key: cord-0969022-5kfaferu
authors: Dalal, Rahul S.; McClure, Emma; Marcus, Jenna; Winter, Rachel W.; Hamilton, Matthew J.; Allegretti, Jessica R.
title: COVID-19 vaccination intent and perceptions among patients with inflammatory bowel diseases
date: 2021-02-04
journal: Clin Gastroenterol Hepatol
DOI: 10.1016/j.cgh.2021.02.004
sha: 3253b46a18a755f74cc6de7c1f5eaae003f74f7b
doc_id: 969022
cord_uid: 5kfaferu

Patients with inflammatory bowel disease (IBD) develop coronavirus disease 2019 (COVID-19) at similar rates as the general population, and there was initial concern regarding potential for severe illness.1-4 Vaccinations were authorized for emergency use in the United States in December 2020 and aim to halt the spread of COVID-19. However, there are concerns that people will be hesitant to receive the vaccine for a variety of reasons including insufficient data in certain populations including those with IBD. We surveyed patients with IBD to identify potential concerns regarding COVID-19 vaccination.

Patients with inflammatory bowel disease (IBD) develop coronavirus disease 2019 at similar rates as the general population, and there was initial concern regarding potential for severe illness. [1] [2] [3] [4] Vaccinations were authorized for emergency use in the US in 12/2020 and aim to halt the spread of COVID-19. However, there are concerns that people will be hesitant to receive the vaccine for a variety of reasons including insufficient data in certain populations including those with IBD. We surveyed patients with IBD to identify potential concerns regarding COVID-19 vaccination. We developed an anonymous survey using the secure platform Research Electronic Data Capture (REDCap). 5, 6 It assessed demographics, IBD history, influenza vaccination status, and concerns as well as intentions regarding COVID-19 vaccination. Participants were asked if they: 1) will receive the vaccine when available, 2) will likely receive it, but at a later time, 3) are undecided, or 4) will not receive it. Those who selected options 2-4 were asked about potential reasons for vaccination hesitancy. Several methods were employed to discourage multiple submissions from the same respondent and submissions from non-IBD patients (Supplementary Methods).

The primary outcome was intention to receive a COVID-19 vaccine as soon as it is available (i.e. "vaccination intent"). We used multivariable logistic regression to calculate adjusted odds ratios Table 1 .

Rates of COVID-19 vaccination intent were 80.9% for local and 60.0% for SM participants. The hesitant participants most commonly selected "concern that long-term safety of vaccines is unknown" (64.4% local, 70.1% SM) and "prefer to see how others tolerate vaccine first" (62.2% local, 55.6% SM). Approximately 70% desire data regarding vaccine safety/efficacy among patients with IBD (Supplementary Table 1 

Discussion A recent poll by the Kaiser Family Foundation estimates that 41% of Americans would "definitely get" the COVID-19 vaccine, though the rate among IBD patients is unknown. 7 Our survey suggests higher vaccination intent among an IBD population, which may be due to frequent interactions with healthcare providers or concerns of severe COVID-19 illness. These hypotheses are supported by the higher rates of influenza vaccination (92%) and COVID-19 vaccination intent (76%) among our local population, comprised entirely of referral patients. We observed that participants who are white, those age > 50 years, those with bachelor's degrees, those reporting prior COVID-19 infection, and those taking biologics were more likely to have vaccination intent. Those with vaccination hesitancy were largely concerned about long-term safety.

This study's strengths include recruitment of two populations with distinct vaccination behaviors, a large sample, and timely distribution of surveys within 2 weeks of vaccine authorizations. Limitations include response bias inherent to online surveys. Low response rates, which are partly due to an abbreviated study period, may overestimate vaccination intent. Therefore, our survey results do not represent the national IBD population or the full range of vaccination concerns. However the similarity of reasons for vaccination hesitancy in two distinct IBD populations suggests that such concerns are commonly shared.

In summary, our study identifies a relatively high rate of COVID-19 vaccination intent among the IBD populations assessed, but concerns about long-term safety are common. Vaccination intent is associated with white race, older age, education level, prior COVID-19 infection, and 

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Kaiser Family Foundation

*Respondents could choose multiple options for survey items #9 and #14

J o u r n a l P r e -p r o o f