Patients with Inflammatory Bowel Disease (IBD), which is an immune-mediated inflammatory disease, are often treated with long-term immunosuppressive therapies. These patients are subsequently at increased risk for vaccine-preventable illnesses mostly because of the immunosuppressive agents, but also due the nature of the disease itself. Pneumococcal infection is one such vaccine-preventable illness, as well as a major risk factor for sepsis. Current guidelines recommend vaccination with PPSV23 if the patient is immunocompetent, or vaccination with PCV13 followed by PPSV23 if the patient is immunosuppressed. Our study aim was to evaluate the impact of race on the receipt of the PPSV23 vaccine among IBD patients.Methods:
Using electronic health records, we performed a retrospective review of IBD patients at an academic medical center over a 6 month period to evaluate the administration of PPSV23 between African American and non-African American patients. All IBD patients were under the care of faculty gastroenterologists. Data regarding demographics and vaccination status were compiled into a database while maintaining subject confidentiality. Statistical analysis was conducted using a 2-tailed Fisher's Exact Test with a significance set at P < 0.05.Results:
Out of 245 total patients, 39 (16%) had received the PPSV23 vaccinations. Among the 82 (33%) African Americans, 20 (24%) had received their PPSV23 vaccination. Among the 163 (67%) non-African Americans, 19 (12%) had received their PPSV23 vaccination. There is an absolute 2-fold increase among African Americans receiving the guideline-recommended pneumococcal vaccine (P = 0.015).Conclusions:
Our data indicate that not only do the majority of IBD patients not receive PPSV23 vaccinations, but that non-African American IBD patients are at significantly greater risk of nonimmunization. Though we are not quite sure of the exact reason behind this finding, we can attribute it to multiple different concepts. Reasons for nonimmunization may include the gastroenterologist's lack of familiarity with immunization guidelines or the patient's concern for possible side effects. Physician bias regarding assumptions on health care utilization and overall health status may play a role as well. It is important that the impact of race on immunizations be noted to ensure optimization of health care for all. This decreased rate of vaccination among non-African American patients is a unique finding. In fact, lower vaccination rates among African Americans have been well-documented in the existing literature. Greater immunization efforts include screening for vaccination history and risk at the time of initial IBD consultation, offering the pneumococcal vaccine regardless of immunosuppression status, and educational programs on vaccinations directed to gastroenterologists who prescribe immunosuppressive medications. Reassurance of patient concerns related to possible side effects and confirmation of vaccination at follow-up appointments could also help ensure higher immunization rates. Adherence to recommended guidelines will hopefully reduce the morbidity and mortality related to vaccine-preventable illnesses among the IBD patient population.