Vaccines in Children with Inflammatory Bowel Disease: Brief Review

Abstract

Incidence of inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC), is increasing worldwide. Children with IBDs have a dysfunctional immune system and they are frequently treated with immunomodulating drugs and biological therapy, which significantly impair immune system functions and lead to an increased risk of infections. 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. However, several factors might lead to insufficient immunization. In this paper, present knowledge on the use of vaccines in children with IBDs is discussed. Literature review showed that despite a lack of detailed quantification of the risk of infections in children with IBDs, these children might have infections more frequently than age-matched healthy subjects, and at least in some cases, these infections might be even more severe. Fortunately, most of these infections could be prevented when recommended schedules of immunization are carefully followed. Vaccines given to children with IBDs generally have adequate immunogenicity and safety. Attention must be paid to live attenuated vaccines that can be administered only to children without or with mild immune system function impairment. Vaccination of their caregivers is also recommended. Unfortunately, compliance to these recommendations is generally low and multidisciplinary educational programs to improve vaccination coverage must be planned, in order to protect children with IBD from vaccine-preventable diseases.

Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data

“…For children with rheumatic diseases, the major national and international medical societies, including the American College of Rheumatology and the European League of Associations for Rheumatology, as well as for children with IBD, including ECCO Guidelines, have recommended expanded vaccinations including pneumococcal, varicella-zoster, influenza and human papillomavirus (HPV) in addition to the common vaccines (hepatitis B, pertussis, diphtheria, tetanus, measles, rubella) [ 4 , 5 , 15 ]. Despite the existing international recommendations and consensus of the European communities of pediatric gastroenterologists and rheumatologists according to vaccination, current studies note a low level of awareness of the necessity and safety of vaccination among both types of physicians and parents, which translates into lower vaccine coverage in patients with both inflammatory bowel disease and juvenile idiopathic arthritis[ 16 - 19 ]. At the same time, it has been proven that maintaining appropriate vaccination status in these patients is critical for optimizing treatment outcomes.…”

“…There is no evidence that vaccines increase the risk of developing immune-mediated conditions or exacerbating the existing IBD or rheumatic diseases in children[ 43 - 45 ]. There are no contraindications for the administration of inactive or live vaccines in patients who are not receiving immunosuppressive treatment[ 15 , 16 ]. Despite the higher risk of live vaccines in immune-mediated diseases patients there was no strong correlation between the type of omitted vaccines (live or non-live) and disease activity[ 30 , 33 ].…”

“…Regular surveys of vaccine status in patients with inflammatory bowel disease have been recommended, as well as mandatory vaccination against common vaccines: tetanus, diphtheria, and poliomyelitis. In addition, each patient with inflammatory bowel disease should be considered for additional vaccination with the following five vaccines: Varicella-zoster vaccine, HPV, annual influenza (trivalent inactivated vaccine), pneumococcal polysaccharide vaccine, and hepatitis B vaccine for all HBV seronegative patients[ 4 , 5 , 16 ].…”

Risks of SARS-CoV-2 Infection and Immune Response to COVID-19 Vaccines in Patients With Inflammatory Bowel Disease: Current Evidence

“…To prevent infectious disease development, careful monitoring of IBD patients together with a rational use of presently available vaccines are recommended. Generally, inactivated vaccines are given to all IBD subjects although immune response can be reduced in patients receiving immunosuppressive therapy (7)(8)(9). Live vaccines are generally prescribed only to IBD patients that are not treated with immunosuppressive drugs (8,9).…”

“…Generally, inactivated vaccines are given to all IBD subjects although immune response can be reduced in patients receiving immunosuppressive therapy (7)(8)(9). Live vaccines are generally prescribed only to IBD patients that are not treated with immunosuppressive drugs (8,9).…”