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

Abstract

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.

Uptake of influenza vaccine in ulcerative colitis

“…In Ontario, Canada, uptake of influenza vaccine was 25.3% and 13.2% in IBD cases and controls, respectively [17]. These results are comparable to the mean vaccine uptake observed in our UC population (32.7%).…”

“…The most common is lack of awareness (58%), however, fear of side effects (33%) and fear of disease activation (5%) are also factors which need to be addressed [5]. Evidence suggesting that influenza vaccine causes IBD activation is limited to case reports, and in fact there is robust data indicating the opposite -IBD patients do not require additional health services following vaccination [17][18][19][20][21]. In most Western countries, including Israel, low vaccine availability and poor access to healthcare are of only minor relevance [1].…”

Immunisation in children and adolescents with inflammatory bowel disease

“…These authors compared a 2-week risk period 180 days post-immunisation with a no-risk control period. The data showed there was no increase in the use of health services in the post-vaccine risk period for IBD patients and that there was evidence for a protective effect of influenza immunisation against IBD-related use of health services [28].…”

“…In two studies conducted examining children with IBD who were treated with infliximab, the response to primary vaccination was considered satisfactory when assessed shortly after vaccination but decreased thereafter [27,28]. The anamnestic response rate after the vaccine boost was as high as 76% [27].…”

“…It is important to emphasise that the examined vaccines appeared to be safe in all of the above studies [20][21][22][23][24][25][26][27][28][29]. The most common adverse effects were reactions at the local injection site that manifested as erythema, induration, or tenderness [21][22][23][24][25][26]29].…”