Ideal Vaccination Strategy in Inflammatory Bowel Disease

Chang Kyun Lee

doi:10.4166/kjg.2015.65.3.159

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Lee: Ideal Vaccination Strategy in Inflammatory Bowel Disease

Review Article

Korean J Gastroenterol 2015;65(3):159-164.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.3.159

Ideal Vaccination Strategy in Inflammatory Bowel Disease

Chang Kyun Lee

Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea

Correspondence to: Chang Kyun Lee, Department of Internal Medicine, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Korea. Tel: +82-2-958-8258, Fax: +82-2-968-1848, E-mail: cklee92@paran.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Inflammatory bowel disease (IBD) is a long-standing disease that often requires long-term use of immunosuppressive agents including immunomodulators (such as azathioprine, 6-mercaptopurine and methotrexate) and tumor necrosis factor-α inhibitors (such as infliximab and adalimumab). Introduction of immunosuppressive therapies, however, involves the risk of host suscepti-bility to opportunistic infections in this patient population. Therefore, adequate immunization for vaccine-preventable infectious diseases is currently recommended for all patients with IBD and is emerging as an important target for quality improvements in IBD care. However, ongoing issues regarding underuse of immunization, safety and efficacy of vaccines in patients with IBD remain. For quality improvements in IBD care, all physicians should follow the recent immunization guidelines proposed by professional IBD societies. Additionally, there are ongoing needs for intensive educational programs regarding a role of immunization in long-term care of IBD and up-to-date immunization guidelines. Immunization status should be checked at the time of diagnosis of IBD and timely vaccination before initiation of immunosuppressive therapies can be a practical solution for maximizing the efficacy of vaccination at this point. Inactivated vaccines can be used safely irrespective of immunization status of patients, while attenuated vaccines are contraindicated in patients on immunosuppressive therapies. This article reviews an ideal strategy for vaccinating patients with IBD based on the currently recommended immunization guidelines.

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Keywords: Vaccination, Inflammatory bowel diseases, Immunosuppressive agents, Tumor necrosis factor-α inhibitor

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Fig. 1.

Vaccination strategy in patients with inflammatory bowel disease. IBD, inflammatory bowel disease; TNF, tumor necrosis factor; MMR, measles, mumps, rubella; DTP, diphtheria, tetanus, pertussis; TIV, trivalent influenza vaccine; PCV13, pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine; HPV, human papillomavirus.

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