv.12236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2013] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to evaluate the influenza vaccination status among paediatric patients with inflammatory bowel disease (IBD) in Poland. This was a questionnaire-based study. 242 patients with IBD and 142 controls were enrolled in the study. Of patients with IBD, 7·8% received an influenza vaccine, compared to 18·3% of controls (P = 0·0013). There were no statistically significant differences in time from IBD diagnosis, disease activity and in drugs, between vaccinated and non-vaccinated IBD children. In conclusion, the data of our study demonstrate an alarmingly poor influenza vaccination status in the majority of children with IBD. Therefore, there is an unmet need to implement better influenza vaccination strategies for this group of patients.
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Affiliation(s)
- Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
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29
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Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement. Inflamm Bowel Dis 2014; 20:246-50. [PMID: 24374881 PMCID: PMC4393851 DOI: 10.1097/01.mib.0000437737.68841.87] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Immunosuppressive agents used to treat inflammatory bowel disease (IBD) can increase the risk for infections, several of which are preventable through vaccination. Our study aimed to describe vaccine utilization by immunosuppression status, examine reasons for vaccine refusal, and identify characteristics associated with lack of influenza vaccination in patients with IBD. METHODS We administered an online survey between February 2012 and April 2012 to an internet-based cohort of patients with IBD in the Crohn's and Colitis Foundation of America Partners program. RESULTS During this time, 958 individuals completed the survey. The median age was 45, 72.8% were female, and 62.0% had Crohn's disease. Self-reported vaccination rates were low. Those on immunosuppression (n = 514) were more likely to be counseled to avoid live vaccines (P < 0.01). However, counseling rates were low (3.5%-19.1% for various live vaccines). Among the 776 individuals who received the influenza vaccine, maintaining health (74.1%), importance of prevention (66.1%), and provider recommendation (38%) were the most frequently cited motivations. Factors associated with lack of influenza vaccine included lower education level (P = 0.01), younger age (P = 0.02), and no chronic immunosuppression use (P < 0.01). Five hundred seventy (59.5%) individuals thought that patients were responsible for keeping track of their vaccines, whereas 428 (44.7%) placed responsibility on their gastroenterologist and 595 (62.1%) on their primary care physician. CONCLUSIONS Vaccine utilization remains suboptimal in patients with IBD. Educational interventions may increase vaccination rates by clarifying misconceptions. Gastroenterologists can play a more active role in health care maintenance in patients with IBD by counseling patients on which vaccines to receive or avoid.
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30
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Melmed GY, Siegel CA. Quality improvement in inflammatory bowel disease. Gastroenterol Hepatol (N Y) 2013; 9:286-92. [PMID: 23943663 PMCID: PMC3740804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Chronic illnesses such as inflammatory bowel disease (IBD) present a unique opportunity to define and improve the quality of care. Processes of care can be complex, and outcomes of care may vary across different healthcare delivery settings. Patients with IBD are managed over long periods of time and often by the same physician within a single care delivery system. Both patients with Crohn's disease and ulcerative colitis have variable courses of disease progression that require changes in therapy over time. These factors necessitate multiple areas of potential assessment and improvement of processes and outcomes of care. A current initiative is the development of quality measures. The American Gastroenterological Association has developed accountability measures for the Physician Quality Reporting System, and the Crohn's and Colitis Foundation of America has developed a set of top 10 recommended processes and outcomes of measurement for high-quality care of patients with IBD. In addition, the pediatric ImproveCareNow collaborative network has collected improvement data from dozens of pediatric centers over the past 5 years and has demonstrated improvement in overall disease activity in their cohort through iterative quality improvement processes. Future directions for quality indicators for adults with IBD will involve implementation of quality-measure reporting, both for purposes of reimbursement as well as improvement of care. These strategies will need to be closely monitored to evaluate the effect of improvement programs on outcomes.
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Affiliation(s)
- Gil Y Melmed
- Dr. Melmed is a Clinical Assistant Professor of Medicine in the Division of Gastroenterology in the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles, California. Dr. Siegel is an Associate Professor of Medicine in the Section of Gastroenterology and Hepatology in the Department of Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire
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31
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Immunogenecity of hepatitis A and B vaccination in pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2013; 56:412-15. [PMID: 23841120 DOI: 10.1097/mpg.0b013e31827dd87d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Aim of the study was to evaluate the response to hepatitis A and B vaccination in pediatric patients with inflammatory bowel disease (IBD). METHODS A total of 47 patients with IBD (25 ulcerative colitis, 14 Crohn's disease, and 8 indeterminate colitis) ages 3 to 17 years were compared with 50 healthy age- and sex-matched controls. Screening for hepatitis A and B serology was carried out before vaccination. Susceptible cases received 20 mg of recombinant DNA vaccine for hepatitis B (0, 1, and 6 months)and 720 milliELISA units of inactivated hepatitis A virus vaccine (HAV) (0 and 6 months). Postvaccination serologic evaluation was performed 1 month after the last dose of primary vaccination, 1 month after the booster dose, and once every year during follow-up. RESULTS A total of 23 patients and 35 controls received HAV and protective anti-HAV antibodies were developed in all of the patients and controls (P =1.00). Forty-seven patients and 50 controls received hepatitis B vaccine and 70.2% of the patients versus 90% of the controls achieved seroprotection(anti-HBs titers 10 mIU/mL) 1 month after primary vaccination (95% confidence interval 0.71–0.87, P = 0.02). The overall seroprotection rates were 96% in controls and 85.1% in patients after the whole hepatitis B vaccination series (95% confidence interval 0.83–0.95, P = 0.08). No significant reduction was observed in antibody response among patients and controls during the follow-up period. CONCLUSIONS The rate of seroconversion to the hepatitis B vaccine was lower in pediatric patients with IBD than in healthy controls and hepatitis A vaccine was highly immunogenic among patients with IBD.
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