P404 Vaccinations and immunization status in Paediatric inflammatory bowel disease: data from the VIP IBD study

Abstract

Objectives and study: Due to the underlying disease, malnutrition status, immunosuppressive and biological therapies, the prevention of vaccine preventable diseases (VPD) in children with inflammatory bowel disease (IBD) is an increasingly recognised issue. In order to give specific recommendations, an ESPGHAN commentary on the risk of infection and prevention in paediatric patients with IBD was published in June 2012 (1). The aims of this study were to describe the compliance with ESPGHAN recommendations for vaccination and immunization status in IBD children and to evaluate differences among patients diagnosed before and after June 2012. Method(s): This retrospective, multicentre study included 12 pediatric IBD referral centres. Each center was asked to retrospectively collect the following data from children with a diagnosis of IBD before and after June 2012: demographic details, diagnosis characteristics, therapies, vaccinations and immunization status at diagnosis and at the start of immunosuppressants (IM) and biologics, reasons for incomplete immunization and decision making on IM and biologics. Result(s): Three-hundred-ninety-four IBD children [M/F: 224/170; Median age at enrolment: 15 years; Crohn's Disease (CD): 218; Ulcerative Colitis (UC): 164; Inflammatory Bowel Disease Unclassified (IBD-U): 12] were enrolled between May and November 2016. Among these, 50.2% and 48.8% were respectively diagnosed before and after June 2012. At diagnosis, the percentages of completion for single vaccination were: Diphtheria (99%), Tetanus (99%), Poliomyelitis (99%), Hepatitis B (99%), Pertussis (89%), Haemophilus Influenzae (69.3%), Pneumococcus (17.3%) Meningococcus C (23.9%), Measles (86%), Mumps (79.4%), Rubella (79.4%), Chickenpox (18.4%), HPV (4.1%) and Rotavirus (2%). Complete immunisation, according to the ESPGHAN commentary, was reported in 36% of the children. Among children with incomplete immunisation, specific vaccinations, before starting IM therapy, were recommended in 54.7% patients. In the remaining children, the reasons for not vaccinating were: need for immediate IM therapies (31.3%), parental refuse (8.4%), vaccination costs (3.4%) and other (56.9%). Two-hundred-fifteen (54.4%) out of 394 children started IM [Azathioprine: 204 (94.8%), Methotrexate: 9 (4.1%), other: 0.9%]. Among the children who startedAZA, EBV status was only checked in 70 patients (34.3%), with 29 (41.4%) resulting EBV immunised and 41 EBV naive (58.6%). Biologics was started in 154 (39%) children [Infliximab: 79.8%, Adalimumab: 20.1%]. Tubercolosis screening before starting biologics was practised in 145/154 patients (94.1%) with different methods: Tubercolin Skin Test (38.6%), Quantiferon TB Gold (65.5%), T-SPOT TB (0.6%) and chest radiography (71%). Only 117/394 (29.6%) patients yearly practice influenza vaccination. No significant differences were identified between patients diagnosed before and after 2012 in all the analysed variables. Conclusion(s): This study suggests a poor compliance with the ESPGHAN recommendations, highlighting the need of new strategies to deal with VPD in IBD children. Disclosure of interest: Annamaria Staiano served as investigator and member of advisory board for the following companies: D.M.G, Valeas, Angelini, Milte, Danone, Nestle, Sucampo, Menarini. Erasmo Miele served as speaker, as investigator and member of advisory board for the following companies: Abbvie, Angelini, Bioprojet, Ferring, Menarini, Milte, Valeas. The remaining authors have no conflict of interest to declare.