NASPGHAN Clinical Report

Abstract

Children and adolescents with inflammatory bowel disease (IBD) receiving therapy with tumor necrosis factor α inhibitors (anti-TNFα) pose a unique challenge to health care providers in regard to the associated risk of infection. Published experience in adult populations with distinct autoinflammatory and autoimmune diseases treated with anti-TNFα therapies demonstrates an increased risk of serious infections with intracellular bacteria, mycobacteria, fungi, and some viruses; however, there is a paucity of robust pediatric data. With a rising incidence of pediatric IBD and increasing use of biologic therapies, heightened knowledge and awareness of infections in this population is important for primary care pediatricians, pediatric gastroenterologists, and infectious disease (ID) physicians. This clinical report is the result of a consensus review performed by pediatric ID and gastroenterology physicians detailing relevant published literature regarding infections in pediatric patients with IBD receiving anti-TNFα therapies. The objective of this document is to provide comprehensive information for prevention, surveillance, and diagnosis of infections based on current knowledge, until additional pediatric data are available to inform evidence-based recommendations.

Pneumococcal Polysaccharide Vaccination in Pediatric Inflammatory Bowel Disease

“…9 Moreover, the mainstay therapy of IBD includes immunosuppressive agents, which further increase the risk of bacterial infections in patients with IBD. 10,11 Studies in adults with IBD have previously shown a significant increase in incidence of IPD in hospitalized patients with immune-mediated diseases such as CD and ulcerative colitis compared with other hospitalized patients, 12 with an incidence rate ratio of 1.82. 3 This increase in risk is not well established in pediatric IBD patients.…”

Preparing Patients With Inflammatory Bowel Diseases For Biological Therapies In Clinical Practice

“…and Salmonella sp. infections, patients should not consume raw eggs, unpasteurized milk products, hot dogs, delicatessen meats (unless reheated at high temperatures), and uncooked meat/fish [29] . People not immune to varicella (i.e., have not been vaccinated and never had the disease) should avoid contact with varicella patients.…”

“…The use of biological agents in the treatment of autoimmune diseases, including IBD has been widely associated with an increased risk of reactivation of various latent infections. International guidelines recommend screening for infectious disorders before initiating these agents [29,31] . In particular, we will approach the screening for latent tuberculosis (LTB) infection, viral hepatitis, and human immunodeficiency virus (HIV).…”

Vaccines in Children with Inflammatory Bowel Disease: Brief Review

“…Children with IBDs have a dysfunctional immune system. Moreover, in order to reduce clinical manifestation of IBDs, they are frequently treated with immunomodulating drugs and biological therapy [ 7 ], which significantly impair immune system functions and lead to an increased risk of infections [ 8 , 9 , 10 ]. Vaccines are essential to prevent at least part of these infections, and this explains why strict compliance to the immunization guidelines specifically prepared for IBD patients is strongly recommended by health authorities worldwide.…”