Abstract
Introduction
Patients with inflammatory bowel disease(IBD) are at risk of infections, many of which
are preventable with vaccinations. We performed a systematic review on various aspects
of vaccination in IBD.
Methods
We searched PubMed, and EMBASE databases, through 31 January 2021. Primary outcomes
included vaccination rates, predictors of vaccination, reasons of vaccination hesitancy
and acceptance, and outcomes of intervention. Findings were presented with medians,
ranges, and narrative synthesis.
Results
We included 33 observational studies comprising 146,918 patients and 681 physicians.
The median vaccination rates of influenza, pneumococcal pneumonia, and hepatitis B
vaccines were 42%(IQR, 28%–61.5%), 20%(IQR, 9%–38.5%), and 48%(IQR, 29%–53%), respectively.
Uses of immunosuppressant, older age and physician recommendations have positive influence
on vaccination rate. Lack of vaccine-related knowledge and awareness of need for vaccination
are main reasons of vaccine hesitancy among patients and physicians. There was disagreement
between gastroenterologists and primary-care physicians on whose responsibility to
offer vaccination. Education was the sole intervention identified, with variable success.
Conclusion
This systematic review demonstrates that the vaccination rates of IBD patients, similar
to other chronic diseases, are suboptimal. Lack of vaccine-related knowledge and awareness
of the need for vaccination are main reasons of vaccine hesitancy amongst patients
and physicians. Education, though effective, was the only available intervention identified.
Gastroenterologist could take the lead in educating, and initiating vaccination among
IBD patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Inflammatory bowel disease patients are at increased risk of invasive pneumococcal disease: a nationwide danish cohort study 1977-2013.Am J Gastroenterol. 2015; 110: 1582-1587
- Biologic therapies and risk of infection and malignancy in patients with inflammatory bowel disease: a systematic review and network meta-analysis.Clin Gastroenterol Hepatol. 2016; 14: 1385-1397
- Risk of serious and opportunistic infections associated with treatment of inflammatory bowel diseases.Gastroenterology. 2018; 155: 337-346
- Hospitalizations for vaccine preventable pneumonias in patients with inflammatory bowel disease: a 6-year analysis of the Nationwide Inpatient Sample.Clin Exp Gastroenterol. 2013; 6: 43-49
- Increased risk of pneumonia among patients with inflammatory bowel disease.Am J Gastroenterol. 2013; 108: 240-248
- Increased risk of herpes zoster among 108 604 patients with inflammatory bowel disease.Aliment Pharmacol Ther. 2013; 37: 420-429
- Vaccine-preventable diseases in hospitalized patients with inflammatory bowel disease: a nationwide cohort analysis.Inflamm Bowel Dis. 2019; 25: 1966-1973
- Increased risk of influenza and influenza-related complications among 140,480 patients with inflammatory bowel disease.Inflamm Bowel Dis. 2019; 25: 369-376
- Infection-related hospitalizations are associated with increased mortality in patients with inflammatory bowel diseases.J Crohns Colitis. 2013; 7: 107-112
- Relevant Infections in inflammatory bowel disease, and their relationship with immunosuppressive therapy and their effects on disease mortality.J Crohns Colitis. 2019; 13: 828-837
- Low rate of influenza and pneumococcal vaccine coverage in rheumatoid arthritis: data from the International COMORA cohort.Vaccine. 2015; 33: 1446-1452
- 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.Annals of the Rheumatic Diseases. 2020; 79: 39-52
- Patients with inflammatory bowel disease are at risk for vaccine-preventable illnesses.Am J Gastroenterol. 2006; 101: 1834-1840
- Vaccinating the inflammatory bowel disease patient: deficiencies in gastroenterologists knowledge.Inflamm Bowel Dis. 2011; 17: 2536-2540
- Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease.J Crohns Colitis. 2014; 8: 443-468
- ACG clinical guideline: preventive care in inflammatory bowel disease.Am J Gastroenterol. 2017; 112: 241-258
- Group on vaccine hesitancy. Vaccine hesitancy: definition, scope and determinants.Vaccine. 2015; 33: 4161-4164
