Retrospective Study
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World J Gastroenterol. Nov 7, 2014; 20(41): 15358-15366
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15358
Hepatitis B vaccination in patients with inflammatory bowel disease
Ruwaida Ben Musa, Anuhya Gampa, Sanjib Basu, Ali Keshavarzian, Garth Swanson, Michael Brown, Rana Abraham, Keith Bruninga, John Losurdo, Mark DeMeo, Sohrab Mobarhan, David Shapiro, Ece Mutlu
Ruwaida Ben Musa, Graduate College, Rush University, Chicago, IL 60612, United States
Anuhya Gampa, Rush University, Chicago, IL 60612, United States
Sanjib Basu, Department of Preventive Medicine, Rush University, Chicago, IL 60612, United States
Ali Keshavarzian, Garth Swanson, Michael Brown, Rana Abraham, Keith Bruninga, John Losurdo, Mark DeMeo, Sohrab Mobarhan, David Shapiro, Ece Mutlu, Department of Gastroenterology and Nutrition, Rush University, Chicago, IL 60612, United States
Ece Mutlu, Department of Medicine, Clinical Research Section of Gastroenterology, Hepatology and Nutrition, Rush University, Chicago, IL 60612, United States
Author contributions: Ben Musa R collected, analyzed, interpreted the data, and wrote the paper; Gampa A wrote project protocol, set up data collection database and collected part of the data; Basu S reviewed all the statistics; Keshavarzian A, Swanson G, Brown M, Abraham R, Bruninga K, Losurdo J, DeMeo M, Mobarhan S and Shapiro D provided data and reviewed the manuscript; Mutlu E provided the hypotheses, designed the study, interpreted the data, supervised the data collection, analysis and wrote the paper; Mutlu E gave final approval of the version to be published.
Correspondence to: Ece Mutlu, MD, MS, MBA, Associate Professor, IBD Program Director, Department of Medicine, Clinical Research Section of Gastroenterology, Hepatology and Nutrition, Rush University, 1725 W. Harrison, Suite 206, Chicago, IL 60612, United States. ece_mutlu@rush.edu
Telephone: +11-312-563-3880 Fax: +11-312-563-3883
Received: November 23, 2013
Revised: May 31, 2014
Accepted: June 26, 2014
Published online: November 7, 2014
Abstract

AIM: To determine the prevalence for hepatitis B virus (HBV) and HBV screening and vaccination practices for inflammatory bowel disease (IBD).

METHODS: This study is a retrospective, cross-sectional observational study. A retrospective chart review was performed in 500 patients who have been consecutively treated for IBD between September 2008 and January 2013 at the Rush University Medical Center Gastroenterology section. The patients were identified through the electronic medical record with the criteria that they attended the gastroenterology clinic, and that they had a diagnosis of IBD at the time of visit discharge. Once identified, each record was analyzed to determine whether the subject had been infected with HBV in the past, already been vaccinated against HBV, or advised to get vaccinated and followed through with the recommended vaccination.

RESULTS: About 254 out of 500 patients (51%) had HBV screening ordered. Among those ordered to have screening tests, 86% followed through with HBV serology. Gastroenterology physicians had significantly different screening ratios from each other (P < 0.001). There were no significant differences in the ratios of HBV screening when IBD specialists were compared to other gastroenterology physicians (0.505 ± 0.023 vs 0.536 ± 0.066, P = 0.66). Of those 220 patients screened, 51% of IBD patients were found not to be immune against HBV. Approximately 50% of gastroenterology physicians recommended HBV vaccinations to their patients in whom serology was negative for antibodies against HBV. IBD specialists recommended vaccinations to a higher percentage of their patients compared to other gastroenterology physicians (0.168 ± 0.019 vs 0.038 ± 0.026, P = 0.015). Present and/or past HBV infection was found in 3.6% of the patients who had serology checked. There was no statistically significant difference in the prevalence of hepatitis B surface antigen (HBsAg) between our study and that reported in previous studies done in Spain (4/220 vs 14/2076 respectively, P = 0.070); and in France (4/220 vs 3/315 respectively, P = 0.159). But, the prevalence of anti-HBcAb in this study was less than that reported in the study in Spain (7/220 vs 155/2076 respectively, P = 0.006); and was not significantly different from that reported in the study in France (7/220 vs 8/315 respectively, P = 0.313).

CONCLUSION: The prevalence of HBsAg in our IBD patients was not higher than previously reported European studies. Most IBD patients are not routinely screened or vaccinated against HBV at a tertiary referral center in the United States.

Keywords: Inflammatory bowel disease, Hepatitis B, Prevalence, Vaccination, Ulcerative colitis, Crohn’s disease

Core tip: With immunomodulatory drugs being used for treatment of inflammatory bowel disease (IBD) patients, it is important that IBD patients be protected against preventable infections, specifically hepatitis B. Compared to previous literature, the prevalence of hepatitis B virus (HBV) in IBD patients in a large tertiary gastroenterology practice in the United States was not higher than Europe. However, a significant portion of IBD patients were not routinely screened and vaccinated against HBV at a large tertiary gastroenterology practice. This corroborates the need for gastroenterologists and primary care physicians to be cognizant of treating IBD patients for preventable diseases in addition to managing IBD itself. Further education and use of electronic record prompters may be needed to increase prevention of HBV.