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  • Mohammad Shehab 1,2,*,
  • Ranim Almatar 1 and
  • Ahmad Alfadhli 1
  • et al.

Reviewer 1: Angel Robles-Marhuenda Reviewer 2: Fatemeh Ashrafian Reviewer 3: Anonymous

Round 1

Reviewer 1 Report

It is not described how patients were informed of the importance of vaccinations. Neither do they describe the measures to improve the data.

It is not stated why men were not informed to be vaccinated with PHV.

There is also no reference to vaccination against covid19.

 

Author Response

Reviewer 1:

It is not described how patients were informed of the importance of vaccinations. Neither do they describe the measures to improve the data.

It is not stated why men were not informed to be vaccinated with PHV.

Author's Reply: Unfortunately, Local guidelines does not recommend HPV vaccine for men yet.

There is also no reference to vaccination against covid19.

Author's Reply: Thank you. We cited it under number 9. 

Macaluso FS, Liguori G, Galli M. Vaccinations in patients with inflammatory bowel disease. Digestive and Liver Disease. 2021;53(12):1539-45.

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Reviewer 2 Report

Dear Editor-in-Chief

 

 The paper deals with interesting subjects related to vaccination prevalence among patients with IBD on specific biologic therapies. This study is well-written,  however, some points need to be corrected. In general, the study is very interesting, while some sections should be improved.

1.     Please indicate the number of patients who participated in the current study in the methods section.

2.     Please include an appropriate reference.

“Patients with IBD who are on biologics therapies are susceptible to opportunistic infections and its complications.”

3.     I would suggest collecting the data from the healthy population as well and comparing it with that of IBD patients.

4.     Have you checked the level of immunity induced by vaccination in IBD patients?

5.     Please correct “meningococcal C vaccine” in line 221.

6.     Many sentences were started with a lowercase letter. Please correct them.

7.     Some sentences in the discussion section are very vague. Please correct them and mention the vaccination prevalence rate in IBD patients.

8.     Please provide possible reasons why your results are inconsistent with other studies.

 

Best regard, 

Minor editing of English language required.

 

Author Response

Reviewer 2:

The paper deals with interesting subjects related to vaccination prevalence among patients with IBD on specific biologic therapies. This study is well-written,  however, some points need to be corrected. In general, the study is very interesting, while some sections should be improved.

  1. Please indicate the number of patients who participated in the current study in the methods section.

Author's Reply: Thank you. Corrected (page2 line 99)

  1. Please include an appropriate reference.

“Patients with IBD who are on biologics therapies are susceptible to opportunistic infections and its complications.”

Author's Reply: Thank you. Added number 22, page 8 line 206.

  1. I would suggest collecting the data from the healthy population as well and comparing it with that of IBD patients.

Author's Reply: Thank you for your suggestions. Unfortunately, our study was a descriptive study, not comparative study, so was not powered for comparison. We would do that in a follow up study. However we addressed your point to our limitations.

  1. Have you checked the level of immunity induced by vaccination in IBD patients?

Author's Reply: Thank you for your idea. Our study was not designed to look for this question. We will do that in a future study.

  1. Please correct “meningococcal C vaccine” in line 221.

Author's Reply: Corrected.  Thank you.

  1. Many sentences were started with a lowercase letter. Please correct them.

Author's Reply: Corrected. Thank you.

  1. Some sentences in the discussion section are very vague. Please correct them and mention the vaccination prevalence rate in IBD patients.

Author's Reply: Thank you corrected.

Page8 lines: 212, 219, 229, 231

  1. Please provide possible reasons why your results are inconsistent with other studies.

Thank you. Added to discussion, especially for childhood vaccines, HPV, and COVID-19.

Page8

lines 252-254: “One of the probable reasons why there was complete adherence to the BCG vaccine in our study is due to its high TB prevalence in Middle East and Asia (36). “

Page 9

lines 271-274: “One of the main reasons why there was a high vaccination uptake in the previous vaccinations mentioned is because it’s part of the national vaccination program in Kuwait, which is mandatory to attend school. However, post high school vaccina-tions become optional.”

Lines 278-281 “One of the reasons of this high uptake rate is awareness campaigns that was promoted during the pandemic. Medical health staff including preventative medicine, primary care physician and gastroenterologist took full responsibility in promoting the safety of this vaccine.”

Page9-10 lines 314-367

Page11 lines 370-372 “One of the key drivers behind this reasonable uptake could be attributed to government regulations that enforce vaccination and restrict travel for non-vaccinated individuals”.

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Reviewer 3 Report

In this manuscript, Mohammad Shehab and colleagues conducted a survey-based cross-sectional study to assess the vaccination prevalence among patients with IBD on specific biologic therapies, and they highlighted the need for interventions to improve patients’ awareness and adherence to prevent infectious complications in patients with IBD. It’s an interesting and necessary study for the guidance of vaccination for IBD patients.  But the issues should be addressed as follows:

1.      The author should give more details about the Age (Table 1) as there are some potential risks between aging-related disorders, IBD, and inflammation, such as listing the percentage of different age groups based on the collected data instead of only showing the mean age.

2.      The authors claimed “The total number of IBD patients who were vaccinated are lower than expected with 136 a percentage of 58.9%”, A critical question is how the 58.9% comes and why the current vaccination prevalence is lower than expected. This needs to be addressed.

3.      A similar question in Conclusion “In our study, we found that the uptake of certain vaccines such as HepB, seasonal 344 influenza, HepA, pneumococcal, HZ and HPV vaccines among patients with IBD were below expectations.”, What is the control compared with the patients with IBD in the uptake of certain vaccines?

 

In the Abstract part and other similar statements, " The uptake of certain vaccines such as Hepatitis 21 B (HepB), seasonal influenza, HepA, pneumococcal, HZ and HPV vaccines among patients with 22 IBD were below expectations. ", Need to include the control, otherwise reader can be confused.

 

Author Response

Reviewer 3:

In this manuscript, Mohammad Shehab and colleagues conducted a survey-based cross-sectional study to assess the vaccination prevalence among patients with IBD on specific biologic therapies, and they highlighted the need for interventions to improve patients’ awareness and adherence to prevent infectious complications in patients with IBD. It’s an interesting and necessary study for the guidance of vaccination for IBD patients.  But the issues should be addressed as follows:

  1. The author should give more details about the Age (Table 1)as there are some potential risks between aging-related disorders, IBD, and inflammation, such as listing the percentage of different age groups based on the collected data instead of only showing the mean age.
  2. The authors claimed “The total number of IBD patients who were vaccinated are lower than expected with 136 a percentage of 58.9%”, A critical question is how the 58.9% comes and why the current vaccination prevalence is lower than expected. This needs to be addressed.

Author's Reply: Thank you. 58.9% was calculated by getting the total number of patients in our sample who took “all vaccines” under question and dividing it on the total sample number.

Given the free availability of vaccines and the easy access in primary care, we would have expected a higher percentage of uptake.

  1. A similar question in Conclusion “In our study, we found that the uptake of certain vaccines such as HepB, seasonal 344 influenza, HepA, pneumococcal, HZ and HPV vaccines among patients with IBD were below expectations.”, What is the control compared with the patients with IBD in the uptake of certain vaccines?

Author's Reply: Thank you. No control group was used our study was not a comparative study. Relative to other studies assessing similar group of patients with similar infection risk and disease state, we thought our rates are low. We added it to our limitations.

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Round 2

Reviewer 3 Report

No further comments.