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Sub-Optimal H1N1 Vaccine Uptake by Immunocompromised IBD Patients
To the Editor
While the published independent review on the H1N1 vaccine during the
2009 H1N1 Pandemic concluded that the UK strategy used in the management
of the pandemic was highly satisfactory1, results of an audit on
immunosuppressed IBD patients we carried out at St. George's Hospital in
London suggests that delivery to high risk groups was sub-optimal.
It is well known that patients with chronic conditions such as
inflammatory bowel disease (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 sixty five years who are on
immunosuppressive drugs including prednisolone (dose of more than
20mg/day), azathioprine, 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 Inflammatory Bowel Disease Clinic at
St. George's Hospital between December 2009 - May 2010.
89 patients (47 males and 42 females) who answered the self-
administered, structured and confidential questionnaire were identified as
eligible for vaccination as per the BSG guidelines.
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 patients (51.6%) were concerned
about its side effects, while 11 (17.2%) were unaware of the vaccine's
existence and 9 (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, 7 (28.3%)
were concerned about its side-effects, while 8 (13.3%) did not believe in
the effectiveness of this vaccine.
Vaccination against Seasonal Flu had a better uptake, as out of the
89 patients, 53 (59.5%) were vaccinated. Amongst the 36 unvaccinated
patients, 23 patients (63.8 %) were concerned about its side-effects and
11 patients (30.5 %) were not worried about getting infected.
Our 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 patients awareness of the
advised vaccinations as well as scaremongering regarding their side-
effects.
We feel that both primary and secondary care physicians should focus on
addressing these factors behind non-vaccination by improving patient
education.
References
1) Wise J. UK response to H1N1 pandemic was highly satisfactory,
independent review says BMJ. 2010;341:c3569
2) Irving PM, Gibson PR. Infections and IBD. Nat Clin Pract
Gastroenterol Hepatol. 2008 Jan;5(1):18-27.
Sub-Optimal H1N1 Vaccine Uptake by Immunocompromised IBD Patients
Sub-Optimal H1N1 Vaccine Uptake by Immunocompromised IBD Patients
To the Editor
While the published independent review on the H1N1 vaccine during the
2009 H1N1 Pandemic concluded that the UK strategy used in the management
of the pandemic was highly satisfactory1, results of an audit on
immunosuppressed IBD patients we carried out at St. George's Hospital in
London suggests that delivery to high risk groups was sub-optimal.
It is well known that patients with chronic conditions such as
inflammatory bowel disease (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 sixty five years who are on
immunosuppressive drugs including prednisolone (dose of more than
20mg/day), azathioprine, 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 Inflammatory Bowel Disease Clinic at
St. George's Hospital between December 2009 - May 2010.
89 patients (47 males and 42 females) who answered the self-
administered, structured and confidential questionnaire were identified as
eligible for vaccination as per the BSG guidelines.
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 patients (51.6%) were concerned
about its side effects, while 11 (17.2%) were unaware of the vaccine's
existence and 9 (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, 7 (28.3%)
were concerned about its side-effects, while 8 (13.3%) did not believe in
the effectiveness of this vaccine.
Vaccination against Seasonal Flu had a better uptake, as out of the
89 patients, 53 (59.5%) were vaccinated. Amongst the 36 unvaccinated
patients, 23 patients (63.8 %) were concerned about its side-effects and
11 patients (30.5 %) were not worried about getting infected.
Our 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 patients awareness of the
advised vaccinations as well as scaremongering regarding their side-
effects.
We feel that both primary and secondary care physicians should focus on
addressing these factors behind non-vaccination by improving patient
education.
References
1) Wise J. UK response to H1N1 pandemic was highly satisfactory,
independent review says BMJ. 2010;341:c3569
2) Irving PM, Gibson PR. Infections and IBD. Nat Clin Pract
Gastroenterol Hepatol. 2008 Jan;5(1):18-27.
3) http://www.bsg.org.uk/patients/general/nacc-advice-on-swine-flu-
and-ibd.html (last accessed on 12/04/2010)
Competing interests:
None declared
Figure 1 uptake rates for H1N1, seasonal flu and swine flu
Figure 2 reasons for non-uptake of H1N1 vaccine
Competing interests: No competing interests