Background: With increasing use of immunomodulators and biologics in IBD patients, there is focus on prevention of infections. ECCO consensus guidelines recommend screening to reduce the risk of infections. The yield and cost benefit of screening has not been ascertained. We aimed to evaluate the usefulness of a screening and vaccination strategy for patients with IBD. Methods: Consecutive patients who had screening tests prior to immunomodulatory and/or biologic therapy were included. Data collected on serologic status of Hepatitis B, Varicella Zoster, Quantiferon Gold for Tuberculosis, EBV IgM & IgG. Evidence of previously unknown hepatitis B, hepatitis C or HIV infection, non immune status to Varicella Zoster, indication for risk of latent or active tuberculosis, and serology indicative of no prior EBV infection were considered significant results. Cost to yield a relevant result was calculated and was compared to the cost of treatment for one patient with disseminated Varicella infection in our institution. Vaccination offered to non immune patients where considered appropriate by treating clinician and its response noted. Results: 147 patients were included (112 Crohn's, 35 UC). Median age was 27 years (range 16-73 years). None of the patients had evidence of active hepatitis B, C or HIV infection. 3 of the high risk patients received hepatitis B vaccination. 6 patients were non-immune to Varicella Zoster and 5 out of these had declared history of having had chicken pox in childhood. Five of these non-immune patients received VZV vaccine with successful seroconversion. Quantiferon Gold test was indeterminate in 7 patients but all were negative on T-SPOT test and had normal chest X-ray. One patient was positive for Quantiferon and had normal chest X-ray with no prior declared history of exposure to Tuberculosis. EBV serology was available in 72 patients and none had EBV IgM and all were positive for EBV IgG indicating past infection. The cost per patient in this cohort to yield a single clinically relevant test was 126. Conclusions: Screening in IBD patients prior to initiation of immunomodulatory and/or anti-TNF therapy may pick up potentially significant number of patients who are at risk of preventable illnesses. The cost of this strategy in this cohort may be offset by a single disseminated Varicella infection. History alone to guide risk status may not be reliable and serological confirmation is recommended. This strategy needs to be modified based on local prevalence data and tested on a larger multicentre cohort.
Miller, S. A., Harrison, L. C., Nelson, A., Ashton, K., Houston, Y., Rolph, M., & Sebastian, S. (2013). P149 Screening for preventable infections in IBD patients as per ECCO Consensus Guidance: Is it worth it? Journal of Crohn’s and Colitis, 7, S68–S69. https://doi.org/10.1016/s1873-9946(13)60171-3