ABSTRACT
Background: Vaccination against COVID19 prevents its severe forms and associated mortality and offers a promising action to control this pandemic. In Spain, by October 2021, 87.9% of the target population, including IBD patients had received the complete vaccination regimen. In September 2021, an additional dose of vaccine was approved in patients with immunosuppression including IBD patients on biologic agents. We evaluated the vaccination rate and additional dose willingness in this group of-at risk patients. Methods: A single-center, cross-sectional study was performed among IBD patients on biologic agents and elegibles for an additional dose of COVID19 vaccine between 19th October and 12th November 2021. Patients were identified by the list provided by the Pharmacy service. IBD clinical characteristics and type of vaccine and date of administration were checked in medical records. Acceptance and adverse effects of vaccination were evaluated after telephone or face-to-face survey in these IBD patients. Results: Out of a total of 344 patients, 269 patients (46.1% male;mean age 47±16 years;crohn's disease n=198/ ulcerative colitis n=66/ indeterminate colitis n=5) received at least one vaccine dose and were included. The patients were on Infliximab (40.9%), Ustekinumab (29.7%), Adalimumab (20%), and Vedolizumab (8.9%). Co-treatment with immunosuppressors was used in 73.2% of patients. Only 15 (5.6%) patients refused the COVID19 vaccine: 26.7% for fear of vaccine's adverse effects, 33.3% for doubts about a new-design vaccine and 40% for conviction (COVID19 pandemic denial). 46.7% of the cases would not change their opinion, but 33.3% would re-consider after discussing with their doctor and/or receiving information on the adverse effects of the vaccine. Previous to the additional dose, COVID19 vaccination was present in 94.4% of patients (n=254) (complete regimen using Pfizer 63%, Astra-Zeneca 15.4%, Moderna 12.2% and Janssen in 9.4% of patients, respectively). 42.7% of patients personally requested the appointment for initial dose of vaccination and 59.1% contacted the IBD Unit to discuss the decision to be vaccinated. Adverse effects occurred in 53.9% of the cases after the standard vaccination regimen, mainly pain in the arm (40%). Up to 94.1% of the patients agreed for an additional dose and 57.2% had already received the additional dose at the time of the assessment. Conclusion: IBD patients on biological agents and at high-risk for COVID19 accept the vaccine as well as an additional dose if recommended. Physicians in charge of IBD units should provide information and confidence in the use of the vaccine in these IBD patients. Remains to be studied the impact of the additional dose of vaccine in these patients.
ABSTRACT
Background: During the COVID-19 pandemic, outpatient activity and the performance of complementary tests have been limited in order to optimize health care resources in patients with SARS-CoV2 infection according to the incidence of cases in each time period. The aim of this study was to determine the impact of the measures implemented by the COVID-19 pandemic on the diagnosis, initiation of treatment, and follow-up of patients referred for suspected inflammatory bowel disease (IBD) at different times during the pandemic. Methods: Retrospective multicenter study comparing three cohorts of patients who were referred for evaluation in IBD consultation during three time periods: pre-pandemic pre-COVID19 (pC), from March to May 2019;during health alert alert-COVID19 (aC), from March to May 2020;and during a recent post-pandemic alert period post-COVID19 alert (p-aC), from January 2021 to March 2021. All patients referred with suspected IBD (first time consultation) were included. Epidemiological and clinical variables were recorded from the onset of digestive symptoms and up to a follow-up of 6 months after consultation. Results: A total of 114 first-time consultations were recorded: 47 in pC (age 45.3, SD 2.6 years;63.83% female), 24 in aC (age 48.3, SD 3.3;male 54.2%) and 43 in p-aC (age 44.5, SD 2.4;male 53.4%). Significant differences were determined in terms of the reason for consultation between the periods (recent diagnosis of IBD: 25.5% pC vs 41.7% cD vs 53.5% a-pC;p= 0.03 and suspicion of IBD: 74.5% pC vs 58.3% aC vs 46.5% in p-aC;p = 0.03). The diagnosis of IBD was confirmed in 44.6% of patients in the pC period, 66.6% in aC and 67.4% in p-aC, (p=0.06). There were no significant differences between the three periods in terms of time from suspicion of the disease to evaluation at the first visit and time to completion of complementary tests. However, there were significant differences in the time between diagnosis and initiation of treatment among the pC group (mean 1.7, SD 1.05 months), in contrast to 4.36 months (SD 2.03) in aC and 3.82 months (SD 1.3) in p-aC (p= 0.05). There were also no differences in the management (treatment and request for complementary tests) of the sucessive consultation, except for the number of hospital admissions in the six months following the first consultation (5 cases in pC vs. no admissions in aC and p-aC,p=0.03). Conclusion: During the COVID19 pandemic,the ability to diagnose patients with IBD has been maintained with no delays in the performance of complementary tests at participating centers. However, a delay in the initiation of treatment that could negatively impact the health of IBD patients is currently being maintained.