Immunizations in patients with inflammatory bowel disease: CAG Guideline
Canada: Inflammatory bowel disease (IBD) patients may be at increased risk of some vaccine-preventable diseases. The safety and effectiveness of vaccinations may be changes by immunosuppressive therapies or IBD itself.
Considering the above, the Canadian Association of Gastroenterology released a clinical practice guideline for immunizations in IBD patients which is focused on live vaccines. The guidelines are published in the journal Gastroenterology.
For developing the guideline, Eric I. Benchimol, SickKids Research Institute, ICES, Toronto, Ontario, Canada, and colleagues performed systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Using an iterative process, key questions were developed and voted on by a multidisciplinary panel.
Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients.
Key recommendations include:
- In all patients with IBD, a complete review of the patient's history of immunization and vaccine-preventable diseases should be performed at diagnosis and updated at regular intervals by IBD care providers.
- In patients with IBD, all appropriate vaccinations should be given as soon as possible, and ideally prior to initiation of immunosuppressive therapy.
- In patients with IBD who require urgent immunosuppressive therapy, treatment should not be delayed in order to provide vaccinations.
- In MMR-susceptible pediatric patients with IBD not on immunosuppressive therapy, the authors recommend MMR vaccine be given.
- In MMR-susceptible pediatric patients with IBD on immunosuppressive therapy, the authors suggest against giving MMR vaccine.
- In MMR-susceptible adult patients with IBD not on immunosuppressive therapy, the authors recommend MMR vaccine be given.
- In MMR-susceptible adult patients with IBD on immunosuppressive therapy, the authors suggest against giving MMR vaccine.
- In varicella-susceptible pediatric patients with IBD not on immunosuppressive therapy, we recommend varicella vaccine be given.
- In varicella-susceptible pediatric patients with IBD on immunosuppressive therapy, the authors suggest against giving varicella vaccine.
- In varicella-susceptible adult patients with IBD not on immunosuppressive therapy, the authors suggest varicella vaccine be given.
- In varicella-susceptible adult patients with IBD on immunosuppressive therapy, the authors suggest against giving varicella vaccine.
"In order to optimize patient outcomes, it is pertinent to maintain appropriate vaccination status in IBD patients. In general, the authors recommend live vaccines in patients not on immunosuppressive therapy, but not for those using immunosuppressive medications," wrote the authors.
However, there is a need for additional studies to evaluate the safety and efficacy of live vaccines in patients on immunosuppressive therapy, they concluded.
Reference:
"Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 1: Live Vaccines," is published in the journal Gastroenterology.
DOI: https://www.gastrojournal.org/article/S0016-5085(21)00427-3/fulltext
