Jordan Ariel, Mills Krystal, Sobukonla Timothy, Kelly Alexander, Flood Michael
Internal Medicine, University of Michigan, Ann Arbor, USA.
Internal Medicine, Morehouse School of Medicine, Atlanta, USA.
Cureus. 2021 Sep 29;13(9):e18387. doi: 10.7759/cureus.18387. eCollection 2021 Sep.
Background Inflammatory bowel disease (IBD) and its immunosuppressive therapy alter the body's immune response, predisposing patients to higher infection risk preventable with vaccination. The CDC recommends every adult receive the annual influenza vaccine and patients with certain comorbidities receive the pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). However, vaccination rates among IBD patients remain unacceptably low. The aim of our study is to present influenza and pneumococcal vaccinations rates of IBD patients at our center. Methods We hypothesized that vaccination rates will be suboptimal at our outpatient center and that patients are not being vaccinated based on comorbid conditions in accordance with guidelines. We retrieved electronic medical records from the gastroenterology clinic between December 2018 and December 2019. Data regarding influenza and pneumococcal vaccines, immunosuppressive drugs, and comorbidities were obtained. Microsoft Excel and SPSS Statistics (IBM Corp., Armonk, NY) were used for data analyses. A p-value < 0.05 was considered statistically significant. Results In total, 109 IBD patients were identified, 46.8% female and 53.2% male. The majority were African American (77.06%). The mean age was 45 years. Around 26.61% of the patients were on immunosuppressive therapy. Around 28.7% received the annual influenza vaccine, 42.2% PPSV23 alone, 19.27% PCV13 alone, and 16.5% received both. Patients >50 years were more likely to receive the influenza vaccine (P = 0.0122). Patients on immunosuppressive therapy were not more likely to be vaccinated with both PCV13 and PPSV23 (P = 0.1848, P = 0.7382). Active smokers were not more likely to be vaccinated with PPSV23 (P = 0.695). Patients with human immunodeficiency virus (HIV), chronic kidney disease (CKD), and sickle-cell disease were more likely to be vaccinated with both PCV13 and PPSV23 (P = 0.02, P = 0.02). Patients with other chronic medical conditions were more likely to be vaccinated with PPSV23 (P = 0.0201). Conclusion Our study revealed suboptimal influenza and pneumococcal vaccination rates among IBD patients at our facility. We also found that patients were not consistently vaccinated based on qualifying co-morbid conditions. Age plays a role in whether patients received the influenza vaccine contrary to guidelines. We urge clinicians to examine IBD patient vaccination rates at their facilities.
背景 炎症性肠病(IBD)及其免疫抑制治疗会改变人体的免疫反应,使患者面临更高的感染风险,而接种疫苗可预防这些感染。美国疾病控制与预防中心(CDC)建议每位成年人每年接种流感疫苗,患有某些合并症的患者接种肺炎球菌结合疫苗(PCV13)和肺炎球菌多糖疫苗(PPSV23)。然而,IBD患者的疫苗接种率仍然低得令人无法接受。我们研究的目的是呈现我们中心IBD患者的流感和肺炎球菌疫苗接种率。
方法 我们假设我们门诊中心的疫苗接种率不理想,并且患者未按照指南根据合并症情况进行疫苗接种。我们检索了2018年12月至2019年12月胃肠病诊所的电子病历。获取了有关流感和肺炎球菌疫苗、免疫抑制药物以及合并症的数据。使用Microsoft Excel和SPSS Statistics(IBM公司,纽约州阿蒙克)进行数据分析。p值<0.05被认为具有统计学意义。
结果 总共识别出109例IBD患者,女性占46.8%,男性占53.2%。大多数为非裔美国人(77.06%)。平均年龄为45岁。约26.61%的患者接受免疫抑制治疗。约28.7%的患者接种了年度流感疫苗,42.2%仅接种了PPSV23,19.27%仅接种了PCV13,16.5%同时接种了两种疫苗。年龄>50岁的患者更有可能接种流感疫苗(P = 0.0122)。接受免疫抑制治疗的患者接种PCV13和PPSV23两种疫苗的可能性并不更高(P = 0.1848,P = 0.7382)。当前吸烟者接种PPSV23的可能性并不更高(P = 0.695)。感染人类免疫缺陷病毒(HIV)、患有慢性肾脏病(CKD)和镰状细胞病的患者更有可能同时接种PCV13和PPSV23(P = 0.02,P = 0.02)。患有其他慢性疾病的患者更有可能接种PPSV23(P = 0.0201)。
结论 我们的研究显示我们机构中IBD患者的流感和肺炎球菌疫苗接种率不理想。我们还发现患者并未始终根据符合条件的合并症情况进行疫苗接种。与指南相反,年龄在患者是否接种流感疫苗方面起作用。我们敦促临床医生检查其机构中IBD患者的疫苗接种率。