Vatche and Tamar Manoukian Division of Digestive Diseases.
Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, CA.
J Clin Gastroenterol. 2023;57(10):1031-1037. doi: 10.1097/MCG.0000000000001783. Epub 2023 Jan 19.
Guidelines for inflammatory bowel disease (IBD) patients receiving immunosuppression encouraged both the pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13). We aimed to evaluate which pneumococcal vaccines are recommended and administered, and to understand provider and IBD patient knowledge regarding pneumococcal vaccinations.
We performed a retrospective, cross-sectional analysis of 357 adult IBD patients on immunosuppression in our health care system. Patient demographics and clinical characteristics were collected. The primary outcome was rate of documented vaccinations recommended by providers; the secondary outcome was rate of receipt of the vaccines. We identified factors associated with receipt of any pneumococcal vaccine through multivariable logistic regression. We also performed provider and IBD patient surveys to understand provider and patient knowledge regarding pneumococcal vaccines. We used χ 2 and Fisher exact tests to assess survey responses.
Fifty seven percent of IBD patients had any pneumococcal vaccination recommended and 35% had recommendations for both PPSV23 and PCV13. Forty percent received any pneumococcal vaccine and 18% received both vaccines. In multivariable analyses, increasing age (adjusted odds ratio: 1.03, 95% CI: 1.01-1.05) was associated with receipt of any pneumococcal vaccine, after adjusting for gender, race, insurance, disease activity, and time seen in our gastroenterology clinics. In the survey study, on average, 59% of providers correctly answered questions regarding pneumococcal vaccination indications.
In our health care system, while recommendation for any pneumococcal vaccination was >50%, receipt of both PPSV23 and PCV13 was low. Simplified vaccine regimens (ie, PCV20) will likely improve vaccination rates.
接受免疫抑制治疗的炎症性肠病（IBD）患者指南鼓励接种肺炎球菌多糖疫苗（PPSV23）和肺炎球菌结合疫苗（PCV13）。我们旨在评估推荐和使用了哪些肺炎球菌疫苗，并了解提供者和 IBD 患者对肺炎球菌疫苗接种的认识。
我们对我们医疗系统中的 357 名接受免疫抑制治疗的成年 IBD 患者进行了回顾性、横断面分析。收集了患者的人口统计学和临床特征。主要结局是提供者记录的疫苗接种推荐率；次要结局是疫苗接种率。我们通过多变量逻辑回归确定了与任何肺炎球菌疫苗接种相关的因素。我们还对提供者和 IBD 患者进行了调查，以了解提供者和患者对肺炎球菌疫苗的认识。我们使用 χ 2 和 Fisher 精确检验来评估调查结果。
57%的 IBD 患者有任何肺炎球菌疫苗接种推荐，35%的患者有 PPSV23 和 PCV13 推荐。40%的患者接受了任何肺炎球菌疫苗接种，18%的患者同时接种了两种疫苗。在多变量分析中，调整性别、种族、保险、疾病活动度和在我们胃肠病学诊所就诊时间后，年龄增长（调整优势比：1.03，95%CI：1.01-1.05）与任何肺炎球菌疫苗接种有关。在调查研究中，平均而言，59%的提供者正确回答了关于肺炎球菌疫苗接种适应症的问题。
在我们的医疗系统中，虽然推荐任何肺炎球菌疫苗接种的比例>50%，但同时接种 PPSV23 和 PCV13 的比例较低。简化的疫苗方案（即 PCV20）可能会提高疫苗接种率。
