Morning MEDtalks with Dr KK Aggarwal

New Delhi, September 18, 2018 :

Inactivated vaccines for patients with inflammatory bowel disease

• Influenza: All patients with IBD should be vaccinated seasonally with the intramuscular/intradermal inactivated influenza vaccine prior to starting immunosuppressive therapy.

• Pneumococcal pneumonia: All patients with IBD should be vaccinated once with the PCV13 followed by the PPSV23 (first dose after 8 weeks if immunocompromised, or after ≥1 year if immunocompetent; second dose after 5 years; and third dose after 65 years of age). If previously vaccinated with the PPSV23, then the PCV13 should be administered at least 1 year after the PPSV23 in both immunocompromised and immunocompetent adults.

• Hepatitis A: Check hepatitis A immune status at the patient’s initial visit. If nonimmune to hepatitis A, vaccinate the patient with a 2-dose series (0 months and 6-12 months).

• Hepatitis B: Check hepatitis B immune status at the patient’s initial visit. If nonimmune to hepatitis B, vaccinate the patient with a 3-dose series (0 months, and 1 and 6 months after first dose) and recheck titers 1 to 2 months after last vaccination. If the patient remains nonimmune, offer booster with a double dose of hepatitis B vaccine or offer combined hepatitis A/B vaccination.

• Human papilloma virus: All male and female IBD patients between the ages of 11 and 26 years should be vaccinated with the human papilloma virus vaccine.

• Meningococcal disease: Patients with IBD should be vaccinated with the meningococcal vaccine according to standard ACIP recommendations for the general population.

• Tetanus, diphtheria, and pertussis: All patients with IBD should be vaccinated with Td every 10 years. TDap should be substituted once for the Td vaccine to provide additional coverage for pertussis.

Live vaccinations for patients with IBD

• Measles, mumps, rubella (MMR): Vaccinate all nonimmune patients with the MMR vaccine as long as they have not been on immunosuppressive therapy within the previous 3 months and there are no plans to start immunosuppressive therapy within the next 6 weeks.

• Varicella zoster: Vaccinate all nonimmune patients with the varicella zoster vaccine as long as they have not been on immunosuppressive therapy within the previous 3 months and there are no plans to start immunosuppressive therapy within the next 6 weeks.

• Herpes zoster: Vaccinate all patients over the age of 60 years with the herpes zoster vaccine. Vaccination is safe in patients on low-dose immunosuppression but contraindicated in patients on biologic therapy or on corticosteroids. Do not vaccinate patients on high-dose immunosuppressive therapy within the past 3 months or who plan to start high-dose immunosuppressive therapy within the next 6 weeks.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI