What are the recommended vaccination considerations for patients with Inflammatory Bowel Disease on immunosuppressive therapy?

Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapy require careful vaccination considerations to reduce their increased risk of infections due to immunosuppression. It is recommended that all vaccinations be reviewed and updated ideally before starting immunosuppressive treatment, with particular attention to pneumococcal and annual influenza vaccines, as these patients are at higher risk of severe infections ¹.

Live vaccines should generally be avoided during immunosuppressive therapy due to the risk of vaccine-related infection; if live vaccines are indicated, they should be administered prior to immunosuppression or delayed until immune function recovers ¹. For example, infants exposed in utero to anti-TNF agents such as adalimumab or infliximab should have live vaccines delayed for several months after birth ¹.

Inactivated vaccines, including pneumococcal, influenza, and meningococcal vaccines, are safe and recommended during immunosuppressive therapy to provide protection against encapsulated bacteria and seasonal viral infections ¹. Pneumococcal vaccination is particularly important given the increased risk of pneumococcal infections in immunosuppressed patients with IBD (Esteve Comas et al., 2009). Annual influenza vaccination is also advised to reduce respiratory infection risk (Culver and Travis, 2010).

Recent literature emphasizes the importance of vaccination during the COVID-19 pandemic, recommending that patients with IBD on immunosuppressants receive COVID-19 vaccines as they are not contraindicated and provide critical protection (Lin et al., 2022). Immunosuppressive therapy may reduce vaccine immunogenicity, so timing and possibly additional doses should be considered in consultation with specialists (Esteve Comas et al., 2009).

Overall, vaccination strategies for patients with IBD on immunosuppressive therapy should be individualized, ensuring inactivated vaccines are up to date, live vaccines are avoided or timed appropriately, and specialist advice is sought for complex cases ¹ (Esteve Comas et al., 2009; Culver and Travis, 2010; Lin et al., 2022).