title: Inadequate knowledge of immunization guidelines: a missed opportunity for preventing infection in immunocompromised IBD patients.
abstract: BACKGROUND
  Immunosuppressive agents, used commonly to treat inflammatory bowel disease (IBD), are associated with an increased risk of infections, including those preventable by immunization. This study aimed to describe physician and patient values and knowledge regarding immunization and immunization histories.
  
  
  METHODS
  In all, 167 IBD patients and 43 gastroenterologists completed mail-out questionnaires. Patients were asked 15 questions about their immunization histories and attitudes towards immunization. Gastroenterologists were asked nine questions about immunization for the immunocompromised host.
  
  
  RESULTS
  The questionnaire return rate was 45.7% (43/94) for gastroenterologists and 25.2% (167/661) for patients. Only 14.3% (6/42) of gastroenterologists reported taking an immunization history from most or all of their patients. Only 5.4% (9/167) of patients recalled being asked by their gastroenterologist whether their immunizations were up to date, and just 0.6% (1/164) recalled being asked for a detailed immunization history. Overall, 21.7% (35/161) of patients had refused to be immunized in the past; 18.6% (8/43) of gastroenterologists did not know if up-to-date immunizations were important prior to starting immunosuppressive therapy. Of note, 23.1% (9/39) of gastroenterologists and 46.7% (35/161) of patients did not know whether live vaccines should be avoided by those in the immunosuppressed state, and 42.9% (18/43) of gastroenterologists acknowledged they did not know which specific immunizations should be avoided for immunosuppressed patients.
  
  
  CONCLUSIONS
  Gastroenterologists have limited knowledge of their IBD patients' immunization status and rarely take an adequate immunization history. Substantial proportions of IBD patients and gastroenterologists lack adequate knowledge of established immunization guidelines prior to initiation of immunosuppressive therapy.
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Canada.
authors.forename: James H
authors.initials: JH
authors.lastname: Yeung
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Goodman
authors.forename: Richard N
authors.initials: RN
authors.lastname: Fedorak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007114:Immunization; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007239:Infections / Q000188:drug therapy / Q000209:etiology*; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000276:immunology* / Q000628:therapy; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents