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Health Maintenance in the Inflammatory Bowel Disease Patient

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Vaccines

IBD patients treated with corticosteroids, immunomodulators, and biologic agents are at increased risk of developing infectious complications because of the immune suppression from these medications. There are multiple case reports of infections including fulminant hepatitis or fatal varicella,2, 3 and some of these diseases are vaccine preventable. Several studies have documented that IBD patients, like other patients on immunosuppressive medications, are inadequately vaccinated.4 It seems

Goals of Vaccination

IBD patients are at risk for the same preventable diseases as the general population, although they often present with more serious complications when on immunosuppressive therapy. Administration of live, attenuated vaccines to immunosuppressed patients is contraindicated, so the timing of vaccinations in IBD patients becomes paramount. The goal of vaccination for individuals with IBD is to utilize the opportune and sometimes short timeframe when their immune suppression is minimal,

Live Vaccines

Administration of live, attenuated vaccines presents unique concerns when a patient is expected to be immunosuppressed in the future.

Inactivated Vaccines

Inactivated vaccines are well tolerated by patient with IBD regardless of their degree of immunosuppression or immune competency. It is also safe for household contacts to receive inactivated vaccines. As noted, however, patients mount a diminished immune response when on dual therapy with an immunomodulator and a biologic agent; therefore, early vaccination remains important.

Cervical Cancer Screening

There is a higher prevalence of abnormal Pap smears in women with IBD, and this is associated with treatment with immunomodulators.33, 34, 39, 40 In 1 study comparing 40 IBD patients who underwent routine cervical cancer screening with a total of 134 Pap smears, the incidence of abnormal Pap in a woman with IBD was 42.5% versus 7% among age-, race-, and parity-matched controls.34 The authors also noted a significant increase in higher risk cervical cytology in the IBD group, and more

Summary

Gastroenterologists are in a unique position to make very positive differences in the lives of their IBD patients. We understand that IBD patients do not receive preventive services at the same rate as general medical patients. Because these individuals are at increased risk for complications from preventable diseases, we have a valuable opportunity to protect this population (Table 1). Establishing a close working relationship with PCPs can facilitate delivering quality care, but it is

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      Live vaccines are contraindicated while immunosuppressed.82 Annual influenza vaccine, tetanus and diphtheria boosters, and pneumococcal vaccine every 5 years are recommended.166 Hepatitis B status should be checked before initiating treatment with anti-TNF-α drugs and those who are not immune should be vaccinated.

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      Nevertheless, IBD patients may be inadequately vaccinated for a variety of reasons, which may be related to fewer primary care visits or hesitance by either gastroenterologists or primary care physicians to take ownership of vaccinating these patients. Moreover, immunosuppressed patients, especially those on combination immunosuppression, may have a diminished response to vaccination or may be anergic.31 Thus, it is opportune to vaccinate patients before initiating immunosuppressive therapy.

    • Preventive care for a 35-year-old woman with inflammatory bowel disease

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      For patients using immunosuppressive therapies, it is safe to administer inactive vaccines, consistent with the Canadian Immunization Guide, although some patients may not mount a sufficient protective response.3 In addition to the annual inactivated influenza vaccine, these patients should be offered pneumococcal vaccine (including a one-time revaccination after five years in patients older than 65 years of age or for patients using immunosuppressive therapies), tetanus and diphtheria vaccine every 10 years, and the human papillomavirus (HPV) vaccine for female patients between the ages of 11 and 26 years.3 Hepatitis B vaccine should be offered if a patient is not immune.

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      2021, Inflammatory Bowel Diseases

    • Caregiver and Adolescent Patient Perspectives on Comprehensive Care for Inflammatory Bowel Diseases: Building a Family-Centered Care Delivery Model

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