Vaccination of persons with Crohn’s and colitis on immunosuppressive therapy presents several challenges. The risk of vaccine-preventable diseases and/or their complications may be increased (eg. influenza and invasive pneumococcal disease); the risk of adverse events from live vaccines (eg. MMR, MMRV, zoster, varicella, BCG, oral typhoid and yellow fever), within at least one month of immunosuppression, is increased; both the immune protection attained from previous immunisation and the response to vaccines given when immunosuppressed may be reduced. Reliable serological testing is not readily available and/or validated to measure vaccine-induced immunity for all vaccines (check VZV, measles, rubella). However, in some cases, it is useful to give additional booster vaccine or measure post-vaccination antibody titres. Degrees of immunocompromise vary from insignificant to profound, and this, together with the risk of acquiring vaccine-preventable disease, should be assessed when considering a vaccination schedule.Household and other close contacts should be fully vaccinated according to current recommendations. If there is uncertainty around the level of immunocompromise and when vaccine administration may be safe, this should be discussed with the treating physician and expert advice should be sought.
Adult (≥19 years) vaccine recommendations for immunosuppressed IBD patients:
|Vaccines recommended per routine guidelines, regardless of immunosuppression|
|Influenza (trivalent inactivated vaccine) first (or new influenza vaccine strain) 2 doses 0, 4 week then annual (eg. with 2009–2010 H1N1 global pandemic seroconversion in immunocompromised improved with 2 vaccine doses|
|Tetanus (as part of dT or dTpa) every 10 years|
|HPV (quadrivalent vaccine against types 6, 11, 16, and 18)
dTap=combination vaccination against diphtheria, tetanus, pertussis acellular ; HPV=human papillomavirus; MCV4=quadrivalent meningococcal vaccine; MPSV-4=quadrivalent meningococcal polysaccharide vaccine; PCV13=13-valent pneumococcal conjugate vaccine; PPSV23=23-valent pneumococcal polysaccharide vaccine; high risk country=CDC recommends HAV and typhoid