Immunizations in the child with inflammatory bowel disease

Abstract

Many patients with inflammatory bowel disease (IBD) are at risk for infections at some point in their disease. Infections may occur as a result of the disease itself (e.g., perianal or abdominal abscess), or be community acquired. Immunosuppressive therapy, commonly utilized in patients with IBD, may increase the risk of opportunistic infections (e.g., varicella, tuberculosis, pneumonia). Therefore, it is important to minimize infections through immunization. Current guidelines recommend against administering live vaccines in patients with IBD receiving immunosuppressive therapy. However, they should receive inactivated vaccines regardless of immunosuppressive status. The IBD scientific literature suggests that inactivated vaccines are safe and do not worsen disease activity. In general, patients develop an adequate immune response to inactivated vaccines, but the response may be suboptimal if patients are on immunosuppressive therapy, especially tumor necrosis factor inhibitors. Therefore, it is ideal to check immunization status at time of diagnosis and administer any necessary vaccinations as early as possible, prior to starting immunosuppressive therapy.