What is the best way to manage screening for infections and vaccination of inflammatory bowel disease patients?

Table 1 Screening and vaccinations for inflammatory bowel disease patients prior to start immunosuppressive including anti-tumor necrosis factor therapy

Infection	Tests	Recommended screening	Vaccine
TB	LTB should be tested by a combination of patient history, chest X-ray, TST and QFT-G	Yes	Always contraindicated during immunosuppressive therapy and in children exposed in utero to anti-TNF, up to 6 mo of age, like any other live vaccine
Clostridium difficile	Enzyme immunoassay Against toxin A and B and PCR assays	Not necessary	Not available
S. Pneumonia	Culture of relevant clinical samples (blood, CSF, good respiratory sample), urine	Not necessary	Yes
HBV	Blood test for HBsAg, anti-HBsAb and HBcAb to determine HBV status. In patients with positive HBsAg, viremia HBV-DNA should also be quantified	Yes	Recommended standard or double dose schedule
HCV	HCV serology	Yes	Not available
CMV	CMV serology	No	Not available
HIV	Blood test for HIV serology	Yes	Not available
VZV	VZV serology	Yes	Vaccine available, vaccinate before starting immune suppressants
HPV	Cervical cytology	Yes	Recommended
HSV	HSV serology	Not necessary	Not available
EBV	EBV serology	Advisable	Not available
Influenza virus	clinical signs and laboratory evaluation	Not necessary	Recommended

TNF: Tumor necrosis factor; TB: Tuberculosis; LTB: Latent tuberculosis; TST: Tuberculin skin test; QFT-G: Quanti FERON TB-Gold; PCR: Polymerase chain reaction; CSF: Cerebrospinal fluid; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CMV: Cytomegalovirus; HIV: Human immunodeficiency virus; VZV: Varicella zoster virus; HPV: Human papillomavirus; HSV: Herpes simplex virus; EBV: Epstein-Barr virus.

Table 2 Vaccination of inflammatory bowel disease patients on immunosuppressive therapy

Vaccine	Dose	Safety
Inactivated vaccines
HAV	2 doses	Yes
HBV	3 doses	Yes
HAV and HBV	3 doses	Yes
HPV	3 doses	Yes
Influenza (trivalent)	Annually	Yes
Meningococcal	≥ 1 dose	Yes
Pneumococcal	1 dose and 1 booster in 5 yr	yes
Tetanus and diphtheria	Every 10 yr	Yes
Live attenuated vaccines
BCG	1 dose	Contraindicated
MMR	1 or 2 doses	Contraindicated
Varicella	2 doses	Contraindicated
Zoster	1 doses	Contraindicated

HAV: Hepatitis A virus; HBV: Hepatitis B virus; HPV: Human papillomavirus; BCG: Bacillus Calmette Guérin; MMR: Measles, mumps, and rubella.