Skip to main content
SpringerLink
Log in
Book cover

Pediatric Inflammatory Bowel Disease pp 765–772Cite as

Immunizations in the Child with Inflammatory Bowel Disease

  • Chapter
  • First Online:

  • 619 Accesses

Abstract

Many patients with inflammatory bowel disease (IBD) are at risk for infections at some point in their disease. Infections may occur as a result of the disease itself (e.g., perianal or abdominal abscess), or be community acquired. Immunosuppressive therapy, commonly utilized in patients with IBD, may increase the risk of opportunistic infections (e.g., varicella, tuberculosis, pneumonia). Therefore, it is important to minimize infections through immunization. Current guidelines recommend against administering live vaccines in patients with IBD receiving immunosuppressive therapy. However, they should receive inactivated vaccines regardless of immunosuppressive status. The IBD scientific literature suggests that inactivated vaccines are safe and do not worsen disease activity. In general, patients develop an adequate immune response to inactivated vaccines, but the response may be suboptimal if patients are on immunosuppressive therapy, especially tumor necrosis factor inhibitors. Therefore, it is ideal to check immunization status at time of diagnosis and administer any necessary vaccinations as early as possible, prior to starting immunosuppressive therapy.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Rufo PA, Bousvaros A. Current therapy of inflammatory bowel disease in children. Paediatr Drugs. 2006;8:279–302.

    PubMed  Google Scholar 

  2. Wang X, Zhao J, Zhu S, Xia B. Herpes zoster in Crohn’s disease during treatment with infliximab. Eur J Gastroenterol Hepatol. 2014;26:237–9.

    CAS  PubMed  Google Scholar 

  3. Ma C, Walters B, Fedorak R. Varicella zoster meningitis complicating combined anti-tumor necrosis factor and corticosteroid therapy in Crohn’s disease. World J Gastroenterol. 2013;19:3347–51.

    PubMed  PubMed Central  Google Scholar 

  4. Magro F, Santos-Antunes J, Albuquerque A, Vilas-Boas F, Macedo GN, Nazareth N, et al. Epstein-Barr virus in inflammatory bowel disease - correlation with different therapeutic regimens. Inflamm Bowel Dis. 2013;19:1710–6.

    PubMed  Google Scholar 

  5. Sager K, Alam S, Bond A, Chinnappan L, Probert CS. Review article: cytomegalovirus and inflammatory bowel disease. Aliment Pharmacol Ther. 2015;41:725–33.

    CAS  PubMed  Google Scholar 

  6. Wasan SK, Baker SE, Skolnik PR, Farraye FA. A practical guide to vaccinating the inflammatory bowel disease patient. Am J Gastroenterol. 2010;105:1231–8.

    PubMed  Google Scholar 

  7. Sands BE, Cuffari C, Katz J, Kugathasan S, Onken J, Vitek C, et al. Guidelines for immunizations in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2004;10:677–92.

    PubMed  Google Scholar 

  8. Lu Y, Jacobson D, Bousvaros A. Immunizations in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:1417–23.

    PubMed  Google Scholar 

  9. The Infectious Diseases Society of America: 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. 2013. http://cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.full. Accessed 25 Oct 2020.

  10. Longuet R, Willot S, Giniès J-L, Pélatan C, Breton E, Segura J-F, et al. Immunization status in children with inflammatory bowel disase. Eur J Pediatr. 2014;173:603–8.

    CAS  PubMed  Google Scholar 

  11. Soon IS, deBruyn JCC, Wrobel I. Immunization history of children with inflammatory bowel disease. Can J Gastroenterol. 2013;27:213–6.

    PubMed  PubMed Central  Google Scholar 

  12. Crawford NW, Catto-Smith AG, Oliver MR, Cameron DJ, Buttery JP. An Australian audit of vaccination status in children and adolescents with inflammatory bowel disease. BMC Gastroenterol. 2011;11:87.

    PubMed  PubMed Central  Google Scholar 

  13. Martinelli M, Giugliano FP, Strisciuglio C, Urbonas V, Serban DE, Banaszkiewicz A, et al. Vaccinations and immunization status in pediatric inflammatory bowel disease: a multicenter study from the Pediatric IBD Porto Group of the ESPGHAN. Inflamm Bowel Dis. 2020;26:1407–14.

