INCREASING HERPES ZOSTER VACCINATION RATES IN A HIGH RISK IBD POPULATION

ABSTRACT

Background and Aim: The American College of Gastroenterology recommendations are that adults over age 50 years old, with Inflammatory Bowel Disease (IBD), including those on immunosuppression, should be vaccinated against Herpes Zoster (HZ). Recently a recombinant HZ vaccine that is safe for people on immunosuppression called Shingrix, was approved and is administered as a 2-dose series with the second dose given 2 to 6 months after the first. The aim of this study is to improve HZ vaccination rates in IBD patients seen in the gastroenterology (GI) clinic at a Houston county hospital serving an indigent population over a 1-year period to over 75%. Methods We performed a retrospective analysis of IBD patients over age 50 years old, that have been seen in the GI clinic over a 2-month period at a 323-bed county hospital in northeast Houston that serves an uninsured/ underinsured lower socioeconomic population. We found that only 4.8% (1/21) of these patients were vaccinated for HZ. We then implemented a series of QI interventions as follows 1) Stakeholders had a 10-minute informal training session about the latest vaccination guidelines, vaccination side effects and safe practices with a stepwise algorithm placed at all clinic computer stations 2) A standardized IBD template was created with hard prompts to record vaccination status and 3) Nurses were educated on performing 2nd dose vaccination series on clinic follow up. Results During the past 4 months, 41 patients have met the vaccination criteria. Out of those 41 patients, 80.5% (33/41) received vaccinations, while 12.2% (5/41) did not receive immunizations and 3 declined immunizations when offered (Figure 1). At this time, 18.2% (6/33) patients have received their second Shingrix dose with no recorded side effects to date. Discussion A query of ICD-10 codes of HZ infections in IBD patients seen in our clinic over the past 5 years, revealed that 15 patients had experienced significant HZ flares;of whom 20 % (3/15) developed a secondary flair during that 5-year period and another 20% (3/15) developed herpes zoster opthalmicus, causing unilateral blindness in 2 out of those 3 patients (Figure 2). Through our QI implementation, we have successfully increased HZ vaccination rates from 4.8% to 80.5%. We hope to increase our 2nd dose vaccination rates in the following year, which has largely been impacted by a decrease in in person clinic visits due to COVID-19. This will help prevent HZ flares and serious complications from HZ in the future (Image Presented) (Image Presented) (Table Presented)