Immunization status in children with inflammatory bowel disease

Abstract

Inflammatory bowel diseases have an increased risk of infections due to immunosuppressive therapies. To report the immunization status according to previous recommendations and the reasons explaining a delay, a questionnaire was filled in by the pediatric gastroenterologist, concerning outpatients, in six tertiary centers and five local hospitals, in a study, from May to November 2011. One hundred and sixty-five questionnaires were collected, of which 106 Crohn's diseases, 41 ulcerative colitis, and 17 indeterminate colitis. Sex ratio was 87:78 M/F. Median age was 14.4 years old (4.2-20.0). One hundred and nine patients (66 %) were receiving or had received an immunosuppressive therapy (azathioprine, infliximab, methotrexate, or prednisone). Vaccines were up to date according to the vaccine schedule of French recommendations in 24 % of cases and according to the recommendations for inflammatory bowel disease in 4 % of cases. Coverage by vaccine was the following: diphtheria-tetanus-poliomyelitis 87 %, hepatitis B 38 %, pneumococcus 32 %, and influenza 22 %. Immunization delay causes were as follows: absence of proposal 58 %, patient refusal 41 %, fear of side effects 33 %, and fear of disease activation 5 %. Therefore, immunization coverage is insufficient in children with inflammatory bowel disease, due to simple omission or to refusal. A collaboration with the attending physicians and a targeted information are necessary.

Uptake of influenza vaccine in ulcerative colitis

“…For example, the uptake of influenza vaccine was 37.5% in South Korea [14], 19-28% in Germany [15,16] and 28% in the United States [1]. The uptake amongst pediatric IBD patients in France was 21.8% [5].…”

“…The most common is lack of awareness (58%), however, fear of side effects (33%) and fear of disease activation (5%) are also factors which need to be addressed [5]. Evidence suggesting that influenza vaccine causes IBD activation is limited to case reports, and in fact there is robust data indicating the opposite -IBD patients do not require additional health services following vaccination [17][18][19][20][21].…”

“…As such, several guidelines recommend universal seasonal influenza vaccination for all IBD patients [2,3]. Nevertheless, vaccination rates remain low due to various factors, including lack of physician awareness, fear of adverse events and uncertainty regarding the effect of vaccination on disease activity [1,4,5]. Furthermore, the efficacy of influenza vaccination has been questioned in patients with IBD, despite there being little evidence of decreased vaccine immunogenicity even in patients receiving immunosuppressant medications [6][7][8][9].…”

The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations

“…Concerns were analysed in more depth for specific vaccines. Articles looking at different vaccines without providing data on each vaccine separately [9][10][11][12][13][14][15][16] and vaccines for which there were only a handful of articles available [17][18][19][20][21][22][23][24][25][26] were excluded from the in depth analysis.…”

Health Care Maintenance for the Pediatric Patient With Inflammatory Bowel Disease

“…13 -17 A study of 165 pediatric patients with IBD revealed vaccination rates of 22% for influenza, 32% for pneumococcus, 38% for hepatitis B, and 87% for diphtheria-tetanusacellular pertussis. 14 …”