Pneumococcal Vaccination Rates in VHA Patients With Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is an inflammatory condition of the digestive tract not caused by infectious agents. Symptoms of IBD, such as diarrhea and pain, diminish one's quality of life. Underlying immune dysregulation may put IBD patients at risk for severe infectious disease making preventative vaccination highly recommended. Therefore, this study sought to assess rates of pneumococcal vaccination in patients with IBD.A cross-sectional observational study was employed utilizing administrative data extracts from the Veterans Health Administration (VHA) to identify patients diagnosed with IBD per International Classification of Diseases, Version 9, Clinical Modification codes. Their pneumococcal vaccine histories were determined from Common Procedural Terminology codes. Data were aggregated to the patient level and subjected to multivariable logistic regression to assess factors associated with receipt of the vaccination and 1-year mortality; survival analyses extended follow-up to as much as 4 years following IBD diagnosis.From October 2004 to September 2009, 49,350 patients were diagnosed with IBD in the VHA. Incidence was approximately 6000 cases/y. Patients averaged 62 years (±15, range 19–98) with 45% aged 65 or older. Approximately 6% were women, 21% were highly disabled from a military service-connected condition, 46% had hypertension, 38% dyslipidemia, and 18% diabetes. Only 20% of the cohort received pneumococcal vaccination including 5% vaccinated prior to IBD diagnosis, 2% on the date of diagnosis, and 13% subsequently. Being married, living outside the Northeast, and having more comorbidities were associated with vaccination before IBD diagnosis; models of vaccination at or after diagnosis demonstrated poor fit: little better than chance. Vaccinations before, after, and at diagnosis were protective against 1-year mortality adjusting for clinical and demographic covariates. Living in the South was an independent risk factor for death among IBD patients.While vaccination for pneumococcus is a low-cost, low-risk recommendation for persons with IBD with an apparent survival benefit, vaccination rates were low.

Preventative care for patients with inflammatory bowel disease in the Veterans Health Administration

“…[ 5 ] A study of 49,350 Veterans Health Administration (VA) patients showed similarly dismal rates of vaccination for pneumovax, with only a 20% rate of vaccination recorded in VA data. [ 6 ]…”

“…Studies have demonstrated suboptimal rates of vaccination in IBD patients. [ 5 , 6 ] Guidelines for vaccination in IBD patients were published in 2004. [ 7 , 8 ] Despite this, poor vaccination rates persist due to several factors, including lack of awareness on the part of clinicians, fear of potential adverse effects, or ambiguity as to which provider should take responsibility for immunizations.…”

Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines

“…113 In patients with IBD, a cross-sectional study found lower 1-year mortality rates among adults who were vaccinated compared to those who were not (2.1% vs 4.5%; P < .001). 114 Data from 5 observational studies suggested that pneumococcal vaccine immunogenic response rates in patients with IBD not on immunosuppressive drugs are similar to those seen in the general population. 15,[115][116][117][118] In a case-controlled study, immune response rates were similar between adults with IBD not on immunosuppressive therapy (80%) and agematched healthy controls (85%), but lower in patients on combination immunosuppressive therapy (45%).…”

Vaccination strategies for Korean patients with inflammatory bowel disease

“…This increased risk is observed even before IBD diagnosis or initiation of immunosuppressive therapy, implicating an underlying immunological change related to the pathogenesis of IBD in the higher risk of IPD [37]. However, 1-year mortality rates were significantly lower among pneumococcal-vaccinated than -unvaccinated IBD patients [38]. The immune response to pneumococcal vaccination in IBD patients is comparable to that of the general population, but immunosuppressive therapy may impair immunogenicity [39,40].…”