Measles Outbreaks Present Special Concerns for Immunosuppressed IBD Patients

By Will Boggs MD

October 24, 2019

NEW YORK (Reuters Health) - Immunosuppressed patients with inflammatory bowel disease (IBD) need careful assessment and management during the increasingly frequent measles outbreaks, according to a new report.

"Overall, patients should be reassured that the risk of contracting measles in the United States is still quite low," Dr. Erica R. Cohen of Cedars-Sinai Medical Center, in Los Angeles, told Reuters Health by email. "Patients who received the appropriate live attenuated vaccines in childhood are immune to measles even if receiving immunosuppressive therapy."

Although measles was deemed eliminated in the United States two decades ago, there have been a number of recent outbreaks, including more than 700 documented cases so far in 2019. This represents a special concern for people who are unvaccinated, pregnant or immunocompromised.

In their report online September 6 in The American Journal of Gastroenterology, Dr. Cohen's team summarize the features of measles and propose an algorithm for managing patients with IBD in today's America.

Patients with documentation of having received the standard vaccination series should be considered immune to measles, regardless of the level of immunosuppression, and should be reassured.

For those without documentation who are not immunosuppressed, empiric measles vaccination should be considered, the authors say.

For immunosuppressed patients without documentation, especially those at high risk for exposure to measles (pregnancy, healthcare workers, childcare providers, those traveling to highly infected areas), measles IgG serology should be checked. If the serology is positive, the patient can be reassured of immunity.

On the other hand, serology-negative immunosuppressed patients without documentation of immunization require individualized discussions regarding the risks versus benefits of vaccination when there is an increased likelihood of exposure to measles.

In general, vaccination of patients with systemic immunosuppression is not recommended, because there is no high-level evidence to confirm the efficacy and safety of this practice.

Family members of vulnerable individuals should receive two doses of MMR vaccine unless they have documentation of previous immunity (or vaccine is otherwise contraindicated), according to the report.

Co-author Dr. Mark Salem told Reuters Health by email, "We aimed to provide a simple and easy-to-follow algorithm to help all gastroenterologists and internists caring for those that are on or considering starting immunosuppression."

"As with all preventative measures, vaccine screening should be done ahead of time, ideally at the first patient visit prior to starting immunosuppression to ensure adequate coverage and counseling," he said. "With a few extra questions during the patient encounter or asking patients to bring a copy of their vaccine records, we can identify those that are potentially at risk and help make informed decisions together."

Dr. Maham Farshidpour of the University of Arizona-Banner Medical Center in Tucson, who recently reviewed immunization strategies in patients with IBD, told Reuters Health by email, "Management of patients with IBD often includes making complex medical decisions. Consequently, it is critical to have a broad knowledge of the issues surrounding administering vaccinations to this group of patients."

"The vaccination recommendation should be tailored to each patient with regard to his/her age, comorbidities, nutritional status, IBD disease severity, immunosuppressive therapy, risk of exposure to pathogens, and geographic clustering," said Dr. Farshidpour, who was not involved in the new report.

SOURCE: https://bit.ly/2n5JiF4

Am J Gastroenterol 2019.

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