ABSTRACT
Background: Patients with Immune Mediated Inflammatory Diseases (IMIDs) treated with immunosuppressive drugs are at an increased risk of infections and a more complicated course of the infection, including vaccine-preventable infections. National and international guidelines have specified vaccination strategies in patients with IMIDs. However, the adherence to these guidelines in clinical practice is uncertain. Therefore, we evaluated the current vaccination status of patients with IMIDs at the outpatient clinic of the Erasmus MC Rotterdam. Method(s): Between August 2022 and October 2022, a survey was sent out to patients with various IMIDs at the rheumatology, dermatology and gastroenterology outpatient clinics. Only patients on immunosuppressive treatment were included. The survey contained questions on patient demographics, disease characteristics and current vaccination status. Result(s): The survey was sent out to 3,345 patients with IMIDs, of whom 1,094 patients filled in the questionnaire (response rate 32.7%). Mean age was 51 +/- 16 years and 40.8% were male (Table 1). Patients were treated by a dermatologist (n=306), gastroenterologist (n=414) and/or rheumatologist (n=527). Overall, 55.1% of patients received a yearly influenza vaccination and 9.2% occasionally (Table 2). Furthermore, 8.7% of patients received the pneumococcal vaccination five-yearly and 1.4% occasionally. Both the influenza and pneumococcal vaccination rates were highest in patients with rheumatoid arthritis (64.1%, and 14.7%, respectively). On the contrary, patients with hidradenitis suppurativa had the lowest rates for both the influenza vaccination (32.3%) and pneumococcal vaccination (n=0). Overall, 91.7% of patients (n=1,003) received one or more COVID-19 vaccinations. Conclusion(s): Patients with Immune Mediated Inflammatory Diseases are insufficiently protected against vaccine-preventable infections due to low vaccination rates. Better implementation strategies of current guidelines on seasonal influenza vaccination and pneumococcal vaccination are required. A high rate of COVID-19 vaccination was observed, possibly indicating the willingness of patients to receive vaccinations. Further research into facilitators and barriers to vaccination in these specific patient populations is required.
ABSTRACT
Background: Patients with inflammatory bowel disease (IBD) have reduced seroconversion rates to COVID-19 vaccination. It is unclear whether an impaired immune response in vaccinated IBD patients impacts the susceptibility to SARS-CoV-2 infection and occurrence of (severe) COVID-19. We evaluated SARS-CoV-2 breakthrough infection rates and the disease course of COVID-19 in vaccinated IBD patients. Method(s): A systematic literature search was performed for studies which reported SARS-CoV-2 breakthrough infection rates and/or the disease course of COVID-19 in patients with IBD after COVID-19 vaccination. Primary outcome was the rates of breakthrough infection per time period. In meta-analyses, the pooled relative risk was calculated with a random effects model for vaccinated patients compared to vaccinated controls, to partially vaccinated and unvaccinated patients with IBD. Result(s): A total of 16 studies were included in analysis. The study period ranged from January 2020 to October 2021, and a follow-up time ranges from 3 weeks to 6 months. The breakthrough infection rates range from 0 to 37.4% in IBD patients within the study follow-up time. Strikingly, only studies with vaccination prior to December 2021 showed a breakthrough infection rate above 2%. (Figure 1). The disease course of a breakthrough infection is generally mild, with mild constitutional and respiratory symptoms in 85% of infected IBD patients. Hospitalization and mortality rates are low (0-8.7% and 0-4.3% respectively). Meta-analyses showed a significantly lower pooled relative risk of breakthrough infection for vaccinated as compared to unvaccinated IBD patients (RR 0.07, 95% CI 0.03;0.18). No difference was observed in risk of breakthrough infections between IBD patients and non-IBD controls (RR 1.01, 95% CI 0.92;1.10), and no difference between vaccinated and partially vaccinated IBD patients (RR 0.67, 95% CI 0.38;1.18). The impact of immunosuppressive therapy on breakthrough infection rates differs between studies. One study reported higher breakthrough infection rates for patients treated with infliximab in comparison to vedolizumab (P<.05). Other studies showed no impact on the breakthrough infection rates for immunosuppressive treatment vs no treatment, anti-TNF-alpha/corticosteroids vs without anti- TNF-alpha/corticosteroids and other biologics vs anti-TNF-alpha. Conclusion(s): Vaccination is effective to prevent COVID-19 infections in patients with IBD. Breakthrough infections do occur, but the disease course is generally mild. Available data seem to suggest a declining trend of breakthrough infections during calendar time. Data on the impact of IBD medication on the rate of breakthrough infections and disease course require further elucidation. (Figure Presented).
ABSTRACT
Introduction: More than 2.5 million people in Europe are diagnosed with inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. It remains unknown if variations in IBD care and education differs across Europe and to help address this question, we conducted this European Variation In IBD PracticE suRvey (VIPER) to study potential differences. Aims & Methods: This trainee-initiated survey, run through SurveyMonkey ®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic. Results: The online survey was completed by 1268 participants from 39 European countries. Most of the participants are specialists (65.3 %), followed by fellows in training (>/< 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/ district hospitals (33.3 %) or private practices (16.3 %). Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). GDP was not a factor that dictated confidence in treating patients. IBD patients seen per week, IBD boards and especially IBD specific training were factors increasing confidence in managing IBD patients. Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001). In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p<0.001), as well as urgent flare clinics (58.6% vs 38.7%, p<0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%). Conclusion: A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.