ABSTRACT
INTRODUCTION: The application of vaccination programs in patients with inflammatory bowel disease (IBD) is heterogeneous and generally deficient. As a result, adherence in these patients to a predefined vaccination program has not been clearly established. The aim of this study was to estimate adherence to a predefined vaccination program among patients with IBD and to identify the factors that may predict poor adherence. METHODS: All patients diagnosed with IBD and followed-up between January and March 2012 were referred to the Department of Preventive Medicine for evaluation of their immune status (with serological testing for hepatitis A, B and C viruses, varicella-zoster virus, mumps, rubella and measles), followed by vaccination based on the test results obtained and on the patient's vaccination history. The percentage of adherence to the vaccination program was determined, along with the factors associated with low adherence. RESULTS: A total of 153 patients with IBD (ulcerative colitis in 50.3% and Crohn's disease in 49.7%) were included (45.1% men and 54.9% women; mean age 43.30 ± 14.19 years, range 17-83). The vaccination program adherence rate was 84.3%. The factors associated with poor adherence were drugs related to IBD (patients not receiving immunosuppressants and/or biological agents showed lower adherence than those receiving these treatments; p = 0.021), adherence to medical treatment (poor adherence to treatment was also associated with poor adherence to vaccination; p = 0.016), and marital status (single, divorced or separated patients showed lower adherence than married individuals; p = 0.015). CONCLUSION: Adherence to vaccination is acceptable among patients with IBD. However, specific actions, such as optimization of patient information on the disease and emphasis on the need for adequate vaccination, are to improve adherence
INTRODUCCIÓN: La implantación de programas de vacunación en pacientes con enfermedad inflamatoria intestinal (EII) es heterogénea y en general, deficiente, por lo que no es bien conocida la adherencia de nuestros pacientes con EII a un programa de vacunación previamente establecido. El objetivo fue determinar la adherencia a un programa de vacunación establecido en nuestro centro en pacientes con diagnóstico de EII y definir qué factores pueden predecir una baja adherencia a dicho programa. MATERIAL Y MÉTODOS: Se derivaron al Servicio de Medicina Preventiva todos los pacientes con diagnóstico de EII revisados en consulta entre enero y marzo de 2012, con el fin de determinar su estado de inmunización (mediante la extracción de analítica con serologías del virus de la hepatitis A, B y C, virus varicela-zoster, parotiditis, rubeola y sarampión) y, posteriormente, ser vacunados teniendo en cuenta sus resultados así como el calendario vacunal previo. Se determinó el porcentaje de adherencia a dicho programa así como los factores relacionados con una baja adherencia. RESULTADOS: Se incluyeron 153 pacientes (45.1% hombres y 54.9% mujeres, con una edad media de 43.30±14.19 años, rango 17-83) con diagnóstico de EII (50.3% colitis ulcerosa y 49.7% enfermedad de Crohn). La adherencia al programa de vacunación fue del 84.3%. Los factores que se asociaron con una baja adherencia fueron: fármacos en relación con la EII (los pacientes que no tomaban inmunosupresores y/o biológicos presentaron una menor adherencia frente aquellos que sí los recibían, p 0.021), adherencia al tratamiento médico (aquellos con mala adherencia al tratamiento presentaron también baja adherencia a la vacunación, p 0.016), estado civil (solteros, divorciados o separados presentaron menor adherencia respecto a los casados, p 0.015). CONCLUSIÓN: La adherencia a la vacunación no es adecuada en pacientes con EII. Acciones específicas como la optimización de la información que se le proporciona al paciente acerca de su enfermedad y la necesidad de una adecuada vacunación, constituye un pilar fundamental para lograr mejorarla
Subject(s)
Humans , Inflammatory Bowel Diseases/epidemiology , Crohn Disease/epidemiology , Colitis, Ulcerative/epidemiology , Vaccination , Patient Compliance/statistics & numerical data , Medication Adherence/statistics & numerical dataABSTRACT
INTRODUCTION: The application of vaccination programs in patients with inflammatory bowel disease (IBD) is heterogeneous and generally deficient. As a result, adherence in these patients to a predefined vaccination program has not been clearly established. The aim of this study was to estimate adherence to a predefined vaccination program among patients with IBD and to identify the factors that may predict poor adherence. METHODS: All patients diagnosed with IBD and followed-up between January and March 2012 were referred to the Department of Preventive Medicine for evaluation of their immune status (with serological testing for hepatitis A, B and C viruses, varicella-zoster virus, mumps, rubella and measles), followed by vaccination based on the test results obtained and on the patient's vaccination history. The percentage of adherence to the vaccination program was determined, along with the factors associated with low adherence. RESULTS: A total of 153 patients with IBD (ulcerative colitis in 50.3% and Crohn's disease in 49.7%) were included (45.1% men and 54.9% women; mean age 43.30±14.19 years, range 17-83). The vaccination program adherence rate was 84.3%. The factors associated with poor adherence were drugs related to IBD (patients not receiving immunosuppressants and/or biological agents showed lower adherence than those receiving these treatments; p=0.021), adherence to medical treatment (poor adherence to treatment was also associated with poor adherence to vaccination; p=0.016), and marital status (single, divorced or separated patients showed lower adherence than married individuals; p=0.015). CONCLUSION: Adherence to vaccination is acceptable among patients with IBD. However, specific actions, such as optimization of patient information on the disease and emphasis on the need for adequate vaccination, are to improve adherence.