    PubMed  Google Scholar 

  14. deBruyn JCC, Soon IS, Fonseca K, Feng S, Purtzki M, Goedhart C, et al. Serologic status of routine childhood vaccines, Cytomegalovirus, and Epstein-Barr Virus in children with inflammatory bowel disease. Inflamm Bowel Dis. 2019;25:1218–26.

    PubMed  Google Scholar 

  15. Temtem T, Whitworth J, Bagga B. Pneumococcal polysaccharide vaccination in pediatric inflammatory bowel disease. Glob Pediatr Health. 2019;6:2333794X19849754.

    PubMed  PubMed Central  Google Scholar 

  16. Peleg N, Zevit N, Shamir R, Chodick G, Levy I. Seasonal influenza vaccination rates and reasons for non-vaccination in children with gastrointestinal disorders. Vaccine. 2015;33:182–6.

    PubMed  Google Scholar 

  17. Banaszkiewicz A, Klincewicz B, Łazowska-Przeorek I, Grzybowska-Chlebowcyzk U, Kąkol P, Mytyk A, et al. Influenza vaccination coverage in children with inflammatory bowel disease. Influenza Other Respir Viruses. 2014;8:431–5.

    PubMed  PubMed Central  Google Scholar 

  18. Lester R, Lu Y, Tung J. Survey of immunization practices in patients with inflammatory bowel disease among pediatric gastroenterologists. J Pediatr Gastroenterol Nutr. 2015;61:47–51.

    CAS  PubMed  Google Scholar 

  19. Waszczuk K, Waszczuk E, Szenborn L. Can we better protect patients with inflammatory bowel disease against infections - patient attitude and personal immunization knowledge. Acta Gastroenterol Belg. 2018;81:257–61.

    PubMed  Google Scholar 

  20. Urganci N, Kalyoncu D. Immunogenecity of hepatitis A and B vaccination in pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;56:412–5.

    CAS  PubMed  Google Scholar 

  21. Radzikowski A, Banaszkiewicz A, Łazowska-Przeorek I, Grzybowska-Chlebowczyk U, Woś H, Pytrus T, et al. Immunogenecity of hepatitis A vaccine in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1117–24.

    PubMed  Google Scholar 

  22. Jacobson DL, Bousvaros A, Ashworth L, Carey R, Shrier LA, Burchett SK, et al. Immunogenicity and tolerability to human papillomavirus-like particle vaccine in girls and young women with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:1441–9.

    PubMed  Google Scholar 

  23. Dembiński L, Krzesiek E, Klincewicz B, Grzybowska-Chlebowczyk U, Demkow U, Banaszkiewicz A, et al. Immunogenicity of diphtheria booster vaccination in adolescents with inflammatory bowel disease. Pediatr Infect Dis J. 2020;39:244–6.

    PubMed  Google Scholar 

  24. Huth K, Benchimol EI, Aglipay M, Mack DR. Strategies to improve influenza vaccination in pediatric inflammatory bowel disease through education and access. Inflamm Bowel Dis. 2015;21:1761–8.

    PubMed  Google Scholar 

  25. Apte M, Reich J, Zahorian T, Farraye FA. Improving vaccination rates for IBD patients through the use of local pharmacies. Inflamm Bowel Dis. 2019;25:e19.

    PubMed  Google Scholar 

  26. Reich J, Wasan SK, Farraye FA. Vaccination and health maintenance issues to consider in patients with inflammatory bowel disease. Gastroenterol Hepatol. 2017;13:717–24.

    Google Scholar 

  27. Nguyen H-T, Minar P, Jackson K, Fulkerson P. Vaccinations in immunosuppressive-dependent pediatiric inflammatory bowel disease. World J Gastroenterol. 2017;23:7644–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Mamula P, Markowitz JE, Piccoli DA, Klimov A, Cohen L, Baldassano RN. Immune response to influenza vaccine in pediatric patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2007;5:851–6.

    PubMed  Google Scholar 

  29. Lu Y, Jacobson DL, Ashworth LA, Grand RJ, Meyer AL, McNeal MM, et al. Immune response to influenza vaccine in children with inflammatory bowel disease. Am J Gastroenterol. 2009;104:444–53.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. deBruyn JC, Hilsden R, Fonseca K, Russell ML, Kaplan GG, Vanderkooi O, et al. Immunogenicity and safety of influenza vaccination in children with inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:25–33.

    PubMed  Google Scholar 

  31. Neuzil KM, Jackson LA, Nelson J, Klimov A, Cox N, Bridges CB, et al. Immunogenicity and reactogenicity of 1 versus 2 doses of trivalent inactivated influenza vaccine in vaccine-naive 5–8-year-old children. J Infect Dis. 2006;194:1032–9.

