P-170 Male IBD Patients Are at Greater Risk of PPSV23 Nonimmunization Compared to Female IBD Patients

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Abstract

Background:

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 gender impact 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 6 months to evaluate the administration of PPSV23 between male and female 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:

There were 275 total patients and 39 (14%) had received the PPSV23 vaccinations. Among the 154 (56%) females, 28 (18%) had received their PPSV23 vaccination. Among the 121 (44%) males, 11 (9%) had received their PPSV23 vaccination. There is an absolute 2-fold increase in females receiving the guideline-recommended vaccine (P = 0.037).

Conclusions:

Our data indicate that not only do the majority of IBD patients not receive PPSV23 vaccinations, but that male 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. There is also potentially greater health utilization and contact of health care personnel by females, thus females may be more inclined to receiving their vaccinations. Inadequate immunization history taking can also contribute to this great lack of vaccinations. This study reminds both patients and providers of the importance of immunizations, especially in the setting of significant risk factors such as chronic illnesses and immunosuppression. Though the lack of vaccine coverage among patients with immune-mediated inflammatory diseases, such as IBD, is well documented in existing literature, the differential rate of vaccination between males and females is a rather unique finding. 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, especially among male IBD patients. Adequate humoral response to pneumococcal vaccination has been demonstrated among immune-mediated inflammatory disease patients. Adherence to recommended guidelines will hopefully reduce the morbidity and mortality related to vaccine-preventable illnesses among the IBD patient population.

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