Shabir Muhammad Shahzad, Arif Sibgha, Yeoh Dan, Grover Zubin
Gastroenterology, Perth Children Hospital, Perth, AUS.
Family Medicine, Sonic Health Plus, Perth, AUS.
Cureus. 2024 Nov 15;16(11):e73744. doi: 10.7759/cureus.73744. eCollection 2024 Nov.
Background Patients with inflammatory bowel disease (IBD) face an increased likelihood of severe illnesses, including those caused by vaccine-preventable diseases. Consequently, the purpose of this study was to evaluate both vaccination rates and serological screening in children with IBD in Western Australia, focusing on compliance with routine and additional vaccines, and pre-treatment screening for infections before starting immunosuppressive (IS) treatment. Method The study was conducted at Perth Children's Hospital (PCH) from June 2021 to February 2022, focusing on children aged 0-18 with confirmed IBD diagnoses. Demographic and medical data were collected and matched with immunization records from the Australian Immunisation Register (AIR) to audit compliance with routine childhood vaccinations and additional vaccines (23-valent pneumococcal, human papillomavirus (HPV), and annual influenza). Data from medical records were analyzed for compliance with serologic testing (QuantiFERON TB, Hep B and C, Varicella, and Epstein-Barr virus (EBV)) before initiating IS therapy, which included immunomodulators, biologics, or small molecules. Results Of the 243 patients, 120 (52%) were diagnosed with Crohn's disease and 106 (43%) with ulcerative colitis. A total of 181 patients (74.5%) were treated with immunomodulators, while 62 (26%) received biologic therapies. Incomplete routine vaccination coverage was identified in 71 (29.2%) patients, with no notable differences observed between the IS and non-IS groups (p=0.3). Specific vaccines with incomplete coverage included HPV in 49 (24%) patients, Varicella in 39 (16%) patients, and diphtheria-tetanus-pertussis (DTP in 16 (6.5%) patients. Pre-treatment serological screening was also suboptimal, with the lowest testing rate for EBV at 32 (13.2) patients and the highest for Varicella at 181 (74.6%) patients. Conclusion The results emphasized the importance of targeted interventions to enhance vaccination and screening practices, enhancing disease management, and reducing the possibility of preventable infections in the vulnerable populace.
背景 炎症性肠病（IBD）患者患重症疾病的可能性增加，包括那些由疫苗可预防疾病引起的重症。因此，本研究的目的是评估西澳大利亚州IBD患儿的疫苗接种率和血清学筛查情况，重点关注常规疫苗和额外疫苗的接种依从性，以及开始免疫抑制（IS）治疗前的感染预处理筛查。方法 该研究于2021年6月至2022年2月在珀斯儿童医院（PCH）进行，重点关注确诊为IBD的0至18岁儿童。收集人口统计学和医疗数据，并与澳大利亚免疫登记册（AIR）的免疫记录进行匹配，以审核儿童常规疫苗和额外疫苗（23价肺炎球菌疫苗、人乳头瘤病毒（HPV）疫苗和年度流感疫苗）的接种依从性。分析病历数据，以审核开始IS治疗（包括免疫调节剂、生物制剂或小分子药物）前血清学检测（结核感染T细胞检测、乙肝和丙肝检测、水痘检测和爱泼斯坦-巴尔病毒（EBV）检测）的依从性。结果 在243例患者中，120例（52%）被诊断为克罗恩病，106例（43%）被诊断为溃疡性结肠炎。共有181例患者（74.5%）接受免疫调节剂治疗，62例（26%）接受生物治疗。71例（29.2%）患者的常规疫苗接种未完成，IS组和非IS组之间未观察到显著差异（p=0.3）。接种未完成的特定疫苗包括49例（24%）患者的HPV疫苗、39例（16%）患者的水痘疫苗和16例（6.5%）患者的白喉-破伤风-百日咳（DTP）疫苗。治疗前血清学筛查也不理想，EBV检测率最低，为32例（13.2%）患者，水痘检测率最高，为181例（74.6%）患者。结论 研究结果强调了针对性干预措施对于加强疫苗接种和筛查措施、改善疾病管理以及降低易感人群中可预防感染可能性的重要性。
