Op Ed: Immunisation rates were suboptimal in patients with IBD on biologic treatment.
Background & Rationale
Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapies, including biologic agents, are at increased risk of infection. Consequently, adherence to recommended immunisation schedules is paramount to mitigate this risk. However, immunosuppression may also impair the immunogenicity of vaccines, potentially leading to suboptimal protection. This retrospective study aimed to assess the proportion of IBD patients on biologic therapy who were up-to-date with recommended vaccinations, identifying potential gaps in immunisation coverage within a single centre in Ireland. Optimising vaccination strategies is crucial for maintaining patient safety and preventing vaccine-preventable illnesses in this vulnerable population.
Study Design
A retrospective chart review was conducted at Our Lady’s Hospital, Navan, Ireland. The study included all IBD patients (Crohn’s disease and ulcerative colitis) currently on biologic therapy as of December 2022. Data were extracted from electronic medical records, focusing on vaccination history against influenza, pneumococcal disease, and SARS-CoV-2. Patients were considered up-to-date if they had received vaccinations according to national guidelines applicable at the time of review. Vaccination records were cross-referenced with documented evidence of administration. The primary outcome measure was the percentage of patients compliant with recommended immunisation schedules.
Patient Population
The study cohort comprised 141 IBD patients receiving biologic therapy. The mean age of participants was 48.4 years, with a standard deviation of 12.3 years. 75 patients (53.2%) were diagnosed with Crohn’s disease, while 66 (46.8%) had ulcerative colitis. 79 patients (56.0%) were female. The majority of patients (86.5%) were receiving anti-TNF therapy, with the remaining patients receiving anti-integrin or anti-IL-12/23 therapy. The mean duration of biologic therapy was 4.5 years.
Key Findings
Of the 141 patients, 53 (37.6%) were fully up-to-date with all three recommended vaccinations – influenza, pneumococcal, and SARS-CoV-2. 67 patients (47.5%) had received the influenza vaccine, 42 (29.8%) had received the pneumococcal vaccine, and 87 (61.7%) had received at least one dose of a SARS-CoV-2 vaccine. 38 patients (27.0%) reported having had no vaccinations during the study period. Amongst the anti-TNF group, 34.8% were fully up to date, compared to 46.2% of patients on non-anti-TNF biologics. Duration of biologic therapy did not show a significant association with vaccination status.
Discussion
The results indicate suboptimal immunisation adherence among IBD patients on biologic therapy in this Irish cohort. Less than half of the patient population had received all three recommended vaccines, highlighting a significant area for improvement in clinical practice. The relatively low uptake of pneumococcal vaccination is particularly concerning, given the increased susceptibility to pneumococcal infection in immunosuppressed individuals. The higher adherence to SARS-CoV-2 vaccination likely reflects public health campaigns and widespread availability of the vaccine during the study period.
The observed difference in vaccination rates between patients on anti-TNF agents and those on other biologics warrants further investigation. Potential reasons include differences in prescribing practices, patient demographics, or awareness of specific immunisation recommendations, as well as differing levels of immunosuppression. Overall, the study underscores the need for proactive strategies to promote vaccination in this vulnerable patient population. The retrospective nature of the study and the single-centre design limit generalisability, but highlight the need for further investigation. Reported tolerability of these vaccines was good with no significant adverse events documented directly related to vaccination.
Authors’ Conclusions
The authors concluded that adherence to recommended immunisation schedules was suboptimal in IBD patients on biologic therapy at their institution. This highlights the need to improve vaccination rates in this population through targeted interventions, including provider education, patient reminders, and integration of vaccination assessments into routine IBD care. Further research is required to identify barriers to vaccination and develop strategies to enhance immunisation coverage.
Reference
Khan A, Shahab M, Anwar MM. Adherence to Recommended Immunisation Schedules for Patients With Inflammatory Bowel Disease (IBD) on Biologics: A Retrospective Study at Our Lady’s Hospital, Navan, Ireland. Cureus. 2026; 18(4): e105024. DOI: 10.7759/cureus.105024.