Sub-optimal H1N1 vaccine uptake by immunocompromised inflammatory bowel disease patients
While the published independent review on the H1N1 vaccine during the 2009 pandemic concluded that UK strategy used in the management of the pandemic was highly satisfactory,1 results of an audit on immunosuppressed inflammatory bowel disease (IBD) patients carried out at St George's Hospital, London, suggests that delivery of the vaccine to high risk groups was suboptimal. It is well known that patients with chronic conditions, such as IBD, who are treated with long-term immunosuppressive agents, are at increased risk of developing infections.2
During the H1N1 pandemic, the British Society of Gastroenterology (BSG) recommended H1N1, seasonal flu and pneumococcal vaccination for people between the ages of six months and 65 years who are on immunosuppressive drugs including prednisolone (dose of more than 20 mg/day), azathioprine, 6-mercaptopurine, methotrexate, infliximab and adalimumab.3
To assess patients' uptake of the recommended vaccines, especially the H1N1 vaccine, and reasons behind non-vaccination, an audit was performed on patients attending the IBD clinic at St George's Hospital from December 2009 to May 2010.
The 89 patients (47 males and 42 females) who answered the self-administered, structured and confidential questionnaire were eligible for vaccination as per the BSG guidelines and all were on immunosuppressant drugs, the most common being azathioprine (64/89) and prednisolone (31/89). Our data analysis showed that in spite of the H1N1 pandemic, vaccine uptake was suboptimal.
Of the 89 patients, only 25 (28.1 %) were vaccinated against swine flu. Of the 64 unvaccinated patients, 33 (51.6%) were concerned about its side effects, while 11 (17.2%) were unaware of the vaccine's existence and nine (14.1%) were not worried about getting infected. Pneumococcal vaccine showed a similarly low uptake as out of the 89 patients, only 29 (32.5%) were vaccinated. Of the 60 unvaccinated patients, 25 (41.7%) were unaware of this vaccine's existence, seven (28.3%) were concerned about its side-effects, while eight (13.3%) did not believe its effectiveness. Vaccination against seasonal flu had a better uptake, as out of the 89, 53 (59.5%) were vaccinated. Among the 36 unvaccinated patients, 23 (63.8%) were concerned about its side-effects and 11 (30.5%) were not worried about getting infected.
These results suggest that even in a pandemic, immunocompromised patients are abstaining from taking up the recommended vaccines and that this is likely due to a combination of lack of patient awareness of the advised vaccinations as well as scaremongering regarding their side-effects. Primary and secondary care physicians should focus on addressing these factors behind non-vaccination by improving patient education.
Footnotes
Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.
- © 2011 Royal College of Physicians
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