Immune Response to Influenza Vaccine in Children With Inflammatory Bowel Disease

Lu, Ying; Jacobson, Denise L.; Ashworth, Lori A.; Grand, Richard J.; Meyer, Anthony L.; McNeal, Monica; Gregas, Matt; Burchett, Sandra; Bousvaros, Athos

doi:10.1038/ajg.2008.120

Cited by 143 publications

(133 citation statements)

References 31 publications

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“…However, when patients are receiving immunosuppressive therapies with combined thiopurines and anti-TNF agents, serologic responses to vaccines are impaired ( 22,23,(43)(44)(45)(46)(47)(48)(49)(50)(51). Nonetheless, even a blunted vaccination response is thought to be of benefi t ( 52 ) and thus recommendations for infl uenza vaccination with inactivated vaccine continue to be broadly applicable to all patients, regardless of immunosuppression status ( 13,53 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

391

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

391

421

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“…87,88 For example, some studies have suggested that patients on TNF inhibitors may have a slightly decreased immune response to influenza vaccine. [89][90][91] Specific data for patients with IBD are very scarce. Some authors have evaluated the serological response to influenza vaccine in patients with IBD and observed that those receiving anti-TNF therapy were less likely to be seroprotected.…”

Section: What Factors Affect the Efficacy Of Hbv Vaccination In Ibd Pmentioning

confidence: 99%

“…Some authors have evaluated the serological response to influenza vaccine in patients with IBD and observed that those receiving anti-TNF therapy were less likely to be seroprotected. 90 Others have demonstrated a suboptimal response to pneumococcal vaccination in patients with IBD who are receiving combination therapy with immunosuppressants plus anti-TNF drugs. 92 In healthy individuals, several risk factors for nonresponse have been identified, including immunosuppressive disease, smoking, older age, male gender and high body mass index.…”

Section: What Factors Affect the Efficacy Of Hbv Vaccination In Ibd Pmentioning

confidence: 99%

Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease

Gisbert

Chaparro

Esteve

2011

Alimentary Pharmacology &Amp; Therapeutics

105

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“…Therefore, we were not able to discern differences in immunization uptake or adverse events in patients receiving immunosuppressive therapy. Although we did not have access to serologic immunity testing in our cohort, most studies have demonstrated adequate immunogenicity to most influenza strains, 24,33,34 and the reduced health services utilization in IBD patients compared with controls in the 6 months after administration suggests protection.…”

Section: Figurementioning

confidence: 99%

Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease

et al. 2013

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OBJECTIVE: Influenza immunization is recommended for children with IBD, however safety concerns may limit uptake. This study assessed whether immunization was associated with adverse events in IBD patients using a population-based database of children with IBD. METHODS: All children <19 years diagnosed with IBD in Ontario, Canada between 1999–2009 were identified using health administrative data, and matched to non-IBD controls. Self-controlled case series (SCCS) analyses determined health services event rates (outpatient visits, hospitalizations and emergency visits) in any 2-week risk period to 180 days post-immunization compared to a no-risk control period. Relative incidence (RI) was calculated for overall and IBD-related events and rates were compared between IBD cases and controls using relative incidence ratios (RIR). RESULTS: A total of 4916 IBD patients were matched to 21 686 controls. IBD patients were more likely to have received immunization than controls (25.3% vs 13.2%, P < .001). No increased event rates existed in IBD cases during risk periods (pooled RI 0.95, 95% CI 0.84–1.07), including hospitalizations and emergency visits. There was a slightly higher event rate in IBD cases versus controls for days 3–14 (RIR 1.60, 95% CI 1.05–2.44, P = .03). IBD-related visit rates were lower in risk periods compared to control period (pooled RI 0.81, 95% CI 0.68–0.96). CONCLUSIONS: There was no increase in health services use in the post-vaccine risk period in IBD patients, and there was evidence for a protective effect of influenza immunization against IBD-related health services use. Influenza immunization is safe in children with IBD and should be encouraged to improve poor coverage rates.

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Immune Response to Influenza Vaccine in Children With Inflammatory Bowel Disease

Cited by 143 publications

References 31 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease

Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease

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