Copyright ©The Author(s) 2015.
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)
Cochlear implants
Cerebrospinal fluid leaks
Immunocompromising conditions
Functional or anatomic asplenia
Residents of nursing homes or long-term care facilities
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 ARisk factors for hepatitis B
18 yr and older who care for an international adopted childPolygamous relationship (e.g., persons with more than one sex partner during the previous 6 mo)
IV and non IV illicit drug usersPersons seeking evaluation or treatment for a sexually transmitted disease
Homosexual malesCurrent or recent injection-drug users
Chronic liver disease patientHomosexual male
Patients awaiting transplantHealth-care personnel and public-safety workers who are potentially exposed to blood or other infectious body fluids
Occupational exposure to Hep AAll diabetics younger than age 60 yr
Persons who receive clotting factor concentratesDiabetics 60 yr or older at the discretion of the treating clinician
Travel to endemic areasESRD, 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]
VaccineBefore initiation of immunosuppressive therapyAlready on immunosuppressive therapy
MMRContraindicated if plans to start therapy in 6 wkContraindicated
ZosterContraindicated if plans to start therapy in 1-3 moContraindicated-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)
VaricellaContraindicated if plans to start therapy in 1-3 moContraindicated
Table 7 Inflammatory bowel disease traveler
VaccineTypeTravel related indication
Yellow feverLiveParts of South America and Sub-Saharan Africa
TyphoidLive and inactivatedAsia, Africa, Latin America, The Caribbean, and Oceania
BCG vaccineLiveHighly endemic area > 1 yr
Hepatitis AinactivatedCentral or South America, Mexico, Asia (except Japan), Africa, and Eastern Europe
Meningococcal vaccineInactivatedAfrica
Japanese encephalitis virusInactivatedRural Japan
Table 8 Vaccination in pregnancy
Category BCategory CCategory X
Influenza (LAIV)PPSV23Varicella; 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 status2nd dose. 4-8 wk later
Boostrix (Tdap)Meningococcus
1 dose of Tdap vaccine during each pregnancy regardless of immunization statusHep A and B
MMR. Non-immune
HPV 4, HPV 21st dose. Upon completion or termination of pregnancy and before discharge from the health care facility
PCV 132nd dose. 4-8 wk later
Table 9 Vaccinations in inflammatory bowel disease summary (quick reference)
VaccineHow oftenLive vaccinePatients on immunosuppressive therapy
Influenza (Flu Vaccine)1 dose every yearNasal sprayUse flu shot only
Varicella (Chicken Pox)If no documented immunity: 2 doses 4-8 wk apartYesContraindicated
Measles, mumps, rubellaIf no documented immunity: 2 doses, 4 wk apartYesContraindicated
Zoster (Shingles)1 dose starting at age 60 yr or olderYesContraindicated
Tetanus, Diphtheria, Acellular Pertussis (Td/Tdap) Human papilloma virusIf no prior vaccination: 3 doses (0, 1, 6-12). Then 1 dose of Tdap followed by a booster of Td every 10 yrNo NoFollow recommended regimen Follow recommended regimen
Female: 3 doses through age 26 (0, 2 and 6 mo)
Pneumococcal (pneumonia vaccine) for subset of patientsMale: 3 doses through age 21 (0, 2 and 6 mo)NoFollow 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 patients2 doses, 2 mo apartNoFollow recommended regimen
Hepatitis A2 doses, 6 mo apartNoFollow recommended regimen
Hepatitis B3 doses (0, 1 and 6 mo)NoFollow recommended regimen