Age, Prior Vaccination Predict Future Vaccine Receipt in Patients with IBD

Gil Melmed, MD

Credit: Cedars-Sinai

A recent study suggests educational videos and text-based interventions may not be enough to move the needle for influenza vaccine uptake in adults with inflammatory bowel disease (IBD).

Results of the study, which included more than 1000 patients with IBD, found these efforts had little impact on vaccine uptake, but also indicate prior vaccine receipt could serve as a reliable predictor of future vaccination.¹

“Preventive health guidelines in IBD emphasize the importance of appropriate vaccination, bone health prevention strategies, and cancer screening. However, the knowledge and uptake of preventive health recommendations for patients and providers alike is suboptimal,” wrote investigators.¹

Although it may not receive the same attention from public health efforts as diabetes or cardiovascular disease, IBD poses a significant threat to overall health and quality of life for many, with the US Centers for Disease Control and Prevention estimating 3.1 million adults in the US have IBD.² The Mayo Clinic outlines vaccination for vaccine-preventable diseases as a cornerstone of management for patients with IBD.³

To address barriers related to vaccination in patients with IBD, a team led by Gil Melmed, MD, director of the Inflammatory Bowel Disease Clinical Research Medicine Center at Cedars-Sinai, conducted a randomized controlled trial in which they assessed the efficacy of 5 iteratively developed educational videos relative to text-only messaging. Immediately following intervention, 73% of patients reported their intention to receive the influenza vaccine regardless of messaging type. The proportion of patients who received the vaccine after intervention did not differ by intervention type (P = .07). Multivariable regression revealed the strongest predictor of intention to receive and actual receipt of the influenza vaccine was prior vaccination.¹

Using the IBD Partners Patient-Powered Research Network, investigators identified a cohort of 1056 adult patients aged 18-80 years with IBD for inclusion in the study. Of note, participants who reported a prior allergic reaction to the influenza vaccine or who were otherwise medically unable to receive the vaccine were excluded from the study.¹

Participants were randomized to receive the video or text-only interventions, with 511 randomized to video and 545 randomized to the text-only intervention. Intervention content was targeted to the individual participant’s medical and demographic profile to ensure they met the criteria for the health recommendation and had not previously received the recommended care.¹

Investigators used stratified analyses to assess for intervention-effect heterogeneity based on prior immunization history and use of immunosuppressive therapy. Age, sex, smoking status, duration of Crohn’s disease or ulcerative colitis, and current use of immunosuppressive therapy were individually examined for potential confounding of influenza vaccine uptake using univariable logistic regression analysis.

Upon analysis, investigators found no difference in participants’ intention to receive influenza vaccine by receipt of the video or text-only interventions immediately after receiving the preventive health recommendation (72% vs 75%; P = .62). Investigators also pointed out73% of patients reported an intention to vaccinate after either intervention compared to 57% of patients who had actually received a vaccine the year prior (P < .001).¹

Further analysis showed no difference in the rate of receipt of the influenza vaccine between the 2 educational interventions. Among the 667 patients who completed the study, 57% (n=345) of those who received text education and 63% (n=322) of those who received video education reported receiving the influenza vaccine between September 2019 and March 2020 compared to 55% and 59% in the prior year, respectively.¹

Investigators identified prior vaccination as the strongest predictor of future vaccine receipt. Older age was also associated with a higher likelihood of both intention to vaccinate (age 36-75 years relative to 18-35 years; P = .006) and actual vaccination (age > 75 years relative to age 18-35 years; P = .05).¹

“Although it is unlikely that messages conveyed by either text or video will modify knowledge, attitudes, and beliefs regarding preventive health, both text-based and video-based messages may be useful tools to open discussion between physicians and patients,” concluded investigators.¹

References:

1. Long M, van Deen W, Weisbein L et al. Web-Based Video Education to Improve Uptake of Influenza Vaccination and Other Preventive Health Recommendations in Adults With Inflammatory Bowel Disease: Randomized Controlled Trial of Project PREVENT. J Med Internet Res 2023;25:e42921 https://www.jmir.org/2023/1/e42921 DOI: 10.2196/42921
2. People with IBD have more chronic diseases. Centers for Disease Control and Prevention. April 15, 2022. https://www.cdc.gov/ibd/features/IBD-more-chronic-diseases.html.
3. Digestive diseases. Mayo Clinic. https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/health-care-maintenance-in-patients-with-ibd/mqc-20536631.