Increasing use of immunosuppression and biological therapies: the establishment of a designated clinic to prevent infectious complications

Abstract number: O42

Mac Nicholas R., Ahmed S.E., Hamed M., De Barra E., El Shariff O., Bergin C., Norris S., Keeling P.W.N., Mahmud N.

Introduction: Many patients with Inflammatory bowel disease (IBD) are young and require long term treatment with immunosuppressants to control their disease. Corticosteroids, immunomodulators and more recently biological therapies increase the risk of infections. Current Irish guidelines recommend vaccination against influenza, pneumococcus, tetanus and varicella zoster virus in patients immunosuppressed by disease or treatment (1).

Aims: To assess the vaccination history and exposure to vaccine preventable diseases in IBD patients on immunosuppression prior to the establishment of a chronic inflammatory diseases assessment clinic.

Method: We conducted a prospective survey of consecutive IBD patients on immunosuppressant medications. A thorough vaccination history was obtained and blood samples were taken to assess past exposure and vaccination status.

Results: A total of 70 IBD patients were assessed (53% Crohn's disease, 33% Ulcerative Colitis, 4% Indeterminate). History of immunosuppressant use included; Azathioprine (51%), Prednisolone (44%) and Methotrexate (2%), Anti-TNF (6%).

91% of patients did not receive their annual influenza vaccination and 80% had never been vaccinated. 97% of patients were not adequately vaccinated against pneumococcus and 86% had never been vaccinated. Varicella Zoster Virus IgG was detected in 100% of patients, 43% had a previous history of chickenpox and 11% had a previous history of shingles. 94% of patients were not vaccinated against hepatitis B, 3% had chronic hepatitis B infection and only 3% were vaccinated.

Conclusion: This study indicates that vaccination uptake amongst IBD patients on immunosuppressant regimens is extremely poor. Current Irish guidelines recommend vaccination in these patients. Ignoring these guidelines puts patients at risk of preventable diseases.

The establishment of a designated infectious disease assessment clinic will commence to address vaccination requirements and provide healthcare advice pertaining to infectious complications of immunosuppressive therapies in particular biological agents. We intend to expand this service to other medical specialties utilising these immunosuppressive regimens.