COVID-19 Vaccination in Patients With Inflammatory Bowel Disease: Communiqué From the Canadian Association of Gastroenterology

摘要

Patients with inflammatory bowel disease (IBD) may be at increased risk of developing certain vaccine-preventable infections such as influenza and pneumococcal pneumonia. The effectiveness and safety of vaccinations may be altered in patients with IBD due to the underlying immune dysregulation inherent to IBD and/or the immunosuppressive therapy that is prescribed for the disease. The Canadian Association of Gastroenterology (CAG) recently completed a comprehensive and rigorous systematic review and grading of evidence of immunization with inactivated and live vaccines in patients with IBD for a clinical practice guideline.(1, 2) The evidence to date suggests that patients with IBD on immunosuppressive therapy may have a lower immune response to certain vaccines. However, inactivated (or non-live) vaccines are safe with no serious adverse events (SAEs) in patients with IBD regardless of whether or not they are on immunosuppressive therapy. The use of live vaccines in patients with immune-mediated diseases (including patients with IBD) on immunosuppressive therapy is also generally safe, although rare SAEs have been reported (3). Both the US Centers for Disease Control and Prevention (CDC) and the Canadian National Advisory Committee on Immunization (NACI) recommend against live vaccines ‘in patients on immunosuppressive therapy equivalent to ≥ 20 mg or 2 mg/kg/day of prednisone for ≥ 14 days’ (4,5).