Immunization Rates of Inflammatory Bowel Disease Patients Receiving TNF-α Inhibitor Therapy

Purpose: Inflammatory bowel disease (IBD) patients are at increased risk of infection secondary to underlying disease and the immunosuppressive therapies used.  Although evidence supports routine vaccination of IBD patients, many opportunities to vaccinate this vulnerable population are missed.  The purpose of this research was to assess vaccination rates for IBD patients receiving tumor necrosis alpha (TNF-α) therapy and compare the vaccination rates to rheumatoid arthritis (RA) patients receiving TNF-α therapy.

Methods: All patients receiving at least one dose of TNF-α medication during a 44 month period were obtained using the pharmacy computer system and were randomly selected for study inclusion.  Included subjects had a diagnosis of IBD or RA.  Patients with multiple autoimmune disease were excluded. Influenza, pneumococcal, hepatitis A, and hepatitis B vaccination rates were manually obtained from the patients’ electronic medical records. Baseline patient characteristics were summarized using descriptive statistics with comparisons for each cohort. Differences in vaccination or screening between treatment cohorts were assessed using chi-square test (categorical measures) or t-tests (continuous measures) of independence. Statistical significance was determined at the 0.05 level.

Results: A total of 48 patients were evaluated (24 IBD, 24 RA). Half of the IBD patients received at least 75% of annual influenza vaccinations during the study period, compared with 54% of RA patients (p=NS).  Pneumococcal vaccine was received in 75% and 79% of IBD and RA subjects, respectfully (p=NS). Hepatitis A vaccination occurred more frequently in IBD patients than RA patients; 37.5% vs. 16.7%, respectively (p=0.193).  Similarly, hepatitis B vaccination was more common in IBD (58.3%) compared with RA (29.2%) patients (p=0.08).

Conclusion: Rates of influenza and pneumococcal vaccinations were similar among IBD and RA patients. Although not statistically significant, IBD patients were more likely to receive hepatitis A and B vaccination than RA patients. Opportunities exist to improve vaccination rates in both IBD and RA patients.