Vaccination guide for patients with IBD
| Objective: Reduce risk of developing vaccine-preventable illnesses |
| Patient population: Individuals diagnosed with inflammatory bowel disease |
IBD Provider:
- Ensure all IBD patients undergo annual vaccination against influenza. Patients on immunosuppressive therapies and their household contacts should receive the inactivated influenza vaccine, not the live inhaled vaccine.
- It is important to review patient's vaccination and travel history at every appointment and especially when a patient is planning or on immunosuppressive therapy such as: corticosteroids, biologics and thiopurines.
- Family members in close contact with immunosuppressed patients should be vaccinated to help prevent disease transmission.
LIVE VACCINES
- Live vaccines (Table 1) are contraindicated in patients who are on immunosuppressants (methotrexate, azathiopurine, steroids, anti-TNFs, ustekinumab, vedolizumab, tofacitinib) and significant protein-calorie malnutrition due to concern that vaccination may result in disease.
- Suggested time intervals to allow for immune system recovery are: (i) 4-6 weeks between last dose and initiation of immune suppression. (ii) 3 months (1 month for high dose steroids) from discontinuation of biologic or immunosuppressive therapy and vaccination.
-
Patients who may require live vaccines due to work or travel (Table 2) should be warned prior to starting anti-TNF therapy to update their vaccinations.
-
Live vaccines are safe to give family members, with the possible exception of rotavirus and varicella (chickenpox) vaccines (Table 4)
-
Blood products of human origin can interfere with the immune response to live vaccines
INACTIVATED VACCINES
- Inactivated vaccines (Table 3) are safe in immunosuppressed patients, but patients on immunosuppressive therapy may have suboptimal response to vaccination.
- Suggested time intervals to allow for best response to vaccine are: (i) At least 2 weeks, preferably 3-4 weeks between vaccine and initiation of immunosuppressant. (ii) ≥ 3 months between discontinuing immunosuppressant and vaccine (this interval may vary with the type and intensity of treatment, underlying disease, or urgency of vaccination if vaccines are needed for post-exposure or outbreak management).
- If vaccines are administered during immunosuppression, attempt to give them when the next 2 weeks represent the least.
- If vaccination with MMR or varicella is indicated and there are no contraindications, the recommended minimal intervals between blood products or immune globulin and vaccination are:
- Reconstituted RBCs: 3 months
- Washed RBCs: No delay necessary
- Intravenous Immune Globulin (400 mg/kg): 8 months
CANIBD Vaccination guide https://badgut.org/information-centre/a-z-digestive-topics/vaccines-for-ibd/
RED BOOK: 2015 Report of the Committee on Infectious Diseases https://redbook.solutions.aap.org/DocumentLibrary/Red%20Book%202015%201.pdf
Canadian immunization schedule https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-13-recommended-immunization-schedules.html
Immunization Record for Children https://immunize.ca/immunization-record-children
Immunization Record for Adults https://immunize.ca/immunization-record-adults
Travel vaccinations https://travel.gc.ca/travelling/health-safety/vaccines
Mir, F. et al. Health maintenance in inflammatory bowel disease. Curr Gastroenterol Reports 2018; 20(23): 22-28
Farraye, F.A. et al. ACG Clinical Guideline: Preventive care in inflammatory bowel disease. Am J of Gastroenterol 2017; 112:241-258
Lopez, A., et al. Vaccination recommendations for the adult immunosuppressed patient: A systematic review and comprehensive field synopsis. J of Autoimmunity 2017; 80:10-27
Long, M. et al. Immunizations in pediatric and adult patients with inflammatory bowel disease: A practical case-based approach. Inflamm Bowel Dis 2015; 21:1993-2003
