SARS-CoV-2 vaccination uptake by patients with inflammatory bowel disease on biological therapy
Authors: Rania Selim, Judith Wellens, Luke Marlow, Jack J Satsangi
Journal: The Lancet. Gastroenterology & hepatology (2021)

Since the development of vaccines effective against COVID-19, there has been widespread expert consensus among clinicians in support of vaccination of patients with inflammatory bowel disease on biological therapies or immunomodulators.1Siegel CA Melmed GY McGovern DPB et al.SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting.Gut. 2021; 70: 635-640Crossref PubMed Scopus (151) Google Scholar Because these patients were not eligible to participate in the pivotal vaccine development trials, safety and efficacy data were not initially available to guide management; these data are now emerging.2Wong S-Y Dixon R Martinez Pazos et al.Serologic response to messenger RNA coronavirus disease 2019 vaccines in inflammatory bowel disease patients receiving biologic therapies.Gastroenterology. 2021; 161: 715-718Summary Full Text Full Text PDF PubMed Scopus (94) Google Scholar The British Society of Gastroenterology has highlighted that qualitative research on SARS-CoV-2 vaccination attitudes and tracking of acceptance rates in inflammatory bowel disease is of great importance.3Alexander JL Moran GW Gaya DR et al.SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement.Lancet Gastroenterol Hepatol. 2021; 6: 218-224Summary Full Text Full Text PDF PubMed Scopus (99) Google Scholar A US survey of 236 patients with inflammatory bowel disease reported a vaccination intent as high as 80·9%.4Dalal RS McClure E Marcus J Winter RW Hamilton MJ Allegretti JR COVID-19 vaccination intent and perceptions among patients with inflammatory bowel diseases.Clin Gastroenterol Hepatol. 2021; 19: 1730-1732Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar We assessed SARS-CoV-2 vaccination uptake in consecutive patients with inflammatory bowel disease regularly attending the infusion centre at the John Radcliffe Hospital (Oxford, UK) for maintenance infliximab or vedolizumab infusions between April, 2020, and January, 2021. These patients were invited to participate in our ongoing COVID-19 seroepidemiology studies. Details of ethical approval are in the appendix (p 2). Of the 485 patients approached to participate, 21 (4%) declined and were excluded from this analysis. Patients on other advanced therapies licensed for inflammatory bowel disease (ustekinumab, adalimumab, tofacitinib) were not included. Three patients were deceased at the time of analysis, so were also excluded. The vaccination status of 461 patients was thus assessed. Vaccination status was determined via electronic health care records (Electronic Patient Records and the National Immunisation and Vaccination System) on Aug 27, 2021. In our cohort, the overall vaccination uptake of at least one dose was 96·5% (445 of 461 patients), with 95·0% (438 patients) fully vaccinated (appendix pp 1–2), surpassing the general population vaccination uptake of 79·4% in Oxfordshire and 88·2% nationwide.5UK GovernmentCoronavirus (COVID-19) in the UK: vaccinations.https://coronavirus.data.gov.uk/details/vaccinationsDate accessed: August 27, 2021Google Scholar All patients older than 60 years were vaccinated. Of note, the majority of patients (11 of 16) who formally declined vaccination were female, and five of these 11 unvaccinated women were pregnant, in the post-partum period, or planning pregnancy, suggesting a need for clearer guidance on vaccination in the peripartum period. Because more than 80% of patients with inflammatory bowel disease in Oxfordshire state their ethnicity to be White British, and more than 70% live in relative affluence (deciles 7–10 on the Index of Multiple Deprivation), we cannot draw clear conclusions on the effect of ethnicity or deprivation within our dataset. 277 of 279 patients in deciles 8–10 are vaccinated, including all 121 patients in decile 10. In the general population, greater vaccine hesitancy is reported in more deprived regions with higher unemployment rates and among people of non-White ethnicity.6Office for National StatisticsCoronavirus vaccine hesitancy falling across the regions and countries of Great Britain. Aug 9, 2021.https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/articles/coronavirusvaccinehesitancyfallingacrosstheregionsandcountriesofgreatbritain/2021-08-09Date accessed: August 27, 2021Google Scholar In conclusion, our analysis of patients with inflammatory bowel disease treated with infliximab and vedolizumab at a single centre shows a very high vaccination uptake and highlights a potential for vaccine hesitancy in female patients of child-bearing age with inflammatory bowel disease. Larger studies in diverse patient populations are needed to assess if these findings can be extrapolated more widely. JJS has received research support from The Helmsley Trust, The Action Medical Research, UK Research and Innovation, the Efficacy and Mechanism Evaluation programme, the European Crohn's and Colitis Organisation, the European Commission Horizon 2020 programme, and the European Commission FP7 programme; JJS is also a board member of the UK IBD Registry. RS, JW, and LM declare no competing interests. This work was partly supported by the Helmsley Trust as part of the ICARUS study (grant number 2107–04731). We thank Stephanie Brann, James Chivenga, Sarah Cripps, Chris Groves, Jennifer Hollis, Stephanie Jones (Oxford Radcliffe Biobank), the Oxford Inflammatory Bowel Disease Cohort Biomedical Research Centre, which is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre (Gastroenterology and Mucosal Immunology Theme), University of Oxford, and the Oxford Inflammatory Bowel Disease Cohort Investigators. We acknowledge the contribution to this study made by the Oxford Radcliffe Biobank, funded by the University of Oxford, the Cancer Research UK Oxford Centre, and the NIHR Oxford Biomedical Research Centre (Molecular Diagnostics Theme/Multimodal Pathology Subtheme). Download .pdf (.14 MB) Help with pdf files Supplementary appendix