P0767 Sub-optimal adherence with vaccination recommendations in immunosuppressed IBD patients in the post COVID-19 pandemic era
Authors: Decker V , Shakweh E , Rejee C , Hart A , Alexander J L 
Published: January 2025

Abstract

Background
People with Inflammatory Bowel Disease (IBD) on immunosuppressive therapy are at increased risk of vaccine-preventable infectious diseases including influenza, COVID-19, pneumococcal pneumonia and varicella zoster (shingles).1 The COVID-19 pandemic has resulted in reduced trust in immunisation guidance.2 Our aim was to assess adherence to vaccination guidance in adult IBD patients and identify barriers to uptake.3,4

Methods
A paper-based survey was completed by patients at two large UK centres (St Mark’s Hospital and Imperial College Healthcare Trust, London). Data were collected on demographics, vaccination history and attitudes and barriers to vaccination. The primary outcome was adherence to the recommended UK vaccination schedule for immunosuppressed individuals in 2023-2024. Univariable and multivariable analyses were performed to identify factors associated with vaccine uptake.

Results
209 IBD patients (102 with ulcerative colitis, 99 with Crohn’s disease, 7 with IBD-unclassified, 1 unknown; 56% male; median age 39.5 years (range 18-86)) completed the survey between February and April 2024. 194 patients were on immunosuppressants (47.4% TNF inhibitors, 31.6% vedolizumab and 31.6% azathioprine/mercaptopurine, 11.5% systemic corticosteroids and 12.9% on other advanced therapies). Only 22.2% of patients reported receiving all recommended vaccinations. Vaccine uptake in eligible patients was influenza 64.4%, COVID-19 56.7%, pneumococcal 30.9%, and shingles (Shingrix®) 16.9% (Figure 1A). Increasing age (OR=1.03, CI=1.00-1.07) and receiving a recommendation for vaccination from a healthcare professional (OR=3.43, CI=1.73-6.92) were associated with increased uptake. Uncertainty about vaccine necessity (66.7% for COVID-19, 44.9% for influenza), lack of awareness of guidance (61.2% for pneumococcal) and concerns about safety (18.8% for Influenza, 17.9% for COVID-19) were the most common reasons for non-uptake (Figure 1B). Shingrix® eligibility in the UK is limited to individuals aged 50 years and above, but 12.1% of ineligible immunosuppressed patients (under 50 years old) reported having an episode of varicella-zoster (shingles).

Conclusion
Vaccination uptake in immunosuppressed IBD patients in the post COVID-19 pandemic era is suboptimal, increasing the risk from preventable infectious diseases. Healthcare professional recommendation plays an important role in reducing non-uptake and IBD clinicians should advocate strongly for patients to be immunised. We have identified high rates of shingles in our cohort and Shingrix® vaccination should be rolled out for all immunosuppressed adults with IBD.

References
1.Malhi G, Rumman A, Thanabalan R, et al. Vaccination in Inflammatory Bowel Disease Patients: Attitudes, Knowledge, and Uptake. Journal of Crohn's and colitis. 2015;9(6):439–444. doi:10.1093/ecco-jcc/jjv0642.
2.Cunniff L, Alyanak E, Fix A, et al. The impact of the COVID-19 pandemic on vaccination uptake in the United States and strategies to recover and improve vaccination rates: A review. Human vaccines & immunotherapeutics. 2023;19(2):2246502. doi:10.1080/21645515.2023.22465023.
3.Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1–s106. doi:10.1136/gutjnl-2019-3184844.
4.UK Health Security Agency. Immunisation of individuals with underlying medical conditions. In: Ramsay DM, ed. The Green Book: Immunisation against infectious disease UK Health Security Agency; 2013:1–8