Many IBD patients don't get hepatitis B vaccine: US study

By Reuters Staff

Most patients with inflammatory bowel disease (IBD) do not receive screening for or vaccination against hepatitis B virus (HBV), according to a new study looking at a large tertiary gastroenterology practice.

"Physicians managing IBD patients should be aware of the need for screening and vaccination to prevent HBV infection and the European and AASLD and CDC guidelines for HBV screening and vaccination," Dr. Ece Mutlu of Rush University in Chicago and colleagues conclude.

IBD patients are at risk of HBV, especially if they are on immunosuppressant treatment long-term, Dr. Mutlu and colleagues note in their report, published November 7 in the World Journal of Gastroenterology.

Also, they write, immunosuppression can reactivate HBV replication in IBD patients who have the infection. The European Crohn's and Colitis Organization recommends patients be screened for HBV at the time of diagnosis, while U.S. guidelines recommend HBV screening and vaccination for people requiring immunosuppressant treatment.

"Given the acute and unpredictable need for biologics and steroids in many IBD patients, many experts recommend screening and vaccination to begin at the time of diagnosis of IBD, especially considering that over 80% of patients will require steroids, 40% will require purine analogs, and 20% will require TNF inhibitors sometime in their lifetime," the authors write.

To investigate prevalence of HBV infection and rates of screening and vaccination among IBD patients, the researchers conducted a retrospective review of 500 consecutive patients treated at their center between September 13, 2010, and January 31, 2013.

HBV screening had been ordered for 254 (51%) of the patients, and 220 (86%) underwent screening. Among the patients who were screened, 51% were not immune to HBV, and 3.6% had current or past HBV infection -- a prevalence similar to that seen in studies done in France and Spain.

Physicians recommended vaccination for 69 of the 129 patients (57%) who had negative titers. IBD specialists were more likely than other gastroenterologists to recommend vaccination to their patients, but their screening rates were similar.

Patients younger than 25 were more likely to have been vaccinated against HBV than patients older than 50, "which may relate to the changes in the last 20 years that have included HBV vaccine as part of childhood immunizations following availability of the recombinant vaccines," Dr. Mutlu and colleagues write.

Dr. Mutlu did not respond to an interview request by press time.


World J Gastroenterol 2014;20:15358-15366.

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