Immunogenicity and mechanisms impairing the response to vaccines in inflammatory bowel disease

Table 1 Vaccines recommended in patients with inflammatory bowel disease

Vaccine	Type of immunogen	General recommendations for vaccination in IBD	Concerns in IBD patients on immunosuppressive therapy
HBV	Recombinant protein	After checking the serological status for HBV: double-dose schedule	None
HPV1	Quadrivalent vaccine (Recombinant proteins)	Women aged between 11-12 yr: 3 doses (0, 2 and 6 mo)	None
Influenza	Inactivated virus	1 dose annually	None
Pneumococcus	Polysaccharides, conju-gated or not to a protein carrier	1 dose every 5 yr	None
Tetanus	Inactivated toxoid		None
		Patient previously vaccinated: 1 dose every 10 years
		Unknown or not previously vaccinated: 3-doses
Measles-mumps-rubella	Live attenuated virus	Non-immunized: Standard schedule	Contraindicated
Varicella	Live attenuated virus	Non-immunized: 2 doses (0 and 1-2 mo)	Risks and benefits should be evaluated on an individual basis
Herpes zoster1	Live attenuated virus	Patients aged over 60 yr: Standard schedule	Risks and benefits should be evaluated on an individual basis

¹Depending on local recommendations. Source: Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease[2]. IBD: Inflammatory bowel disease; HBV: Hepatitis B virus; HPV: Human papillomavirus.

Table 2 Vaccines recommended in patients with inflammatory bowel disease and mechanisms associated with impaired response in these patients

Vaccine	Immunogen	Impaired response	Factors associated with a lower response	Mechanisms associated with lower immunogenicity
HBV	Recombinant protein	Yes	Age[20,21,23], immunosuppressive or anti-TNF therapy[20,21,23]	Not described
HPV	Recombinant protein	No	-	-
Influenza	Inactivated virus	Yes	Immunosuppressive therapy[8]	Not described
Pneumococcus	Polysaccharides	Yes	Immunosuppressive and/or anti-TNF therapy[9,10,55]	Conflicting results about memory B cells[60,62]
Tetanus	Inactivated toxoid	Unclear	None described	Defects in the development of IgG-secreting plasma cells[65]
Measles-mump-rubella	Live attenuated virus	No	-	-
Varicella	Live attenuated virus	No	-	-
Herpes zoster	Live attenuated virus	No	-	-

HBV: Hepatitis B virus; HPV: Human papillomavirus; TNF: Tumor necrosis factor.