    CAS  PubMed  Google Scholar 

  32. deBruyn J, Fonseca K, Ghosh S, Panaccione R, Gasia MF, Ueno A, et al. Immunogenicity of influenza vaccine for patients with inflammatory bowel disease on maintenance infliximab therapy: a randomized trial. Inflamm Bowel Dis. 2016;22:638–47.

    PubMed  Google Scholar 

  33. Ojiro K, Naganuma M, Ebinuma H, Kunimoto H, Tada S, Ogata H, et al. Reactivation of hepatitis B in a patient with Crohn’s disease treated using infliximab. J Gastroenterol. 2008;43:397–401.

    PubMed  Google Scholar 

  34. Zeitz J, Mullhaupt B, Fruehauf H, Rogler G, Vavricka SR. Hepatic failure due to hepatitis B reactivation in a patient with ulcerative colitis treated with prednisone. Hepatology. 2009;50:653–4.

    PubMed  Google Scholar 

  35. Moses J, Alkhouri N, Shannon A, Raig K, Lopez R, Danziger-Isakov L, et al. Hepatitis B immunity and response to booster vaccination in children with inflammatory bowel disease treated with infliximab. Am J Gastroenterol. 2012;107:133–8.

    CAS  PubMed  Google Scholar 

  36. Gisbert JP, Villagrasa JR, Rodríguez-Nogueiras A, Chaparro M. Efficacy of hepatitis B vaccination and revaccination and factors impacting on response in patients with inflammatory bowel disease. Am J Gastroenterol. 2012;107:1460–6.

    CAS  PubMed  Google Scholar 

  37. Gisbert JP, Menchén L, García-Sánchez V, Marín I, Villagrasa JR, Chaparro M. Comparison of the effectiveness of two protocols for vaccination (standard and double dosage) against hepatitis B virus in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2012;35:1379–85.

    CAS  PubMed  Google Scholar 

  38. Park SH, Yang SK, Park SK, Kim JW, Yang DH, Jung KW, et al. Efficacy of hepatitis A vaccination and factors impacting on seroconversion in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2014;20:69–74.

    PubMed  Google Scholar 

  39. Banaszkiewicz A, Targońska B, Kowalska-Duplaga K, Karolewska-Bochenek K, Sieczkowska A, Gawrońska A, et al. Immunogenicity of 13-valent pneumococcal conjugate vaccine in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21:1607–14.

    PubMed  Google Scholar 

  40. Pittet LF, Verolet CM, Michetti P, Girardin M, Juillerat P, Mottet C, et al., Swiss Inflammatory Bowel Disease Cohort Study Group. High immunogenicity of the pneumococcal conjugated vaccine in immunocompromised adults with inflammatory bowel disease. Am J Gastroenterol. 2019;114:1130–41.

    Google Scholar 

  41. Melmed GY, Agarwal N, Frenck RW, Ippoliti AF, Ibanez P, Papakakis KA, et al. Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease. Am J Gastroenterol. 2010;105:148–54.

    PubMed  Google Scholar 

  42. Lee CK, Kim HS, Ye BD, Lee KM, Kim YS, Rhee SY, et al. Patients with Crohn’s disease on anti-tumor necrosis factor therapy are at significant risk of inadequate response to the 23-valent pneumococcal polysaccharide vaccine. J Crohns Colitis. 2014;8:384–91.

    PubMed  Google Scholar 

  43. Fiorino G, Peyrin-Biroulet L, Naccarato P, Szabò H, Sociale OR, Vetrano S, et al. Effects of immunosuppression on immune response to pneumococcal vaccine in inflammatory bowel disease: a prospective study. Inflamm Bowel Dis. 2012;18:1042–7.

    PubMed  Google Scholar 

  44. Dotan I, Werner L, Vigodman S, Agarwal S, Pfeffer J, Horowitz N, et al. Normal response to vaccines in inflammatory bowel disease patients treated with thiopurines. Inflamm Bowel Dis. 2012;18:261–8.

    PubMed  Google Scholar 

  45. Banaszkiewicz A, Gawronska A, Klincewicz B, Kofla-Dłubacz A, Grzybowska-Chlebowczyk U, Toporowska-Kowalska E, et al. Immunogenicity of pertussis booster vaccination in children and adolescents with inflammatory bowel disease: a controlled study. Inflamm Bowel Dis. 2017;23:847–52.

