While the use of biologic agents has led to longer symptom-free durations and improved prognosis, it can also cause unexpected adverse events [2], infection being one of the most common adverse events [3,4]. Barberio et al. [5] reported that infections account for 31.2% and 27.3% of adverse events in patients with IBD, who are treated with adalimumab (anti-TNF agents) and vedolizumab (integrin α4β7 antagonist), respectively. Owing to the inappropriate immune response due to medication, infections can be fatal for patients. Therefore, clinicians treating IBD must always be alert for infections. The main strategy to prevent infections is vaccination. In fact, clinical practice guidelines published by the European Crohn’s and Colitis Organisation and the American College of Gastroenterology strongly recommend vaccination in patients with IBD [3,4]. In addition, the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic highlighted the importance of vaccination in immunocompromised patients and in patients with underlying chronic diseases, such as IBD; Lee et al. [6] strongly recommended SARS-CoV2 vaccination for the patients with IBD who are treated with immunosuppressants and biologic agents, since the benefits outweigh the risks.

In patients with IBD, vaccines against viruses, such as hepatitis B virus, hepatitis A virus, influenza, and human papilloma-virus, as well as vaccines against bacteria, such as pneumococcus, are recommended. However, the timing of vaccinations is yet to be established [3,4]. Mishra et al. [7] reported that although hepatitis B virus vaccination in patients with ulcerative colitis showed a lower serologic response than in general population, an appropriate vaccine effect could be expected if they are not exposed to corticosteroid, immunosuppressant, or biologic agents. Therefore, several guidelines have suggested the timing of vaccination as either at diagnosis or just prior to starting the immunosuppressive therapy [3,4].

Despite the need and recommendations for vaccination, it may not be implemented in practice for a variety of reasons. A survey of gastroenterologists’ practices regarding vaccination in patients with IBD in the United States reported that while physicians recognize the importance of vaccines, only approximately half of their patients are appropriately vaccinated as recommended [8]. In addition, a survey in South Korea reported that a large number of doctors who responded did not adequately take an immunization history or recommend vaccinations to patients with IBD, in their practice, and most of them lacked concern and knowledge regarding vaccination [9].

In the current issue, a second follow-up to the previous survey in 2014 about management of patients with IBD was conducted [10]. Clinicians in South Korea, China, Japan, and other coun­tries in Southeast and Southwest Asia were asked about their current opinion on vaccination in patients with IBD and about their actual practice trends. Most of the respondents were in tertiary care settings, and many were specialists in IBD, with more than 10 years of clinical experience. Most of them followed the clinical practice guidelines, barring some national differences. Despite many guidelines recommending hepatitis A virus vaccination and tetanus/diphtheria vaccination, more than half of the respondents did not recommend them to their patients.

This article is significant in that it is the first study based on a multinational survey that investigated trends and opinions about vaccination in patients with IBD among Asian specialists. However, both the survey and the study would be more meaningful if there are interventions and follow-ups in future to address the inconsistent vaccination trends among the specialists. If possible, the Asian Organization for Crohn’s and Colitis (AOCC) should continue to collect opinions and provide intensive education program about vaccination during the relevant conferences and meetings.

Disease characteristics of IBD are reported differently in the West and East, presumably due to the genetic differences [2]. However, practice in Asia is also based on the practice guidelines from Europe and the United States. Therefore, creating practice guidelines for IBD that would be appropriate for the genetic and geographic characteristics of Asians, including unified vaccination recommendations, would be required by the AOCC. This survey and study should lead to the development of standardized guidelines for evidence-based treatment beyond the current individual experience and policy-based treatment.