Wasan Sharmeel K, Calderwood Audrey H, Long Millie D, Kappelman Michael D, Sandler Robert S, Farraye Francis A
*Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston, MA; and †Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC.
Inflamm Bowel Dis. 2014 Feb;20(2):246-50. doi: 10.1097/01.MIB.0000437737.68841.87.
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.
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.
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.
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.
用于治疗炎症性肠病（IBD）的免疫抑制剂会增加感染风险，其中一些感染可通过接种疫苗预防。我们的研究旨在描述根据免疫抑制状态的疫苗使用情况，探讨拒绝接种疫苗的原因，并确定IBD患者未接种流感疫苗的相关特征。
2012年2月至2012年4月期间，我们对美国克罗恩病和结肠炎基金会合作伙伴项目中基于互联网的IBD患者队列进行了在线调查。
在此期间，958人完成了调查。中位年龄为45岁，72.8%为女性，62.0%患有克罗恩病。自我报告的疫苗接种率较低。接受免疫抑制治疗的患者（n = 514）更有可能被建议避免接种活疫苗（P < 0.01）。然而，建议接种率较低（各种活疫苗的建议接种率为3.5%-19.1%）。在776名接种流感疫苗的个体中，保持健康（74.1%）、预防的重要性（66.1%）和医生建议（38%）是最常提及的动机。与未接种流感疫苗相关的因素包括教育水平较低（P = 0.01）、年龄较小（P = 0.02）以及未使用慢性免疫抑制剂（P < 0.01）。570名（59.5%）个体认为患者有责任跟踪自己的疫苗接种情况，而428名（44.7%）将责任归咎于胃肠病医生，595名（62.1%）归咎于初级保健医生。
IBD患者的疫苗使用情况仍不理想。教育干预可能通过澄清误解来提高疫苗接种率。胃肠病医生可以通过就接种或避免接种哪些疫苗向患者提供咨询，在IBD患者的医疗保健维护中发挥更积极的作用。
