title: Vaccination in inflammatory bowel disease patients: attitudes, knowledge, and uptake.
abstract: BACKGROUND
  Immunomodulators and biological agents, used to treat inflammatory bowel disease [IBD], are associated with an increased risk of infection, including vaccine-preventable infections. We assessed patient attitudes towards vaccination, knowledge of vaccine recommendations, and uptake of recommended vaccines.
  
  
  METHODS
  Patients attending IBD clinics completed a self-administered, structured, paper-based questionnaire. We collected demographic data, medical and immunisation history, self-reported patient uptake, knowledge, and perceptions of childhood and adult vaccinations.
  
  
  RESULTS
  The prevalence of treatment with biologicals, steroids, thiopurines, and methotrexate among the 300 respondents were 37.3%, 16.0%, 16.0%, and 5.7%, respectively. Self-reported vaccine completion was reported by 45.3% of patients. Vaccination uptake rates were 61.3% for influenza, 10.3% for pneumococcus, 61.0% for hepatitis B, 52.0% for hepatitis A, 26.0% for varicella, 20.7% for meningococcus, 5.3% for herpes zoster, and 11.0% for herpes papilloma virus [females only]. Significant predictors of vaccine completion were annual vaccination review by family physician (odds ratio [OR] = 1.82) or gastroenterologist [OR = 1.72], current steroid use [OR = 1.28], and current or prior treatment with biologicals [OR = 1.42]. The majority of patients reported that the primary responsibility to ensure vaccine completion lies with the patient [41.7%] and the family physician [32.3%]. Uncertainty about indications, fears of side effects, and concerns regarding vaccine safety were the most commonly reported reasons for non-uptake [22.0%, 20.7%, and 5.3%, respectively].
  
  
  CONCLUSIONS
  Uptake of recommended vaccines among IBD patients is suboptimal. Annual vaccination reviews by both family physician and gastroenterologist may improve vaccine uptake. Interventions targeted at improving vaccination uptake in IBD patients are needed.
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, ON, Canada Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Gurtej
authors.initials: G
authors.lastname: Malhi
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Rumman
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, ON, Canada.
authors.forename: Reka
authors.initials: R
authors.lastname: Thanabalan
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, ON, Canada Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Croitoru
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, ON, Canada Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Silverberg
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, ON, Canada Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Hillary Steinhart
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, ON, Canada Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada geoff.nguyen@utoronto.ca.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D019433:Chickenpox Vaccine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines; D053061:Herpes Zoster Vaccine; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D007252:Influenza Vaccines; D008297:Male; D022401:Meningococcal Vaccines; D008875:Middle Aged; D053918:Papillomavirus Vaccines; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D022242:Pneumococcal Vaccines; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D014612:Vaccines / Q000009:adverse effects; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine; D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines; D053061:Herpes Zoster Vaccine; D007252:Influenza Vaccines; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines; D022242:Pneumococcal Vaccines; D014612:Vaccines
keywords: IBD; vaccination; vaccination uptake