Vaccination Guidelines for IBD patients (before and during immunosuppression)

/Vaccination Guidelines for IBD patients (before and during immunosuppression)
Vaccination Guidelines for IBD patients (before and during immunosuppression) 2017-11-15T16:50:54+00:00

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)

Vaccines recommended per routine guidelines, ideally before initiation of immunosuppression 
Pneumococcus (PPSV23) every 5 years
Pertussis (as part of dTpa)
Vaccines contraindicated during immunosuppression (within 1 month of steroids)
Live, attenuated influenza (intranasal vaccine)
Varicella zoster: check varicella-zoster virus (VZV), . if seronegative give 2-dose varicella vaccine schedule, at least 6 months before or after immunosuppression
Herpes zoster (live zoster vaccine)
Yellow fever
Measles-mumps-rubella
Typhoid live oral
Smallpox
Tuberculosis BCG
Polio live oral
Anthrax_________________________________________________________________________Vaccines in Special risk groups

Hepatitis A (single-antigen vaccine or hepatitis A and B combination vaccine “Twinrix”)

Hepatitis B  (H-B-Vax II – 20ug dialysis formulation) standard or accelerated 0, 1, 2 months if 5-12 month titre <100IU/L give 4th dose)

Meningococcus (MCV4 or MPSV-4) authorised not recommended (esp. functional hyposplenism or anatomical asplenia )

Screen prior to immunosuppression, vaccination or travel to high risk countries

HAV, HBV and TB (especially prior to steroids and biologicals)

VZV, Measles (especially potentially inadequately vaccinated 1968-84 children), rubella

Vaccine boosters if well, not immunosuppressed and risk of future immunosuppression:

  • single dose dT or reduced antigen content dTpa
  • single dose of MMR, IPV, hepatitis B vaccines
  • single dose of 13vPCV (if previous age-appropriate dose(s) not received;
  • 23vPPV dose(s) (≥8 weeks after 13vPCV)
  • single dose  Hib vaccine (if either <5 years of age or if ≥5 years of age with asplenia)
  • 4vHPV vaccine:  single dose if previously completed a primary course; 3-dose (0, 2 and 6 months) schedule if not previously received
  • varicella vaccine: persons who are seronegative to varicella-zoster virus (VZV) should receive a 2-dose schedule of varicella vaccine, at least 1 month after high dose steroids, 6 months after other immunosuppression or 3-11 months after a blood transfusion.

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Vaccines for Household and other close contacts

Influenza annual

Assess need for Pertussis (as part of dTap) and/or Varicella zoster

MMR, MMRV, varicella and zoster, where indicated, are safe

small risk of transmission of rotavirus vaccine virus: Hand washing and careful disposal of soiled nappies to decrease transmission

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