Alimentary Tract
Vaccination coverage of children with inflammatory bowel disease after an awareness campaign on the risk of infection

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Abstract

Background

Children with inflammatory bowel disease are at risk of vaccine-preventable diseases mostly due to immunosuppressive drugs.

Aim

To evaluate coverage after an awareness campaign informing patients, their parents and general practitioner about the vaccination schedule.

Methods

Vaccination coverage was firstly evaluated and followed by an awareness campaign on the risk of infection via postal mail. The trial is a case–control study on the same patients before and after the awareness campaign. Overall, 92 children were included. A questionnaire was then completed during a routine appointment to collect data including age at diagnosis, age at data collection, treatment history, and vaccination status.

Results

Vaccination rates significantly increased for vaccines against diphtheria–tetanus–poliomyelitis (92% vs. 100%), Haemophilus influenzae (88% vs. 98%), hepatitis B (52% vs. 71%), pneumococcus (36% vs. 57%), and meningococcus C (17% vs. 41%) (p < 0.05). Children who were older at diagnosis were 1.26 times more likely to be up-to-date with a minimum vaccination schedule (diphtheria–tetanus–poliomyelitis, pertussis, H. influenzae, measles–mumps–rubella, tuberculosis) (p = 0.002).

Conclusion

Informing inflammatory bowel disease patients, their parents and general practitioner about the vaccination schedule via postal mail is easy, inexpensive, reproducible, and increases vaccination coverage. This method reinforces information on the risk of infection during routine visits.

Introduction

The use of immunosuppressive therapy such as corticosteroids, antimetabolites (6-mercaptopurine [6MP], methotrexate, and azathioprine), and biologics has led to marked improvements for patients (children and adults) with inflammatory bowel disease (IBD); however, at the same time, these therapies increase the risk of opportunistic infections [1], [2], [3], [4]. These infections can be prevented through vaccination. This is why specific recommendations have been implemented in addition to the usual recommendations. Patients must be brought up-to-date with scheduled vaccinations as soon as possible in the course of their disease (ideally from diagnosis) in order to achieve a better immune response and be able to administer live attenuated vaccines, which will be contraindicated if immunosuppressive therapy is subsequently administered [1], [4], [5]. The recommended vaccines are those of the vaccination schedule (for France) plus the influenza and pneumococcal vaccines [6], [7].

Several studies have shown that the level of vaccination coverage for IBD patients is insufficient [8], [9]. A previous study involving 165 children with IBD, conducted between May and November 2011 at 11 hospitals in western France, showed that vaccination coverage in this population was largely insufficient [8]. The primary cause seems to be the lack of information provided to patients and to doctors responsible for vaccination. In addition to vaccine catch-up, prevention must also be implemented [8], [10], [11].

The aim of our study was to evaluate vaccination coverage among children with IBD following an awareness campaign about the infection risk to their family and their GP. To this aim, a letter was sent to patients of a previously evaluated cohort [8] and to their GP, in order to raise awareness about the vaccination schedule.

Section snippets

Materials and methods

The dosing schedule recommended to patients, their family, and their doctor was the one published by the French High Council for Public Health (HCSP) in February 2012 [6].

All patients with known vaccination coverage subsequent to data collection in 9 hospitals in western France [8] were included in this prospective study conducted from March 6, 2013 to January 31, 2014. The awareness-raising campaign implemented in this study consisted of providing information about the infection risk and the

Results

The campaign letters were sent out to 105 includable patients and their GPs. Among these, 2 refused to participate in the study and 11 were not subsequently seen. Hence, 92 patients were included, giving a response rate of 88%.

Discussion

Clear recommendations exist for evaluating IBD patients before initiating treatment, especially with anti-TNF agents, and bringing them up-to-date with vaccinations [1], [6], [7], [12], [13]. Although such patients, who are currently immunosuppressed or likely to be immunosuppressed in the future, are at a higher risk of infection, particularly opportunistic infections [1], [2], [3], [4], several studies have shown that doctors and patients are not provided information [8], [9] about the

Conflict of interest

None declared.

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