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Immunization Rates and Vaccine Beliefs Among Patients with Inflammatory Bowel Disease: An Opportunity for Improvement

Wasan, Sharmeel K. MD*; Calderwood, Audrey H. MD*; Long, Millie D. MD, MPH; Kappelman, Michael D. MD; Sandler, Robert S. MD, MPH; Farraye, Francis A. MD, MSc*

doi: 10.1097/01.MIB.0000437737.68841.87
Original Clinical Articles

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.

Article first published online 26 December 2013Supplemental Digital Content is Available in the Text.

*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.

Reprints: Sharmeel K. Wasan, MD, Section of Gastroenterology, Department of Medicine, Boston Medical Center, 85 East Concord Street, 7th Floor, Boston, MA 02118 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Supported, in part, by a grant from the Crohn's and Colitis Foundation of America.

The authors have no conflicts of interest to disclose.

Received September 27, 2013

Accepted October 22, 2013

© Crohn's & Colitis Foundation of America, Inc.
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