Vaccination against SARS-CoV-2 in IBD: Acceptance and concerns in a cohort from Southern Italy

Introduction: Vaccination against severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) offers hope in the fight against the current pandemic. However, the rapid development of SARS-CoV-2 vaccines has led to uncertainties among the Italian population, as well as among patients with inflammatory bowel disease (IBD) despite the international recommendations.1,2 Therefore, identification of valuable strategies to increase vaccine uptake in this population is needed. Aims & Methods: The aim of this study was to measure the acceptance of anti-SARS-CoV-2 vaccination in IBD patients, in order to develop measures against vaccine hesitancy. An anonymous web-based questionnaire was sent from Apr 05 to Apr 15, 2021 to patients of our IBD tertiary referral center addressing socio-demographic and therapeutic features as well as willingness and potential concerns regarding anti-SARS-CoV-2 vaccination. Results: Among the 450 questionnaires, 276 (61.3%) forms were returned. The population included 149 (54.0%) males, 109 (39.4%) patients with a mean age range of 35-54 years and 148 (56.8%) patients with Crohn's disease. 127 (46.0%) were on biologics, 28 (10.0%) were on steroids > 20 mg, 18 (6.0%) were on immunomodulators and only 10 (3.6%) were treated with combination therapy. Almost half of the cohort (47.1%) had received an influenza vaccine in 2020. A very small proportion (7.2%) of respondents declared they had contracted COVID-19. The proportion of patients willing to get vaccinated against SARS-CoV-2 was 148 (53.6%);among them, 110 (74.3%) had already received the first dose of vaccine. 103 (37.3%) patients reported they were uncertain but likely to change their mind after more safety information, whereas 25 (9.0%) declared to definitely refuse vaccination. For patients in favour of vaccination, the main reasons were duty for collective responsibility (65.4%), the wish to return to a normal life (53.0%), fear about their health (51.4%) and the desire to protect their relatives (42.7%). For patients against vaccination, the main reasons were the fear of side-effects (52.0%) and the possible negative effects on IBD course (52.0%). The predictors for vaccination acceptance in a multivariate analysis were influenza vaccination during the last year [odds ratio (OR) 3.78;95% confidence interval (CI) 2.22-6.44, P<0.0001], presence of an household member aged over 65 years (OR 2.22;95% CI 1.20-4.10, P=0.01) and gastroenterologist advice before booking vaccination (OR 3.30;95% CI 1.77-6.17, P=0.001). In particular, age, educational status and associated comorbidities were not significantly associated with vaccination willingness. Conclusion: This survey indicates that the majority of IBD patients wish to be vaccinated against SARS-CoV-2. Vaccine acceptance was associated with prior seasonal influenza vaccination, presence of an household member aged over 65 years and notably, gastroenterologist advice. Indeed, gastroenterology counselling plays a crucial role in combat hesitancy among uncertain patients.