Pneumococcal Vaccination Recommendation and Completion Rates Among Patients With Inflammatory Bowel Disease and Barriers to Vaccination

BACKGROUND

Guidelines for inflammatory bowel disease (IBD) patients receiving immunosuppression encouraged both the pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13). We aimed to evaluate which pneumococcal vaccines are recommended and administered, and to understand provider and IBD patient knowledge regarding pneumococcal vaccinations.

METHODS

We performed a retrospective, cross-sectional analysis of 357 adult IBD patients on immunosuppression in our health care system. Patient demographics and clinical characteristics were collected. The primary outcome was rate of documented vaccinations recommended by providers; the secondary outcome was rate of receipt of the vaccines. We identified factors associated with receipt of any pneumococcal vaccine through multivariable logistic regression. We also performed provider and IBD patient surveys to understand provider and patient knowledge regarding pneumococcal vaccines. We used χ 2 and Fisher exact tests to assess survey responses.

RESULTS

Fifty seven percent of IBD patients had any pneumococcal vaccination recommended and 35% had recommendations for both PPSV23 and PCV13. Forty percent received any pneumococcal vaccine and 18% received both vaccines. In multivariable analyses, increasing age (adjusted odds ratio: 1.03, 95% CI: 1.01-1.05) was associated with receipt of any pneumococcal vaccine, after adjusting for gender, race, insurance, disease activity, and time seen in our gastroenterology clinics. In the survey study, on average, 59% of providers correctly answered questions regarding pneumococcal vaccination indications.

CONCLUSION

In our health care system, while recommendation for any pneumococcal vaccination was >50%, receipt of both PPSV23 and PCV13 was low. Simplified vaccine regimens (ie, PCV20) will likely improve vaccination rates.

Declining Rates of Surgery for Inflammatory Bowel Disease in the Era of Biologic Therapy

BACKGROUND

Medical therapy for inflammatory bowel disease (IBD) has markedly advanced since the introduction of biologic therapeutics, although surgery remains an important therapeutic strategy for both Crohn's disease (CD) and ulcerative colitis (UC). This study evaluated how rates of bowel resection surgery and post-operative mortality for IBD have changed over the last decade in the era of biologic therapies.

METHODS

The Nationwide Readmission Database (NRD) was queried for patients with IBD (based on ICD-9 and -10 diagnosis and procedure codes) who were hospitalized between 2010 and 2017. Longitudinal trends in bowel resection surgery, urgent surgery, and post-operative mortality were analyzed.

RESULTS

During the 8-year period, a total of 1795,266 IBD-related hospitalizations (1,072,110 with CD and 723,156 with UC) were evaluated. There was an increase in the annual number of IBD patients hospitalized, but a statistically significant decrease in the proportion of IBD patients undergoing surgery, from 10 to 8.8% (p < 0.001) for CD and 7.7 to 7.5% (p < 0.001) for UC. From 2014 through 2017, the proportion of urgent surgeries remained stable around 25% (p = 0.16) for CD and decreased from 21 to 14% (p < 0.001) for UC. For CD, the rate of post-operative 30-day mortality varied between 1.2 and 1.6% and for UC decreased from 5.8 to 2.3% (p < 0.001).

CONCLUSIONS

Analysis of a nationwide dataset from 2010 to 2017 determined that despite an increase in total admissions for IBD, a smaller proportion of hospitalized patients underwent surgery. A greater proportion of surgeries for UC were performed on an elective basis, and overall the rates of post-operative mortality for CD and UC decreased. The growth of biologic medical therapy during the study period highlights a probable contributing factor for the observed changes.

MR imaging in hepatic transplantation

This article reviews the utility of MR imaging in the evaluation of liver transplantation. Issues related to the prospective transplant donor and recipient, such as inclusion and exclusion criteria, indications and contraindications, and imaging of donor anatomy and recipient pathology, are discussed. Post-transplantation complications and their imaging features are reviewed, with emphasis on the use of MR arteriography, venography, and cholangiography. MR is a single, noninvasive examination that allows a comprehensive investigation of anatomic and pathologic features in pre- and postoperative liver transplant patients, and may eventually replace many, if not all, of the numerous diagnostic examinations performed in this patient population.

Staphylococcal enterotoxin A has two cooperative binding sites on major histocompatibility complex class II

The superantigen staphylococcal enterotoxin A (SEA) binds to major histocompatibility complex (MHC) class II molecules at two sites on either side of the peptide groove. Two separate but cooperative interactions to the human class II molecule HLA-DR1 were detected. The first high affinity interaction to the DR1 beta chain is mediated by a zinc atom coordinated by H187, H225, and D227 in SEA and H81 in the polymorphic DR1 beta chain. The second low affinity site is to the DR1 alpha chain analogous to SEB binding and is mediated by residue F47 in SEA. Binding of one SEA to the DR1 beta chain enhances the binding of a second SEA molecule to the DR1 alpha chain. The zinc site is on the opposite side of the SEA molecule from residue F47 so that one SEA molecule can readily bind two class II molecules. Both binding sites on SEA are required for maximal activity. Thus, unlike, SEB, SEA requires two separate binding sites for optimal activity, which may allow it to stabilize SEA interaction with T cell receptors, as well as to activate the antigen-presenting cell by cross-linking MHC class II.

Infectious transcripts and nucleotide sequence of cloned cDNA of the potexvirus white clover mosaic virus

The complete nucleotide sequence of white clover mosaic virus (WCIMV) strain O has been determined and compared to the WCIMV strain M sequence. The two virus strains show 12% divergence at the nucleotide level and 3% divergence at the amino acid level (open reading frames 1 to 5). Two open reading frames, 10 and 21 kDa, identified in the strain M sequence were not found in the strain O sequence. High levels of infectious RNA transcripts were produced from a full-length cDNA clone of strain O constructed downstream of the SP6 RNA polymerase promoter (greater than 2 micrograms RNA/micrograms template DNA). Symptoms characteristic of WCIMV developed when host plants were inoculated with SP6 RNA transcripts. The specific infectivity of transcript RNA produced in the presence of m7GpppG was similar to that of virion RNA. The SP6 transcripts lacked 5' nonviral nucleotides, but contained 6, 14, or 198 3' nonviral nucleotides (derived from the pUC19 vector). Transcripts were infectious without m7GpppG, or with long nonviral 3' nucleotide stretches. Progeny virus RNA from infections initiated with transcripts containing 198 nonviral 3' nucleotides did not maintain these sequences.