Post pandemic vaccination adherence in patients with inflammatory bowel disease: a cross-sectional observational study

Objective Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapy are at increased infection risk. Although many infections are vaccine-preventable, immunisation uptake in IBD remains suboptimal, and hesitancy has increased since the COVID-19 pandemic. We assessed adherence to vaccination recommendations and barriers to uptake among immunosuppressed patients with IBD in North West London. Methods A paper-based survey was completed by 209 patients with IBD attending St Mark’s Hospital and Imperial College Healthcare NHS Trust between 19 February and 19 April 2024. Data on demographics, vaccination history and prior counselling were collected. The primary composite outcome was receipt of pneumococcal, influenza and SARS-CoV-2 vaccines within recommended timeframes, according to UK guidelines for immunosuppressed patients. Univariate and multivariate analyses identified factors associated with uptake, and adherence to national guidance on pre-treatment vaccine counselling was evaluated. Results Of 194 patients on immunosuppressive medication, only 22.2% were fully vaccinated. Uptake was low for pneumococcal (30.9%), COVID-19 booster (56.7%) and influenza (64.4%) vaccines. Older age and receiving vaccine recommendations from healthcare professionals were significantly associated with uptake (OR=1.03 (95% CI 1.00 to 1.07) and OR=3.43 (95% CI 1.73 to 6.92), respectively). Common barriers included uncertainty about necessity, limited awareness and safety concerns. Over 40% reported inadequate counselling before starting immunosuppression. Vaccine recommendations from healthcare professionals were infrequent (66.8% for influenza, 59.1% for COVID-19 booster, 22.4% for Shingrix). Conclusion Vaccination uptake among immunosuppressed patients with IBD remains low in the post pandemic era. Clinicians and the wider multidisciplinary team should actively promote vaccination, given the strong association between healthcare professional-led counselling and improved uptake.