Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapy require careful vaccination considerations to reduce their increased risk of infections due to immunosuppression. It is recommended that all vaccinations be reviewed and updated ideally before starting immunosuppressive treatment, with particular attention to pneumococcal and annual influenza vaccines, as these patients are at higher risk of severe infections NICE CKS.
Live vaccines should generally be avoided during immunosuppressive therapy due to the risk of vaccine-related infection; if live vaccines are indicated, they should be administered prior to immunosuppression or delayed until immune function recovers NICE CKS. For example, infants exposed in utero to anti-TNF agents such as adalimumab or infliximab should have live vaccines delayed for several months after birth NICE CKS.
Inactivated vaccines, including pneumococcal, influenza, and meningococcal vaccines, are safe and recommended during immunosuppressive therapy to provide protection against encapsulated bacteria and seasonal viral infections NICE CKS. Pneumococcal vaccination is particularly important given the increased risk of pneumococcal infections in immunosuppressed patients with IBD Esteve Comas et al. 2009. Annual influenza vaccination is also advised to reduce respiratory infection risk Culver & Travis 2010.
Recent literature emphasizes the importance of vaccination during the COVID-19 pandemic, recommending that patients with IBD on immunosuppressants receive COVID-19 vaccines as they are not contraindicated and provide critical protection Lin et al. 2022. Immunosuppressive therapy may reduce vaccine immunogenicity, so timing and possibly additional doses should be considered in consultation with specialists Esteve Comas et al. 2009.
Overall, vaccination strategies for patients with IBD on immunosuppressive therapy should be individualized, ensuring inactivated vaccines are up to date, live vaccines are avoided or timed appropriately, and specialist advice is sought for complex cases NICE CKS Esteve Comas et al. 2009Culver & Travis 2010Lin et al. 2022.
Key References
- CKS - Ulcerative colitis
- CKS - Coeliac disease
- CKS - Crohn's disease
- CG118 - Colorectal cancer prevention: colonoscopic surveillance in adults with ulcerative colitis, Crohn's disease or adenomas
- NG129 - Crohn's disease: management
- NG130 - Ulcerative colitis: management
- (Esteve Comas et al., 2009): How do we manage vaccinations in patients with inflammatory bowel disease?
- (Culver and Travis, 2010): How to manage the infectious risk under anti-TNF in inflammatory bowel disease.
- (Lin et al., 2022): Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic.