title: Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement.
abstract: BACKGROUND
  Immunosuppressive agents used to treat inflammatory bowel disease (IBD) can increase the risk for infections, several of which are preventable through vaccination. Our study aimed to describe vaccine utilization by immunosuppression status, examine reasons for vaccine refusal, and identify characteristics associated with lack of influenza vaccination in patients with IBD.
  
  
  METHODS
  We administered an online survey between February 2012 and April 2012 to an internet-based cohort of patients with IBD in the Crohn's and Colitis Foundation of America Partners program.
  
  
  RESULTS
  During this time, 958 individuals completed the survey. The median age was 45, 72.8% were female, and 62.0% had Crohn's disease. Self-reported vaccination rates were low. Those on immunosuppression (n = 514) were more likely to be counseled to avoid live vaccines (P < 0.01). However, counseling rates were low (3.5%-19.1% for various live vaccines). Among the 776 individuals who received the influenza vaccine, maintaining health (74.1%), importance of prevention (66.1%), and provider recommendation (38%) were the most frequently cited motivations. Factors associated with lack of influenza vaccine included lower education level (P = 0.01), younger age (P = 0.02), and no chronic immunosuppression use (P < 0.01). Five hundred seventy (59.5%) individuals thought that patients were responsible for keeping track of their vaccines, whereas 428 (44.7%) placed responsibility on their gastroenterologist and 595 (62.1%) on their primary care physician.
  
  
  CONCLUSIONS
  Vaccine utilization remains suboptimal in patients with IBD. Educational interventions may increase vaccination rates by clarifying misconceptions. Gastroenterologists can play a more active role in health care maintenance in patients with IBD by counseling patients on which vaccines to receive or avoid.
authors.affiliation: *Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston, MA; and †Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC.
authors.forename: Sharmeel K
authors.initials: SK
authors.lastname: Wasan
authors.forename: Audrey H
authors.initials: AH
authors.lastname: Calderwood
authors.forename: Millie D
authors.initials: MD
authors.lastname: Long
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Francis A
authors.initials: FA
authors.lastname: Farraye
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014765:Viral Vaccines / Q000008:administration & dosage*; D014777:Virus Diseases / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D014765:Viral Vaccines