Vaccinating the inflammatory bowel disease patient

Abstract

Current therapeutic options for patients with inflammatory bowel disease (IBD) include several agents that can alter their immune response to infections. Effective vaccines exist and offer protection against a number of infectious diseases. However, recent data has shown that IBD patients are inadequately vaccinated and, as a result, at risk to develop certain preventable infections. Furthermore, gastroenterologists’ knowledge regarding the appropriate immunizations to administer to their IBD patients is suboptimal. This review article focuses on the current immunization schedule for the IBD patient and stresses the important role of the gastroenterologist as an active participant in the management of vaccination in their IBD patients.

Keywords:

• Crohn’s disease
• hepatitis A
• hepatitis B
• HPV
• immunocompromised
• infections
• inflammatory bowel disease
• PCV 13
• PPSC23
• travel
• ulcerative colitis
• vaccination
• varicella
• zoster

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The inflammatory bowel disease (IBD) patient is at risk of developing certain infectious diseases due to the use of immunomodulators and biological agents, malnutrition and comorbidities.

• The rates of immunization among patients with IBD are low and coordination between the gastroenterologist and primary care provider is needed for better preventive care of the patient.

• At the time of IBD diagnosis, a full vaccination history should be reviewed and specific antibodies titers should be checked.

• Inactivated vaccines, pneumococcal, Td, DTaP, Tdap, HPV, influenza, hepatitis B, hepatitis A and meningococcal, are considered safe for individuals with IBD regardless of the level of immunosuppression.

• In general, the live vaccines, MMR, varicella and zoster are contraindicated for the immunocompromised IBD individual though exceptions exist.

• Although immune response of immunosuppressed IBD patients to vaccination maybe impaired, vaccination followed ACIP guidelines is recommended

• Vaccination does not appear to cause an acute flare of IBD.

• The traveler with IBD needs extra care in order to avoid a vaccine-preventable infectious disease, and their pre-travel care should be coordinated with an infectious disease or travel expert.