Subject(s)
Health Behavior , Immunization Schedule , Inflammatory Bowel Diseases/psychology , Vaccination/statistics & numerical data , Adolescent , Adult , Aged , Antibodies, Viral/blood , Biological Factors/therapeutic use , Comorbidity , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/immunology , Male , Marriage , Middle Aged , Patient Compliance , Prospective Studies , Young AdultABSTRACT
BACKGROUND AND OBJECTIVE: Patients with Inflammatory Bowel Disease (IBD) may have an increased risk of developing hepatitis B virus (HB) infection. Invasive procedures such as colonoscopies and surgery might be some of the reasons for this. Moreover, the use of immunosuppressors may reactivate a latent infection. We assessed the immune status among IBD patients receiving HB vaccine and the circumstances that predicted its results. AIMS AND METHODS: Serological markers of B and C hepatitis virus in patients with IBD who were referred for consultation were assessed since 2006. The subsequent determination of antibodies against superficial antigen (HBsAb) could differentiate between responders and non responders to the vaccine and an adequate immunity to HB was defined as higher than 10mUI/ml. RESULTS: One hundred and twenty nine patients were included in our study. Fifty-six (43,4%) patients had received immunosuppressive medication before the first vaccine dose. Notably, 85 (65.9%) patients had inadequate levels of HBsAb: 36 had no detectable levels and 49 had less than 10mUI/ml. Younger patients had a better immunity response than older patients (30.91+/-14.8 vs 39.91+/-14.2) (p<0.001). CONCLUSION: More than half of the patients had a suboptimal serologic response after vaccination. Only the younger group showed a better rate of response. It was not demonstrated whether an additional fourth dose of vaccination or a complete revaccination improved the rate of responders.
Subject(s)
Hepatitis B Vaccines/immunology , Inflammatory Bowel Diseases/immunology , Adult , Female , Hepatitis B/prevention & control , Hepatitis B Antibodies/blood , Hepatitis B Surface Antigens/immunology , Humans , Inflammatory Bowel Diseases/blood , Inflammatory Bowel Diseases/complications , MaleABSTRACT
Fundamento y objetivo: Aunque parece que no hay un aumento en la prevalencia de infección por el virus de la hepatitis B (VHB) en pacientes con enfermedad inflamatoria intestinal (EII), se especula que la necesidad de exploraciones invasivas e intervenciones quirúrgicas sitúa a estos pacientes dentro de un grupo de riesgo para contraer esta infección. Además, el uso cada vez más frecuente de inmunomoduladores puede conducir a una reactivación vírica latente. El objetivo de este trabajo fue evaluar la eficacia de la vacuna contra el VHB en pacientes con EII y las circunstancias que pueden influir en su resultado. Pacientes y métodos: Desde el año 2006, se determinaron los marcadores serológicos de los virus B y C de la hepatitis en los pacientes con EII atendidos en esta consulta médica de forma consecutiva. La posterior determinación de los anticuerpos contra el antígeno de superficie del VHB (anti-HBs) diferenció entre reactivos o no a la vacuna, y se consideró como respuesta valores iguales o superiores a≥10mUI/ml. Resultados: Se incluyó en el estudio a 129 pacientes. Cincuenta y seis pacientes (43,4%) habían recibido algún tratamiento inmunomodulador previo a la vacuna. En 85 pacientes (65,9%) la vacuna no indujo una respuesta adecuada: 36 pacientes no crearon anti-HBs y en 49 pacientes se desarrollaron títulos inferiores a 10mUI/ml. El único factor implicado en la respuesta de la vacuna fue la edad, de forma que en los pacientes más jóvenes la eficacia de la vacuna fue mayor (media de 30,91 [14,8] frente a 39,91 [14,2] años, p<0,001). Conclusiones: En más de la mitad de los pacientes con EII no se desarrolló una respuesta adecuada a la vacuna del VHB. El único factor relacionado con una mejor eficacia fue la edad más joven. Queda por demostrar si una cuarta dosis o si la revacunación completa aumentarían esta tasa de respuesta (AU)
Background and objective: Patients with Inflammatory Bowel Disease (IBD) may have an increased risk of developing hepatitis B virus (HB) infection. Invasive procedures such as colonoscopies and surgery might be some of the reasons for this. Moreover, the use of immunosuppressors may reactivate a latent infection. We assessed the immune status among IBD patients receiving HB vaccine and the circumstances that predicted its results. Aims and methods: Serological markers of B and C hepatitis virus in patients with IBD who were referred for consultation were assessed since 2006. The subsequent determination of antibodies against superficial antigen (HBsAb) could differentiate between responders and non responders to the vaccine and an adequate immunity to HB was defined as higher than 10mUI/ml. Results: One hundred and twenty nine patients were included in our study. Fifty-six (43,4%) patients had received immunosuppressive medication before the first vaccine dose. Notably, 85 (65.9%) patients had inadequate levels of HBsAb: 36 had no detectable levels and 49 had less than 10mUI/ml. Younger patients had a better immunity response than older patients (30.91±14.8 vs 39.91±14.2) (p<0.001). Conclusion: More than half of the patients had a suboptimal serologic response after vaccination. Only the younger group showed a better rate of response. It was not demonstrated whether an additional fourth dose of vaccination or a complete revaccination improved the rate of responders (AU)
