Efficacy of the vaccination in inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) is associated with conditions that may predispose to infections, such as the lack of an appropriate innate immune response to infectious agents, malnutrition, surgery, and immunosuppressive and biological drugs. Some of these infections may be preventable by vaccination. Therefore, for this particular patient population, the benefits of implementing a well-established immunization protocol in daily clinical practice are potentially even greater than for the general population. In recent years international consensus guidelines have been published, but in spite of theses recommendations, studies have shown that a significant number of patients with IBD remain inadequately immunized. Another important issue regarding immunization in this population is that vaccine efficacy among patients receiving immunosuppressive therapies has been variable. In a healthy population, a humoral immune response to hepatitis B vaccination (HBV) is expected in > 90%, whereas a much lower rate is achieved in the IBD patients. Immunosuppressive, anti-tumor necrosis factor therapy and disease activity have been implicated in the impaired efficacy of the vaccination. The serological response to HBV should be confirmed and patients with an inadequate response should receive a second full series of vaccine. Modified dosing regimens, including doubling the standard antigen dose, might increase the effectiveness. Response to influenza, pneumococcal and tetanus immunization is still not clear, as there are studies that show a normal response to the vaccination while others demonstrate a lack of efficacy. We pose a series of questions on the efficacy of the different vaccinations recommended for IBD patients and attempt to answer them using scientific evidence.

Literature‐based immunization recommendations for patients requiring immunosuppressive medications for autoimmune bullous dermatoses

“…There is conflicting evidence in the IBD literature regarding immunogenicity of tetanus vaccination . One study in patients with rheumatoid arthritis on methotrexate alone or methotrexate plus rituximab identified suboptimal, albeit similar, response to tetanus toxoid (42.3% vs 39.1% response, respectively) .…”

“…47 There is conflicting evidence in the IBD literature regarding immunogenicity of tetanus vaccination. 49 One study in patients with rheumatoid arthritis on methotrexate alone or methotrexate plus rituximab identified suboptimal, albeit similar, response to tetanus toxoid (42.3% vs 39.1% response, respectively). 50 Patients with bullous pemphigoid had similar immune responses to tetanus toxoid compared with healthy age-matched controls, but immunosuppression regimen at the time of vaccination is unknown.…”

Comparing Anti-hepatitis B Antibody Level in Iranian Obese or Overweight with Non-obese Cases

“…However, one study has shown low response rate to hepatitis B vaccine in immunosuppressed patients with inflammatory bowel disease[14]. Other investigations have revealed that immunosuppressive regimens used by mothers do not affect the offsprings’ immune status[15].…”

Biological Therapy for Inflammatory Bowel Diseases: Screening Prior to Initiating and How to Proceed When Surgery Is Necessary

“…If infection is present by testing before vaccination, other specific tests should be performed, and the patient should be evaluated by a specialist for the need of treatment. The importance of care in relation to HVB infection consists in the fact that reactivation of HBV is a well-described complication of immunosuppression [4,5,7].…”

“…In addition to the hepatitis B vaccine, the patient should also receive the following vaccines before starting the treatment with biological therapy [4][5][6][7]9]: It is important to emphasize that immunosuppressed patients do not respond properly to immunization. In addition, patients receiving biological therapy cannot be vaccinated with live attenuated virus (varicella zoster, yellow fever, measles, mumps, and rubella) [9].…”