    PubMed  Google Scholar 

  46. Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57:1–30.

    PubMed  Google Scholar 

  47. Harris RE, Curtis L, Hegde V, Garrick V, Gervais L, Armstrong L, et al. A decade of varicella screening within a paediatric inflammatory bowel disease population. J Crohns Colitis. 2020;14:608–16.

    PubMed  Google Scholar 

  48. Lu Y, Bousvaros A. Varicella vaccination in children with inflammatory bowel disease receiving immunosuppressive therapy. J Pediatr Gastroenterol Nutr. 2010;50:562–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Ansari F, Baker RD, Patel R, Baker SS. Varicella immunity in inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2011;53:386–8.

    PubMed  Google Scholar 

  50. Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017;112:241–58.

    PubMed  Google Scholar 

  51. Waszczuk K, Waszczuk E, Mulak A, Szenborn L, Paradowski L. A ‘cocoon immunization strategy’ among patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol. 2015;27:249–53.

    CAS  PubMed  Google Scholar 

  52. Sheibani S, Cohen R, Kane S, Dubinsky M, Church JA, Mahadevan U. The effect of maternal peripartum anti-TNFα use on infant immune response. Dig Dis Sci. 2016;61:1622–7.

    CAS  PubMed  Google Scholar 

  53. Beaulieu DB, Ananthakrishnan AN, Martin C, Cohen RD, Kane SV, Mahadevan U. Use of biologic therapy by pregnant women with inflammatory bowel disease does not affect infant response to vaccines. Clin Gastroenterol Hepatol. 2018;16:99–105.

    PubMed  Google Scholar 

  54. American Academy of Pediatrics. Varicella-Zoster infections. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009. p. 714–27.

    Google Scholar 

  55. World Health Organization Coronavirus Disease (COVID-19) Dashboard. 2020. https://covid19.who.int/. Accessed 3 Jan 2021.

  56. Sharma O, Sultan AA, Ding H, Triggle CR. A review of the progress and challenges of developing a vaccine for COVID-19. Front Immunol. 2020;11:585354. https://doi.org/10.3389/fimmu.2020.585354.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Brenner EJ, Ungaro RC, Gearry RB, Kaplan GG, Kissous-Hunt M, Lewis JD, et al. Corticosteroids, but not TNF antagonists, are associated with adverse COVID-19 outcomes in patients with inflammatory bowel diseases: results from an international registry. Gastroenterology. 2020;1359:481–91.

    Google Scholar 

  58. Fact sheet for healthcare providers administering vaccine (Vaccination providers) emergency use authorization (EUA) of the Moderna COVID-19 vaccine to prevent coronavirus disease 2019 (COVID-19). https://www.modernatx.com/covid19vaccine-eua/eua-fact-sheet-providers.pdf. Accessed 3 Jan 2021.

  59. Fact sheet for healthcare providers administering vaccine (Vaccination providers) emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine to prevent coronavirus disease 2019 (COVID-19). http://labeling.pfizer.com/ShowLabeling.aspx?id=14471. Accessed 3 Jan 2021.

  60. Centers for Disease Control and Prevention: Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020. 2020. http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Accessed 25 Oct 2020.

Download references

Author information

Authors and Affiliations

  1. IBD Center, Children’s Hospital Boston, Boston, MA, USA

    Athos Bousvaros

  2. Division of Pediatric Gastroenterology, Liver Disease and Nutrition, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children’s Medical Center of New York, Lake Success, NY, USA

    Ying Lu

Authors
  1. Athos Bousvaros
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ying Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ying Lu .

Editor information

Editors and Affiliations

  1. Division of GI, Hepatology & Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Petar Mamula

  2. Division of GI, Hepatology & Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Judith R. Kelsen

  3. Division of GI, Hepatology & Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Andrew B. Grossman

  4. Division of GI, Hepatology & Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Robert N. Baldassano

  5. Division of Pediatric Gastroenterology, Prisma Health Children’s Hospital—Upstate, Greenville, SC, USA

    Jonathan E. Markowitz

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bousvaros, A., Lu, Y. (2023). Immunizations in the Child with Inflammatory Bowel Disease. In: Mamula, P., Kelsen, J.R., Grossman, A.B., Baldassano, R.N., Markowitz, J.E. (eds) Pediatric Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-14744-9_55

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-14744-9_55

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14743-2

  • Online ISBN: 978-3-031-14744-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation