title: Many Inflammatory Bowel Disease Patients Are Not Immune to Measles or Pertussis.
abstract: Current guidelines emphasize vaccination for influenza and pneumococcus for IBD patients and the avoidance of live virus vaccines for those who are on immunosuppressive (ISS) therapy. Given the recent resurgence of measles and pertussis infections, we assessed the immune status of our IBD population in order to advise about these risks.
  
  
  
  We prospectively collected measles and pertussis titers in our IBD patients from February 1-May 1, 2015. Immune status based on standard threshold values was determined: measles antibodies ≤0.8 antibody index (AI) = negative immunity, 0.9-1.1 AI = equivocal immunity and titers ≥1.2 AI = positive immunity. For pertussis immunity, anti-pertussis antibodies ≤5 IU/mL were considered negative immunity. Univariate analysis was performed to examine predictive factors including age, disease duration, and current medical therapies.
  
  
  
  A total of 122 patients' titers were assessed (77 Crohn's disease, 1 indeterminate colitis, and 45 ulcerative colitis). Sixteen (13.1 %) patients lacked detectable immunity to measles, and four (3 %) had equivocal immunity. Twelve (75 %) of the measles non-immune patients were on ISS therapy versus 65 (64 %) of 102 immune patients (OR 1.7, 95 % CI 0.5-5.9, p = 0.34). Out of 96 patients, 58 (60 %) were not immune to pertussis. Disease duration ≥10 years and age ≥50 were associated with significant lower measles titers.
  
  
  
  A significant number of our IBD patients lack immunity to measles, and a majority of our IBD patients do not have detectable immunity to pertussis. Importantly, the majority of the measles non-immune patients are on ISS therapy and therefore unable to receive a booster.
authors.affiliation: University of Chicago Medicine, 5841 S. Maryland Ave., MC 4076, Chicago, IL, 60637, USA.
authors.forename: Noa Krugliak
authors.initials: NK
authors.lastname: Cleveland
authors.affiliation: University of Chicago Medicine, 5841 S. Maryland Ave., MC 4076, Chicago, IL, 60637, USA.
authors.forename: Dylan
authors.initials: D
authors.lastname: Rodriquez
authors.affiliation: University of Chicago Medicine, 5841 S. Maryland Ave., MC 4076, Chicago, IL, 60637, USA.
authors.forename: Alana
authors.initials: A
authors.lastname: Wichman
authors.affiliation: University of Chicago Medicine, 5841 S. Maryland Ave., MC 4076, Chicago, IL, 60637, USA.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pan
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
authors.affiliation: University of Chicago Medicine, 5841 S. Maryland Ave., MC 4076, Chicago, IL, 60637, USA. drubin@medicine.bsd.uchicago.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000276:immunology*; D000914:Antibodies, Viral / Q000276:immunology*; D001886:Bordetella pertussis / Q000276:immunology*; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000276:immunology; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008457:Measles / Q000209:etiology / Q000276:immunology*; D008458:Measles Vaccine / Q000627:therapeutic use; D008875:Middle Aged; D018103:Morbillivirus / Q000276:immunology*; D010567:Pertussis Vaccine / Q000627:therapeutic use; D011446:Prospective Studies; D014481:United States; D014917:Whooping Cough / Q000209:etiology / Q000276:immunology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D008458:Measles Vaccine; D010567:Pertussis Vaccine
keywords: Inflammatory bowel disease; MMR; Measles; Pertussis; Tdap; Vaccination