PTU-084 Prevention of Opportunistic Infections in Patients on Biological Agents for Management of Inflammatory Bowel Disease

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Abstract

Introduction

Patients with inflammatory bowel disease are at increased risk of infection; this is especially true of the 20% on biological agents. ECCO guidelines recommend the following vaccines:

Introduction

Influenza (annual), Pneumococcal, Hepatitis B, Varicella, HPV (women under 26).

Introduction

The guidelines also highlight the need to exclude latent TB; local policy is to perform an interferon gamma release assay.

Introduction

Within the UK vaccination services are provided by primary care.

Methods

The measures taken to prevent opportunistic infection in patients prescribed anti-TNFs for IBD at Chelsea and Westminster Hospital in 2013 were audited against the ECCO OI Guidelines.

Methods

The following were retrieved from electronic records: age, sex, anti TNF prescribed, pneumococcal antibodies, hepatitis B core and surface antibodies, varicella IgG, Elispot®.

Methods

Attempts were made to retrieve vaccination history from General Practice.

Results

60 patients were prescribed infliximab and 15 patients were prescribed adalimumab. 46 GPs were able to provide vaccination history.

Results

Influenza: 50% (23/46) patients received vaccination against influenza within the past year.

Results

Pneumococcus: 55% (47/85) patients demonstrated immunity. 6% (5/85) were not immune and the remainder were not tested. The vaccination history of 26 patients who were not immune or not tested was retrieved. 27% (7/26) had since been vaccinated.

Results

Hepatitis B: No patients were core Ab positive. Surface Ab levels demonstrated immunity in 7% (6/85). 53% (45/85) were not immune, and the remainder were not tested. Vaccination history of 44 patients who were not immune or not tested was retrieved. Of these, 25% (11/44) had since been vaccinated.

Results

HPV: 4 patients were women under 26 years old. 25% (1/4) had confirmed HPV vaccination.

Results

Varicella: 21% (18/85) patients demonstrated immunity to varicella. 2% 2/85 were not immune.

Results

Elispot: 65% (55/85) patients had a nonreactive assay. 1% (1/85) had a positive result and the remainder were not tested.

Conclusion

The standards set out by ECCO to protect patients from opportunistic infection are not being met.

Conclusion

Problems obtaining accurate vaccination history from GP records include incorrect surgery details, lack of availability of staff able to review records and incomplete records. HPV vaccination usually takes place at school and is not routinely recorded by primary care.

Conclusion

Potential service improvements include provision of vaccines at clinic, improved patient education regarding the importance of vaccination and a check list to review bloods at first anti-TNF prescription.

Disclosure of Interest

None Declared.

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