title: Efficacy of the vaccination in inflammatory bowel disease.
abstract: Inflammatory bowel disease (IBD) is associated with conditions that may predispose to infections, such as the lack of an appropriate innate immune response to infectious agents, malnutrition, surgery, and immunosuppressive and biological drugs. Some of these infections may be preventable by vaccination. Therefore, for this particular patient population, the benefits of implementing a well-established immunization protocol in daily clinical practice are potentially even greater than for the general population. In recent years international consensus guidelines have been published, but in spite of theses recommendations, studies have shown that a significant number of patients with IBD remain inadequately immunized. Another important issue regarding immunization in this population is that vaccine efficacy among patients receiving immunosuppressive therapies has been variable. In a healthy population, a humoral immune response to hepatitis B vaccination (HBV) is expected in > 90%, whereas a much lower rate is achieved in the IBD patients. Immunosuppressive, anti-tumor necrosis factor therapy and disease activity have been implicated in the impaired efficacy of the vaccination. The serological response to HBV should be confirmed and patients with an inadequate response should receive a second full series of vaccine. Modified dosing regimens, including doubling the standard antigen dose, might increase the effectiveness. Response to influenza, pneumococcal and tetanus immunization is still not clear, as there are studies that show a normal response to the vaccination while others demonstrate a lack of efficacy. We pose a series of questions on the efficacy of the different vaccinations recommended for IBD patients and attempt to answer them using scientific evidence.
authors.affiliation: Department of Gastroenterology, University Hospital of Guadalajara, 19002 Guadalajara, Spain. ecarreraa@hotmail.com
authors.forename: Elisa
authors.initials: E
authors.lastname: Carrera
authors.forename: Rebeca
authors.initials: R
authors.lastname: Manzano
authors.forename: Elena
authors.initials: E
authors.lastname: Garrido
mesh_terms: D001424:Bacterial Infections / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D001428:Bacterial Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014611:Vaccination / Q000009:adverse effects; D014765:Viral Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D014777:Virus Diseases / Q000276:immunology / Q000517:prevention & control* / Q000821:virology
chemical_list: D001428:Bacterial Vaccines; D007166:Immunosuppressive Agents; D014765:Viral Vaccines
keywords: Efficacy; Hepatitis B vaccines; Immunization; Immunosuppressive medications; Infections; Inflammatory bowel disease; Influenza vaccines; Pneumococcal vaccines; Tetanus vaccines; Vaccination
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