| Popis: |
Introduction Newham University Hospital, Bart’s NHS Trust, serves the London Borough of Newham which had the highest incidence of tuberculosis in the UK at 78.0 per 100,000 in 2014. Newham also has the highest average annual rate of new reported acute hepatitis B infection in the UK. There have been clear guidelines on pre-biologic screening for opportunistic infections since 2014. Our aim is to assess whether patients who are on biologic therapy have been appropriately screened prior to initiation of biologic therapy. Methods A retrospective review of all IBD patients on the biologic database was performed in November 2019. Patients who were initiated on biologics prior to the publication of guidelines in June 2014 were excluded. Results The total number of patients was 63. 31 patients (49.2%) had latent tuberculosis testing with Interferon-gamma release assay (IGRA) testing and 2 were positive. Screening with Chest XR (CXR) was better with 58.9% concordance. 36 patients had normal CXRs and 1 had an appearance of a granuloma. In comparison, viral screening had higher completion rates. Hepatitis B Surface Antigen (HbsAg) was sent in 53 patients (84%) and all were negative. Hepatitis B Core Antibody (HbcAb) was sent in 23 patients (36.5%) and 1 was positive. 1 patient was HbcAb positive but HbsAg negative. In terms of Hepatitis C, 51 patients (80.9%) had Hepatitis C IgG sent and all were negative. All 50 patients (79.3%) who were tested for Human immunodeficiency virus (HIV I+II antibody) were negative. Ebstein Bar Virus IgG was sent in 20 patients (31.7%), out of which, 15 were negative. Varicella-Zoster Virus IgG was sent in 39 patients (61.9%) and 2 were positive. An infection history was not taken, for either bacterial, fungal or viral infections and Bacille Calmette-Guerin vaccination status was not documented. No documentation was present regarding measles status. Routine vaccination status was not confirmed for diphtheria, poliomyelitis, pertussis, tetanus or Human Papilloma Virus. Prior to initiation of immunomodulation, vaccination was not considered for pneumococcal or influenza infections. Conclusions Despite suboptimal pre biologics screening in this high risk region of East London for Tuberculosis and Hepatitis B, no cases of reactivation of either Tuberculosis or Hepatitis B have been identified to date. The results suggest that clinicans are requesting some tests but not all. Following on from these results, we will be streamlining the process for ensuring all tests are performed prior to biologic initiation with a checklist proforma for the patients notes and on our biologics database for all prescribing gastroenterologists, as per ECCO guidelines. |