- The immunization status of patients with IBD is alarmingly poor before the introduction of specific guidelines.Scand J Gastroenterol. 2011; 46: 855-861
- Vaccination coverage in immunosuppressed patients: results of a regional health services research study.Dtsch Arztebl Int. 2011; 108: 105-111
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.PLoS Medicine. 2009; 6: 1-28
National Heart, Lung, and Blood Institute. Study Quality Assessment Tools. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools Accessed 1 Dec 2020
- Assessing bias in studies of prognostic factors.Ann Intern Med. 2013; 158: 280-286
- An audit of influenza vaccination status in adults with inflammatory bowel disease.Can J Gastroenterol. 2012; 26: 593-596
- Inadequate knowledge of immunization guidelines: a missed opportunity for preventing infection in immunocompromised IBD patients.Inflamm Bowel Dis. 2012; 18: 34-40
- A quality improvement project significantly increased the vaccination rate for immunosuppressed patients with IBD.Inflamm Bowel Dis. 2013; 19: 1809-1814
- Factors associated with vaccination among inflammatory bowel disease patients in Korea.Korean J Gastroenterol. 2013; 61: 203-208
- Vaccination and complementary and alternative medicine in patients with inflammatory bowel disease.Intest Res. 2014; 12: 124-130
- Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement.Inflamm Bowel Dis. 2014; 20: 246-250
- Insufficient knowledge of Korean gastroenterologists regarding the vaccination of patients with inflammatory bowel disease.Gut Liver. 2014; 8: 242-247
- Uptake of influenza vaccine in ulcerative colitis.Vaccine. 2014; 32: 5484-5489
- Hepatitis B vaccination in patients with inflammatory bowel disease.World J Gastroenterol. 2014; 20: 15358-15366
- Pneumococcal vaccination rates in VHA patients with inflammatory bowel disease.Medicine (Baltimore). 2015; 94: e417
- Influenza and pneumococcal vaccination rates in patients with inflammatory bowel disease.Gastroenterol Hepatol (N Y). 2015; 11: 396-401
- Systematic Information to health-care professionals about vaccination guidelines improves adherence in patients with inflammatory bowel disease in anti-TNFα therapy.Am J Gastroenterol. 2015; 110: 1526-1532
- Vaccination in inflammatory bowel disease patients: attitudes, knowledge, and uptake.J Crohns Colitis. 2015; 9: 439-444
- Preventative care for patients with inflammatory bowel disease in the veterans health administration.Medicine (Baltimore). 2016; 95: e4012
- Effects of education and information on vaccination behavior in patients with inflammatory bowel disease.Inflamm Bowel Dis. 2017; 23: 318-324
- Vaccination practices in patients with inflammatory bowel disease among general internal medicine physicians in the USA.Postgrad Med J. 2017; 93: 333-337
- Rates and predictors of vaccinations among inflammatory bowel disease patients receiving anti-tumor necrosis factor agents.Dig Dis Sci. 2018; 63: 209-217
- Pneumococcal and influenza vaccine uptake in adults with inflammatory bowel disease in France: results from a web-based study.Dig Liver Dis. 2018; 50: 563-567
- Can we better protect patients with inflammatory bowel disease against infections - patient attitude and personal immunization knowledge.Acta Gastroenterol Belg. 2018; 81: 257-261
- Frequency of herpes zoster vaccination among inflammatory bowel disease patients.Inflamm Bowel Dis. 2019; 25 (2019): 345-351
- Herpes zoster infection and herpes zoster vaccination in a population-based sample of persons with ibd: is there still an unmet need?.Inflamm Bowel Dis. 2019; 25: 532-540
- Immunization status of patients with inflammatory bowel disease.Arq Gastroenterol. 2019; 56: 124-130
- Preventive health care among postpartum women with inflammatory bowel disease: results from the PIANO registry.Inflamm Bowel Dis. 2019; 25: 797-802
- Receipt of preventive care services among US adults with inflammatory bowel disease, 2015-2016.Dig Dis Sci. 2019; 64: 1798-1808
- Vaccination for influenza and pneumococcus in patients with gastrointestinal cancer or inflammatory bowel disease: A prospective cohort study of methods for improving coverage.Aliment Pharmacol Ther. 2019; 49: 84-90
