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Rates and Predictors of Vaccinations Among Inflammatory Bowel Disease Patients Receiving Anti-Tumor Necrosis Factor Agents

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Abstract

Background

As an important quality measure, the rates of recommended immunizations among immunocompromised inflammatory bowel disease (IBD) patients in community practice have not been well studied.

Aims

This study sought to investigate the rates and predictors of recommended immunizations and screening tests among IBD patients receiving anti-tumor necrosis factor (TNF) therapy in a large integrated healthcare organization.

Methods

We conducted a retrospective cohort study of 1401 IBD patients on anti-TNF therapy between 2010 and 2013 within the Kaiser Permanente Northern California healthcare system. The rates of vaccinations and screening tests were quantified, and the associated predictors were investigated.

Results

Vaccination rates for influenza and pneumococcus were 43.5 and 24.1%, respectively. The majority of patients (73.7%) received hepatitis B screening and/or vaccine. Patients receiving infliximab had higher rates of pneumococcal vaccine (P = 0.002), hepatitis B screening (P < 0.001), and tuberculin skin test (P < 0.001) compared with patients receiving adalimumab. Older patient age (≥50 years) was associated with higher likelihood of having HBsAg test (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2–2.0, P = 0.002), influenza vaccine (OR 2.6 [2.1–3.4], P < 0.001), and pneumococcal vaccine (OR 4.0 [3.0–5.3], P < 0.001). In contrast, older providers (≥50 years) were associated with significantly lower likelihood of their patients’ having hepatitis A and B screening tests, and pneumococcal vaccination.

Conclusions

The rates of immunizations for IBD patients receiving anti-TNF treatment were lower than recommended. Structured reminders for vaccinations and education for both patients and providers (older physicians in particular) may prove beneficial in improving immunization rates among immunocompromised IBD patients.

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Abbreviations

IBD:

Inflammatory bowel disease

CD:

Crohn’s disease

UC:

Ulcerative colitis

TNF:

Tumor necrosis factor

KPNC:

Kaiser Permanente Northern California

Tdap:

Tetanus, diphtheria, pertussis

HBsAg:

Hepatitis B surface antigen

HBsAb:

Hepatitis B surface antibody

HAV Ab:

Hepatitis A antibody

TST:

Tuberculin skin test

CXR:

Chest X-ray

OR:

Odds ratio

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Acknowledgments

The authors thank Drs. Jonathan Blum and Ryan Knueppel for their helpful suggestions. Funding support was provided by Kaiser Permanente Northern California Graduate Medical Education Research, supported by Kaiser Permanente Community Benefits.

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Authors and Affiliations

  1. Department of Medicine, Kaiser Permanente Medical Center, Santa Clara, CA, USA

    Hung-Viet Pham & Imran Hasan

  2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Natalia Udaltsova, Mary Anne Armstrong & Debbie Postlethwaite

  3. Department of Pharmacy, Kaiser Permanente Medical Center, Santa Clara, CA, USA

    Kathy Pham

  4. Department of Pediatrics, Kaiser Permanente Medical Center, Santa Clara, CA, USA

    Oren Abramson

  5. Department of Gastroenterology, Kaiser Permanente Medical Center, Santa Clara, CA, USA

    Dan Li

Authors
  1. Hung-Viet Pham
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  2. Imran Hasan
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  3. Natalia Udaltsova
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  4. Kathy Pham
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  5. Oren Abramson
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  6. Mary Anne Armstrong
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  7. Debbie Postlethwaite
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  8. Dan Li
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Correspondence to Dan Li.

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All authors declare that they have no conflicts of interest.

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Pham, HV., Hasan, I., Udaltsova, N. et al. Rates and Predictors of Vaccinations Among Inflammatory Bowel Disease Patients Receiving Anti-Tumor Necrosis Factor Agents. Dig Dis Sci 63, 209–217 (2018). https://doi.org/10.1007/s10620-017-4716-6

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  • DOI: https://doi.org/10.1007/s10620-017-4716-6

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