P127 Assessing the vaccination and immunization status in a Paediatric Inflammatory Bowel Disease diagnosis
Palomino Pérez, L.M.(1);Velasco Rodríguez-Belvis, M.(1);León Falconi, J.L.(1);Sánchez Fernández-Bravo, C.(1);Vazquez Gómez, J.A.(1);Muñoz Codoceo, R.A.(1);
(1)Hospital Infantil Universitario Niño Jesús, Paediatric Gastroenterology and Nutrition, Madrid, Spain
Background
Paediatric inflammatory bowel disease (PIBD) patients are especially prone to vaccine-preventable diseases and opportunistic infections. The aim was to evaluate the immunization and vaccination status in PIBD.
Methods
Descriptive and retrospective study that analyzes the immunization and/or vaccination for measles, mumps and rubella (MMR), hepatitis B virus (HBV), chickenpox, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) of PIBD patients in a tertiary paediatric hospital (Jan 2015- Oct 2019) in the first 6 months after diagnosis.
Results
Amongst 57 patients, 17 (30%) had ulcerative colitis (UC), 35 (61%) Crohn ́s disease (CD) and 5 (9%) unclassified IBD (uIBD). Up to 35 (61%) were male and the mean age at diagnosis was 10.2±4.1 years. A total of 18 (32%) were currently on biological treatment and 45 (79%) on immunosuppressants. The disease location in CD patients was L3 (Paris classification) in 22 (63%) and L4a in 13 (37%). Only 2 (6%) showed perianal involvement. From the UC patients, 11 (65%) were E4. A delayed growth was observed in 6 (10%), all CD patients. At diagnosis, 37 (65%) were HBV-vaccinated, 13 of them (35%) had a serological response and 22 (59%) had no response. 18 were re-vaccinated and 9 (50%) had a documented serological response. Up to 34 patients (60%) were MMR-vaccinated and 13 (38%) showed a complete response. Only 6 patients could be re-vaccinated. Up to 30 (52%) showed chickenpox immunization. Only 4 of the non-immunized patients could be vaccinated and all of them responded to a single dose. Regarding CMV and EBV, 17 and 16 patients (46 and 43%) were IgG positive respectively, all of them IgM negative. Patients with CD were more likely to need HBV re-vaccination than other IBDs (p< 0.05). Regarding chickenpox, CD patients without growth delay (G0) needed less re-vaccination than those whose growth was affected (G1) (p< 0.05). However, UC patients with extensive disease (E4) needed less re-vaccination than those with limited disease (p< 0.05). Male patients seemed to be less likely to need re-vaccination, with no significant differences.
Conclusion
The serological assessment of vaccine-preventable diseases immunization yielded poor results. A high percentage of HBV and MMR vaccinated patients showed no response. CD patients tended to more likely need revaccination, especially in the most severe cases (G1). Surprisingly, severity was not related with vaccination response in UC. Our results suggest that less than half of the patients had been previously infected by CMV or EBV. It seems reasonable to serologically check the immunization status in PIBD patients in order to, when appropriate, re-vaccinate before starting immunosuppressive therapies.