- Physicians' knowledge and application of immunization strategies in patients with inflammatory bowel disease: a survey of the Italian group for the study of inflammatory bowel disease.Digestion. 2020; 101: 433-440
- Compliance with the guidelines on recommended immunization schedule in patients with inflammatory bowel disease: implications on public health policies.BMC Public Health. 2020; 20: 713
- Insufficient knowledge and vaccination practice of inflammatory bowel disease patients in the People's Republic of China.Patient Prefer Adherence. 2020; 14: 1513-1521
- Accuracy of self-reported vaccination status in a cohort of patients with inflammatory bowel disease.Dig Dis Sci. 2020; : 1-7
- Influenza vaccination for immunocompromised patients: summary of a systematic review and meta-analysis.Influenza Other Respir Viruses. 2013; 7: 72-75
- A Multifaceted Intervention to Improve Influenza, Pneumococcal, and Herpes Zoster Vaccination among Patients with Rheumatoid Arthritis.J Rheumatol. 2016; 43: 1030-1037
- Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA).Ann Rheum Dis. 2014; 73: 62-68
- Suboptimal immunization coverage among canadian rheumatology patients in routine clinical care.J Rheumatol. 2020; 47: 770-778
- Recommended childhood and adolescent immunization schedule: United States, 2020.Pediatrics. 2020; 145e20193995
- Overall and comparative risk of herpes zoster with pharmacotherapy for inflammatory bowel diseases: a nationwide cohort study.Clin Gastroenterol Hepatol. 2018; 16: 1919-1927
- A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.N Engl J Med. 2005; 352: 2271-2284
- Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years.Clin Infect Dis. 2012; 54: 922-928
- Improvement in herpes zoster vaccination in patients with rheumatoid arthritis: a quality improvement project.J Rheumatol. 2017; 44: 11-17
- Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Recomm Rep. 2008; 57: 1-30
- Efficacy of live attenuated herpes zoster vaccine in patients with inflammatory bowel diseases.Clin Gastroenterol Hepatol. 2019; 17: 1341-1347
- Safety of herpes zoster vaccination among inflammatory bowel disease patients being treated with anti-TNF medications.Aliment Pharmacol Ther. 2017; 46: 668-672
- ZOE-50 study group: efficacy of an adjuvanted herpes zoster subunit vaccine in older adults.N Engl J Med. 2015; 372: 2087-2096
- Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in adults with haematological malignancies: a phase 3, randomised, clinical trial and post-hoc efficacy analysis.Lancet Infect Dis. 2019; 19: 988-1000
- Safety of Janus Kinase inhibitors in patients with inflammatory bowel diseases or other immune-mediated diseases: a systematic review and meta-analysis.Gastroenterology. 2020; 158 (e12): 1554-1573
Shingrix vaccine in patients with moderate to severe ulcerative colitis on tofacitinib. https://ClinicalTrials.gov/show/NCT03591770.
- Factors associated with HPV vaccine uptake in teenage girls: a systematic review.Vaccine. 2012; 30: 3546-3556
- Provider communication and HPV vaccination: the impact of recommendation quality.Vaccine. 2016; 34: 1187-1192
- Are primary care providers uncomfortable providing routine preventive care for inflammatory bowel disease patients?.Dig Dis Sci. 2011; 56: 819-824
Article info
Publication history
Published online: May 11, 2021
Accepted:
April 12,
2021
Received:
December 13,
2020
Footnotes
Source of support: Nil
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Immunization in patients with inflammatory bowel disease: Still far from standardsDigestive and Liver DiseaseVol. 53Issue 11
- PreviewWe have recently read with great interest the manuscript, entitled “Vaccinations and inflammatory bowel disease – a systematic review” from Chan W et al. [1]. It is a systematic review that summarizes the literature on vaccination rates and predictors, reasons of vaccine hesitancy and interventions to improve vaccination rates in inflammatory bowel disease (IBD) patients. We agree with the most important message of the article, that there is a significant deficiency in immunization schedules in IBD patients.
- Full-Text
- Preview
