Review Article

Vaccination for Patients With Inflammatory Bowel Disease During the COVID-19 Pandemic

Jayne Doherty; Sean Fennessy; Roisin Stack; Neil O' Morain; Garret Cullen; Elizabeth J. Ryan; Cillian De Gascun; Glen A. Doherty


Aliment Pharmacol Ther. 2021;54(9):1110-1123. 

In This Article

Are we Complying With Current Vaccination Recommendations for Patients With IBD?

Expert recommendations promoting the efficacy and safety of vaccinations are widespread in the IBD literature.[5,18–20] Both ECCO and BSG guidelines advocate screening for OI and vaccinating where possible, prior to commencing immunomodulatory therapy.[5,18] Given 80% of patients will require corticosteroids, 40% thiopurines and 20% anti-TNF therapy over their disease course,[5,16] the following vaccinations should be considered for patients with IBD: Varicella-zoster, Human Papilloma Virus (HPV), Influenza (yearly), Hepatitis B (HBV) and Pneumococcal vaccines.[5]

Despite current guidelines, multiple studies have shown suboptimal vaccination levels amongst patients with IBD. Reasons include lack of patient education and the importance of vaccination being overlooked by gastroenterologists or general practitioners.[21–25] One observational study found implementation of a screening and vaccination proforma significantly improved gastroenterologists' compliance with vaccination guidelines.[26]

From the patient's perspective, lack of awareness (49%) and fear of side effects (18%) are the most common reasons for not having the influenza vaccine.[6] Uptake of the COVID-19 vaccine worldwide has been promising. Several studies have looked at attitudes to COVID-19 vaccine uptake and reasons for vaccine hesitancy but none to date specifically in the IBD community. One study of 1000 people online in Ireland and the UK revealed 75% of participants intend to get a COVID-19 vaccine, 11% said they would not be vaccinated and 14% were unsure regarding vaccination. Women and younger people were significantly less likely to report an intention to avail of a COVID-19 vaccine. The survey revealed that peer influences are strongly associated with young women's intentions on vaccination.[27] A separate polish study questioned 1427 people on COVID-19 vaccine uptake. Interesting predictors for acceptance of the vaccination included being talked through the importance of vaccination and potential side-effects by a medical professional and suffering from chronic illnesses. Those who opted not to be vaccinated were most frequently concerned about the vaccine efficacy or side-effects.[28] Both these studies highlight the importance and need for members of the IBD multidisciplinary team to inform and counsel our patients to ensure optimal uptake of COVID-19 vaccines. Involvement of patient organisations is also necessary with clear and concise patient information available which clinicians can refer their patients to.[29]