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

Disclosures

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

In This Article

Conclusion

From observations related to the use of established vaccines in patients with IBD, we can conclude that patients with IBD tend to have poorer vaccine-induced immunity than the general population. The use of immunosuppressants and disease activity are both implicated in causing lower rates of seroconversion. For certain vaccines including the hepatitis B vaccine and influenza vaccines accelerated protocolls and higher dosing have shown potential to improve the immunity achieved for patient with IBD. To date, data are limited in the IBD population on response rates to the COVID-19 vaccine but similar issues seem to be arising as seen with established vaccines. There is clearly a requirement for large scale collaborative research efforts to gather larger datasets on the response rates to different vaccines amongst patients with IBD and examine the impact of both disease activity and different IBD therapies on the immunity generated by vaccination. It is recommended all patients with IBD can be vaccinated against COVID-19 with the currently available vaccines. To improve immunogenicity, it seems prudent to take a few elementary precautions prior to patients being vaccinated; patients should ideally be in disease remission and if possible, corticosteroids doses should be minimised. Preferably, the vaccination should be given prior to newly commencing potentially immunosuppressant medications where possible (though IBD treatments should not be unduly delayed to allow vaccination). Research into the benefits of double dose vaccines, additional booster dosing or use of heterologous prime–boost vaccination schedules for immunosuppressed patients' needs to be considered. Finally, the potential for short drug holidays (with oral agents), vaccination at the trough level for biologic agents or antibody testing in vulnerable cohorts may be an area that would benefit from prospective evaluation.

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