Chaudrey K, Salvaggio M, Ahmed A, Mahmood S, Ali T. Updates in vaccination: Recommendations for adult inflammatory bowel disease patients. World J Gastroenterol 2015; 21(11): 3184-3196 [PMID: 25805924 DOI: 10.3748/wjg.v21.i11.3184]
Corresponding Author of This Article
Khadija Chaudrey, MD, Department of Medicine, Section of Gastroenterology, Oklahoma University Health Sciences Center, Oklahoma, OK 73104, United States. drkchaudrey@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Mar 21, 2015; 21(11): 3184-3196 Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3184
Table 1 Definition of the immune compromised inflammatory bowel disease patient[1]
Treatment with glucocorticoids: > prednisone 20 mg/d equivalent for 2 wk or more
Ongoing treatment with effective doses of 6-mercaptopurine, AZT, Methotrexate and anti tumor necrosis factor therapy
Within 3 mo of stopping the above listed immunosuppressive therapies
Significant protein-calorie malnutrition
Table 2 Risk factors for pneumococcal disease
All adults 65 and older
Symptomatic or asymptomatic human immunodeficiency virus
Chronic lung disease (COPD, emphysema, and asthma)
Chronic cardiovascular diseases
Diabetes mellitus
Chronic renal failure
Nephrotic syndrome
Chronic liver disease (including cirrhosis)
Alcoholism
Cochlear implants
Cerebrospinal fluid leaks
Immunocompromising conditions
Functional or anatomic asplenia
Residents of nursing homes or long-term care facilities
Smokers
Table 3 Risk factors for meningococcal disease
College freshman living in dormitories
Microbiologists routinely exposed to Neisseria meningitidis
Military recruits
Persons who travel to or reside in countries where Neisseria meningitidis is hyper-endemic or epidemic particularly if contact with the local population will be prolonged
Persons with persistent complement component deficiency
Persons with anatomic or functional asplenia
Persons with human immunodeficiency virus infection
Table 4 Risk factors for hepatitis
Risk factors for hepatitis A
Risk factors for hepatitis B
18 yr and older who care for an international adopted child
Polygamous relationship (e.g., persons with more than one sex partner during the previous 6 mo)
IV and non IV illicit drug users
Persons seeking evaluation or treatment for a sexually transmitted disease
Homosexual males
Current or recent injection-drug users
Chronic liver disease patient
Homosexual male
Patients awaiting transplant
Health-care personnel and public-safety workers who are potentially exposed to blood or other infectious body fluids
Occupational exposure to Hep A
All diabetics younger than age 60 yr
Persons who receive clotting factor concentrates
Diabetics 60 yr or older at the discretion of the treating clinician
Travel to endemic areas
ESRD, HD
Human immunodeficiency virus chronic liver disease
Household contacts and sex partners of hepatitis B surface antigen positive persons;
clients and staff members of institutions for persons with developmental disabilities
International travelers to countries with high or intermediate prevalence of chronic HBV infection
Table 5 Evidence of immunity to varicella in adults includes any of the following
Documentation of 2 doses of varicella vaccine at least 4 wk apart
United States-born before 1980 except health-care personnel and pregnant women
History of varicella based on diagnosis or verification of varicella disease by a health-care provider
History of herpes zoster based on diagnosis or verification of herpes zoster disease by a health-care provider
Laboratory evidence of immunity or laboratory confirmation of disease
Table 6 Live attenuated vaccines with recommended times of administration[2]
Vaccine
Before initiation of immunosuppressive therapy
Already on immunosuppressive therapy
MMR
Contraindicated if plans to start therapy in 6 wk
Contraindicated
Zoster
Contraindicated if plans to start therapy in 1-3 mo
Contraindicated-could consider if:
On short-term corticosteroids (< 14 d)
On Methotrexate (< 0.4 mg/kg per week)
On Azathioprine (< 3.0 mg/kg per day)
On 6-mercaptopurine (< 1.5 mg/kg per day)
Varicella
Contraindicated if plans to start therapy in 1-3 mo
Contraindicated
Table 7 Inflammatory bowel disease traveler
Vaccine
Type
Travel related indication
Yellow fever
Live
Parts of South America and Sub-Saharan Africa
Typhoid
Live and inactivated
Asia, Africa, Latin America, The Caribbean, and Oceania
polio
influenza
BCG vaccine
Live
Highly endemic area > 1 yr
Hepatitis A
inactivated
Central or South America, Mexico, Asia (except Japan), Africa, and Eastern Europe
Meningococcal vaccine
Inactivated
Africa
Japanese encephalitis virus
Inactivated
Rural Japan
Table 8 Vaccination in pregnancy
Category B
Category C
Category X
Influenza (LAIV)
PPSV23
Varicella; non-immune
Adacel( Tdap)
1st dose. Upon completion or termination of pregnancy and before discharge from the health care facility
Influenza (IIV)
1 dose of Tdap vaccine during each pregnancy regardless of immunization status
2nd dose. 4-8 wk later
Zoster
Boostrix (Tdap)
Meningococcus
1 dose of Tdap vaccine during each pregnancy regardless of immunization status
Hep A and B
MMR. Non-immune
HPV 4, HPV 2
1st dose. Upon completion or termination of pregnancy and before discharge from the health care facility
PCV 13
2nd dose. 4-8 wk later
Table 9 Vaccinations in inflammatory bowel disease summary (quick reference)
Vaccine
How often
Live vaccine
Patients on immunosuppressive therapy
Influenza (Flu Vaccine)
1 dose every year
Nasal spray
Use flu shot only
Varicella (Chicken Pox)
If no documented immunity: 2 doses 4-8 wk apart
Yes
Contraindicated
Measles, mumps, rubella
If no documented immunity: 2 doses, 4 wk apart
Yes
Contraindicated
Zoster (Shingles)
1 dose starting at age 60 yr or older
Yes
Contraindicated
Tetanus, Diphtheria, Acellular Pertussis (Td/Tdap) Human papilloma virus
If no prior vaccination: 3 doses (0, 1, 6-12). Then 1 dose of Tdap followed by a booster of Td every 10 yr
Pneumococcal (pneumonia vaccine) for subset of patients
Male: 3 doses through age 21 (0, 2 and 6 mo)
No
Follow recommended regimen
If no prior vaccination: (0, 2 then 5 yr) 1 dose at 65
If had prior vaccination: 1 dose 5 yr after the last dose and 1 dose at age 65
Meningococcal (meningitis vaccine) for subset of patients
2 doses, 2 mo apart
No
Follow recommended regimen
Hepatitis A
2 doses, 6 mo apart
No
Follow recommended regimen
Hepatitis B
3 doses (0, 1 and 6 mo)
No
Follow recommended regimen
Citation: Chaudrey K, Salvaggio M, Ahmed A, Mahmood S, Ali T. Updates in vaccination: Recommendations for adult inflammatory bowel disease patients. World J Gastroenterol 2015; 21(11): 3184-3196