IDDF2018-ABS-0238 Uncovered dilemmas regarding vaccination in inflammatory bowel disease – should we follow the west?

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Abstract

Background

Vaccination is the most cost-effective strategy in disease prevention but remains an ambiguous area in Inflammatory Bowel Disease (IBD). Most patients will require immunomodulators/biologics at some time point; hence there exists a large unmet need for vaccination. Guidelines are not strict around the world while western guidelines are not pragmatic in Indian population; extrapolating may not be cost-effective. However, certain diseases are uncommon in Asia-Pacific countries including India. We gathered details on the recommendation for vaccination in IBD around the world, explored the appropriateness, and calculated the probable cost of implementing them.

Methods

A computer-assisted publication search of MEDLINE was performed on August 9, 2017, to identify guidelines and/or recommendations (in English) from the year 1980–2017 for vaccination in IBD which were later critiqued. Current Index of Medical Specialties (August 2017) was used for costing, expressed in Indian Rupee (INR) and UK pound sterling (£).

Results

This narrative review included nine articles, all highlighting the need to assess immunosuppressed state prior to administering live vaccines, while inactivated can be used safely. Hepatitis A, Meningococcal, Japanese encephalitis and Yellow fever vaccine (for travellers) could perhaps be withheld in Indian patients with IBD since their occurrence is low. Hepatitis B, Varicella Zoster (VZ), pneumococcal, HPV and yearly influenza shots look appropriate; rest should be decided on clinical wisdom based on the type of flare (MMR, DPT if unvaccinated). Majority of the vaccines have been available after 1980, patients born prior might need additional protection. The total cost of vaccinating per patient with IBD in the Indian context is INR 48016 (£ 534).

Conclusions

The timing of vaccination is crucial; patients with IBD need it regardless of age. Screening is necessary, but some can be excluded, rest decided on local disease prevalence. The disease should be in remission, medication optimised and health care maintenance updated. The need for specific vaccines should currently follow national guidelines. Proposed strategy preferably would be the development of Indian guidelines for vaccination in IBD. The cost of VZ, pneumococcal and Hepatitis A/B combination vaccine is colossally highlighting the need for prescribing cost-effective alternate vaccine brands when available.

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