Primary Care Professionals Mixed on Vaccine Recommendations for IBD Patients

Fang Xu, PhD

Clinical tools and reviewing current medical guidelines are some of the tools that could help increase vaccine reccomendations from primary care professionals (PCP) to patients with inflammatory bowel disease (IBD).

A team, led by Fang Xu, PhD, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, characterized the attitudes of primary care professionals on immunization practices for patients with IBD.

The Vaccines

In the study, the investigators assessed the likelihood of primary care professions recommending influenza, pneumococcal disease, herpes zoster, and human papilloma virus vaccinations for patients with IBD by PCP characteristics and availability of clinical tools using a web-based opt-in panel of primary care professionals.

The team examined the reasons for unlikelihood of recommending vaccines and different approaches to improve vaccine recommendations in the study.

A total of 1503 primary care professionals were included in the study, 64% of which recemented all of the vaccines. The most likely vaccine to be recommended was the herpes zoster, which was recommended by 89.8% of participants.

On the other hand, the pneumococcal vaccine was the least likely to recommended at just 74% of participants.

Clinical Tools

Some of the clinical tools significantly associated with the likelihood of recommending vaccines (P <.001) included electronic health records (48.9%) and staff tracking of patients’ vaccine needs (36.3%).

There was also a greater likelihood of vaccine recommendation observed from pediatricians compared to other medical specialties, as well as in group outpatient clinics compared to other worksites. In addition, primary care professionals who see more than 50 patients per week were likelier to recommend vaccinations (P <.05).

In addition, one-third of primary care professionals were unlikely to recommend more than 1 vaccine, with the top reason being unfamiliarity with vaccine guidelines for patients with IBD (48.0%)

The most frequently selected approaches identified to improve certainty of vaccine reccomendations include a review of guidelines or continued medical education (63.0%) and decision support from electronic health records (51.2%).

“There is room for improvement of vaccination recommendations by PCPs. Promoting continuing education and use of clinical tools may help support PCP immunization practices for patients with IBD,” the authors wrote.

COVID-19 Vaccines and IBD

Earlier this year, research confirmed that the SARS-CoV-2 vaccinations are safe and effective for patients with IBD.

Since the beginning of the COVID-19 pandemic there has been concerns regarding outcomes and increased risk of infections for patients with IBD, particularly those who are treated with immunosuppressive therapies.

Patients not currently on medications or being treated with 5-aminosalicylic acid (5-ASA)-based therapy had a pooled seroconversion rate of 95.6% (95% CI, 91.3-97.8%).

Patients treated with anti-Tumor Necrosis Factor alpha (anti-TNF α) had a pooled seroconversion rate of 95.4% (95% CI, 88.9-98.1%), compared to 97.2% (95% CI, 93.3-98.9%) for patients treated with anti-integrin therapy.

In addition, there was not a statistically significant difference in seroconversion rates of patients treated with anti-TNF α therapy and anti-integrin therapy (P = 0.43).

The pooled seroconversion rate for patients treated with anti-interleukin 12/23 therapy was 96.2% (95% CI, 89.6–98.7%) (compared to anti-TNF α therapy, P = 0.77; compared to anti-integrin therapy, P = 0.66) and the pooled seroconversion rate was 92.2% (95% CI, 68.9–98.4%) with Janus Kinase Inhibitor therapy (compared to anti-TNF α, P = 0.57; compared to anti-integrin therapy, P = 0.26).

The study, “Primary Care Professionals’ Attitudes Towards Vaccination Recommendation for Patients With Inflammatory Bowel Disease,” was published online in Inflammatory Bowel Diseases.