The Immunosuppressed Traveler

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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“…Th e immunosuppressive treatment should not be restarted earlier than 4 weeks aft er vaccination ( 81 …”

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

359

362

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“…T and B cell immune response to the vaccine booster dose is better preserved than that to primary vaccination, because more memory T and B cells are present, having been induced by the previous dose. 75,76 In one prospective study, a booster dose restored immune response in 76% of pediatric patients with IBD who had lost seroprotection. 77 In cases of HIV-infected children, approximately 30% of patients on antiviral therapy who were vaccinated had no protective titers 3 years after HBV vaccination, but 82% had an anamnestic response to a single booster dose.…”

Section: Statementmentioning

confidence: 99%

Prevention and management of viral hepatitis in inflammatory bowel disease: a clinical practice guideline by the Korean Association for the Study of Intestinal Diseases

et al. 2020

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 18ologics. With immunosuppression of this kind, opportunistic infection becomes a key safety concern in patients with IBD. 1 In particular, the course of viral hepatitis is determined by the interaction between the virus and the host' s immunity. If immunity is compromised by immunosuppression, the risk of reactivation increases, and HBV reactivations in immunosuppressed patients have been associated with hepatic decompensation in a considerable proportion of cases. 2,3 Thus, risk assessment for viral hepatitis is one of the important quality process indicators for the management of IBD patients. 4 In addition, several areas of Asia, including Korea, show in-pISSN 1598-9100 • eISSN 2288-1956 https://doi.The treatment of inflammatory bowel disease (IBD) has been revolutionized for the last 10 years by the increasing use of immunomodulators and biologics. With immunosuppression of this kind, opportunistic infection is an important safety concern for patients with IBD. In particular, viral hepatitis is determined by the interaction between the virus and the host' s immunity, and the risk of reactivation increases if immunity is compromised by immunosuppression therapy. Parts of Asia, including Korea, still show intermediate endemicity for the hepatitis A virus and hepatitis B virus compared with the United States and Western Europe. Thus, members of IBD research group of the Korean Association for the Study of Intestinal Diseases have produced a guideline on the prevention and management of viral hepatitis in IBD. (Intest Res 2020;18:18-33)

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“…8–13 Safe pet care tips include washing hands with soap and running water after handling animals and their feces. If possible, survivors should avoid direct contact with animal feces.…”

Section: Interventions For Prevention Of Infectionsmentioning

confidence: 99%

Survivorship: Immunizations and Prevention of Infections, Version 2.2014

Denlinger¹,

Ligibel²,

Are³

et al. 2014

J Natl Compr Canc Netw

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Cancer survivors are at an elevated risk for infection because of immune suppression associated with prior cancer treatments, and they are at increased risk of complications from vaccine-preventable diseases. This section of the NCCN Guidelines for Survivorship provides recommendations for the prevention of infections in survivors through education, antimicrobial prophylaxis, and the judicious use of vaccines. These guidelines provide information about travel and gardening precautions and safe pet care/avoidance of zoonosis, and include detailed recommendations regarding vaccinations that should be considered and encouraged in cancer and transplant survivors.

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The Immunosuppressed Traveler

Cited by 49 publications

References 57 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Prevention and management of viral hepatitis in inflammatory bowel disease: a clinical practice guideline by the Korean Association for the Study of Intestinal Diseases

Survivorship: Immunizations and Prevention of Infections, Version 2.2014

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