Vaccines and recommendations for their use in inflammatory bowel disease

ArticleinWorld Journal of Gastroenterology 19(9):1354-8 · March 2013with18 Reads
DOI: 10.3748/wjg.v19.i9.1354 · Source: PubMed
The patient with inflammatory bowel disease will be predisposed to numerous infections due their immune status. It is therefore important to understand the immune and serologic status at diagnosis and to put the patient into an adapted vaccination program. This program would be applied differently according to two patient groups: the immunocompromised and the non-immunocom-promised. In general, the first group would avoid the use of live-virus vaccines, and in all cases, inflammatory bowel disease treatment would take precedence over vaccine risk. It is important to individualize vaccination schedules according to the type of patient, the treatment used and the disease pattern.In addition, patient with inflammatory bowel disease should be considered for the following vaccines: varicella vaccine, human papilloma virus, influenza, pneumococcal polysaccharide vaccine and hepatitis B vaccine.
    • "We read with interest the case report authored by Sanchez-Tembleque et al [1] entitled " Vaccines and recommendations for their use in inflammatory bowel disease " which emphasized the importance of physicians analyzing vaccination status in all inflammatory bowel disease (IBD) patients prior to starting immunosuppressive therapy and the recommendation that live vaccines are contraindicated for the first six months in newborns with in utero immunosuppressant exposure. We are in agreement that physicians need to counsel pregnant mothers regarding the risks of live vaccinations in newborns. "
    [Show abstract] [Hide abstract] ABSTRACT: Inflammatory bowel disease patients are prone to immunosuppression due to effects of their medications. Physicians are recommended to assess vaccination status and overall health in all patients, prior to initiation of immunosuppressive therapy. Immunosuppressant medications in women with inflammatory bowel disease are often continued during pregnancy, which can result in newborns having an increased risk of immunosuppression at birth. While medication-induced immunosuppression in infants is transient, parents should be counselled about delaying live vaccine administration in newborns until they are immune competent. A retrospective study was done over six months at an urban multispecialty medical center to assess whether physicians are counselling pregnant immunosuppressed inflammatory bowel disease patients regarding live vaccinations in their newborns. The study revealed that only 57% of patients had documented counselling in their charts. Further studies are necessary to determine physician counselling practices of pregnant women about live vaccines. It is critical that physicians and patients are aware of the risks of immunosuppression in pregnancy and the potential impact of live vaccines upon the newborn.
    Article · Sep 2014
    • "The intranasal influenza vaccine is contraindicated in immunosuppressed individuals. In addition, at least 1 dose of pneumococcal vaccine should be administered, with revaccination after 5 years, to patients who are over 65 years and/or immunosuppressed505152. Tetanus and diphtheria vaccines should be administered every 10 years, and at least once in a lifetime it should be associated with pertussis. "
    [Show abstract] [Hide abstract] ABSTRACT: Abstract Current therapy of moderate-to-severe inflammatory bowel disease (IBD) often involves the use of anti-tumor necrosis factor alpha (TNF-α) agents. Although very effective, theses biologics place the patient at increased risk for developing infections and lymphomas, the latter especially when in combination with thiopurines. Appropriate patient selection, counseling, and education are all important features for the successful use of anti-TNF-α therapy. A thorough history to rule-out contraindications of this therapy and emphasis on monitoring guidelines are important steps preceding administration of anti-TNF-α agents. This therapy should only be considered if a recent evaluation has established that the patient has active IBD. In addition, it is important to exclude disease mimickers. Anti-TNF-α agents have been considered to present a globally favorable benefit/risk ratio. However, it is important that in routine practice, initiation of anti-TNF-α therapy be carefully discussed with the patient, extensively explaining the potential benefits and risks of such treatment. Prior to starting anti-TNF-α therapy, the patients need to be screened for latent tuberculosis, hepatitis B virus infection, and (usually) hepatitis C virus and HIV infection. Vaccination schedules of IBD patients should be evaluated and updated prior to the commencement of anti-TNF-α therapy. Ordinarily, immunization in adult patients with IBD should not deviate from recommended guidelines for the general population. With the exception of live vaccines, immunizations can be safely administered in patients with IBD, even those on immunosuppressants or biologics. The purpose of this review is providing an overview of appropriate steps to prepare patients with IBD for anti-TNF-α therapy.
    Full-text · Article · Mar 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Inflammatory bowel disease (IBD) is an inflammatory condition of the digestive tract not caused by infectious agents. Symptoms of IBD, such as diarrhea and pain, diminish one's quality of life. Underlying immune dysregulation may put IBD patients at risk for severe infectious disease making preventative vaccination highly recommended. Therefore, this study sought to assess rates of pneumococcal vaccination in patients with IBD. A cross-sectional observational study was employed utilizing administrative data extracts from the Veterans Health Administration (VHA) to identify patients diagnosed with IBD per International Classification of Diseases, Version 9, Clinical Modification codes. Their pneumococcal vaccine histories were determined from Common Procedural Terminology codes. Data were aggregated to the patient level and subjected to multivariable logistic regression to assess factors associated with receipt of the vaccination and 1-year mortality; survival analyses extended follow-up to as much as 4 years following IBD diagnosis. From October 2004 to September 2009, 49,350 patients were diagnosed with IBD in the VHA. Incidence was approximately 6000 cases/y. Patients averaged 62 years (±15, range 19–98) with 45% aged 65 or older. Approximately 6% were women, 21% were highly disabled from a military service-connected condition, 46% had hypertension, 38% dyslipidemia, and 18% diabetes. Only 20% of the cohort received pneumococcal vaccination including 5% vaccinated prior to IBD diagnosis, 2% on the date of diagnosis, and 13% subsequently. Being married, living outside the Northeast, and having more comorbidities were associated with vaccination before IBD diagnosis; models of vaccination at or after diagnosis demonstrated poor fit: little better than chance. Vaccinations before, after, and at diagnosis were protective against 1-year mortality adjusting for clinical and demographic covariates. Living in the South was an independent risk factor for death among IBD patients. While vaccination for pneumococcus is a low-cost, low-risk recommendation for persons with IBD with an apparent survival benefit, vaccination rates were low.
    Full-text · Article · Feb 2015