Vaccinations and Immunization Status in Pediatric Inflammatory Bowel Disease: A Multicenter Study From the Pediatric IBD Porto Group of the ESPGHAN

Abstract Background Vaccine-preventable diseases and opportunistic infections in pediatric inflammatory bowel disease (IBD) are increasingly recognized issues. The aims of this study were to evaluate vaccinations, immunization status, and consequent therapeutic management in children with IBD and to analyze the differences among patients diagnosed before (Group 1) and after June 2012 (Group 2). Methods This was a multicenter, retrospective cohort investigation. Between July 2016 and July 2017, 430 children with IBD were enrolled in 13 centers. Diagnosis, therapeutic history, vaccinations, and immunization status screening at diagnosis and at immunosuppressant (IM)/biologic initiation and reasons for incomplete immunization were retrieved. Results Vaccination rates at diagnosis were unsatisfactory for measles, mumps, and rubella (89.3%), Haemophilus influenzae (81.9%), meningococcus C (23.5%), chickenpox (18.4%), pneumococcus (18.6%), papillomavirus (5.9%), and rotavirus (1.9%). Complete immunization was recorded in 38/430 (8.8%) children, but specific vaccines were recommended in 79/430 patients (18.6%), without differences between the 2 groups. At IM start, 22% of children were tested for Epstein-Barr virus (EBV) status, with 96.2% of EBV-naïve patients starting azathioprine, without differences between Groups 1 and 2. Screening for latent tuberculosis (TB) before start of biologics was performed in 175/190 (92.1%), with up to 9 different screening strategies and numerous inconsistencies. Conclusions We demonstrated a poor immunization status at diagnosis in children with IBD, which was not followed by proper vaccination catch-up. EBV status before IM initiation and latent TB before biologics were not adequately assessed. Thus, the overall impact of the current guidelines seems unsatisfactory.

Download Full-text

P172 Immunisation and vaccination status at diagnosis in Pediatric inflammatory bowel disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.301 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S223-S224

Author(s):

M Velasco Rodríguez-Belvís ◽

L M Palomino Pérez ◽

C Sánchez Fernández-Bravo ◽

L F Jose Luis ◽

A Sanchiz Perea ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Opportunistic Infections ◽

Vaccination Status ◽

Growth Delay ◽

Serological Response ◽

Paediatric Hospital ◽

Vaccine Preventable Diseases ◽

Pediatric Inflammatory Bowel Disease ◽

Inflammatory Bowel

Abstract Background Pediatric inflammatory bowel disease (PIBD) patients are especially prone to vaccine-preventable diseases and opportunistic infections. The aim was to evaluate the immunisation and vaccination status in PIBD. Methods Descriptive and retrospective study that analyses the immunisation and/or vaccination for measles, mumps and rubella (MMR), hepatitis B virus (HBV), chickenpox, cytomegalovirus (CMV) and Epstein–Barr virus (EBV) of PIBD patients in a tertiary paediatric hospital (January 2015- Oct 2019) in the first 6 months after diagnosis. Results Amongst 57 patients, 17 (30%) had ulcerative colitis (UC), 35 (61%) Crohn’s disease (CD) and 5 (9%) unclassified IBD (uIBD). Up to 35 (61%) were male and the mean age at diagnosis was 10.2 ± 4.1 years. A total of 18 (32%) were currently on biological treatment and 45 (79%) on immunosuppressants. The disease location in CD patients was L3 (Paris classification) in 22 (63%) and L4a in 13 (37%). Only 2 (6%) showed perianal involvement. From the UC patients, 11 (65%) were E4. A delayed growth was observed in 6 (10%), all CD patients. At diagnosis, 37 (65%) were HBV-vaccinated, 13 of them (35%) had a serological response and 22 (59%) had no response. Amongst the latter, 18 were re-vaccinated and 9 (50%) had a documented serological response. Up to 34 patients (60%) were MMR-vaccinated and 13 (38%) showed a complete response. Only 6 patients could be re-vaccinated. Up to 30 (52%) showed chickenpox immunisation. Only 4 of the non-immunised patients could be vaccinated and all of them responded to a single dose. Regarding CMV and EBV, 17 and 16 patients (46 and 43%) were IgG positive respectively, all of them were IgM negative. Patients with CD were more likely to need HBV re-vaccination than other IBDs (p < 0.05). Regarding chickenpox, CD patients without growth delay (G0) needed less re-vaccination than those whose growth was affected (G1) (p < 0.05). However, UC patients with extensive disease (E4) needed less re-vaccination than those with limited disease (p < 0.05). Male patients seemed to be less likely to need re-vaccination, with no significant differences. Conclusion The serological assessment of vaccine-preventable diseases immunisation yielded poor results. Remarkably, a high percentage of HBV and MMR vaccinated patients showed no response. CD patients tended to more likely need revaccination, especially in the most severe cases (G1). Surprisingly, severity was not related with vaccination response in UC. Our results suggest that less than half of the patients had been previously infected by CMV or EBV. Based on this, it seems reasonable to serologically check the immunisation status in PIBD patients in order to, when appropriate, re-vaccinate before starting immunosuppressive therapies.

Download Full-text

P127 Assessing the vaccination and immunization status in a Paediatric Inflammatory Bowel Disease diagnosis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.254 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S218-S218

Author(s):

L M Palomino Pérez ◽

M Velasco Rodríguez-Belvis ◽

J L León Falconi ◽

C Sánchez Fernández-Bravo ◽

J A Vazquez Gómez ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Opportunistic Infections ◽

Disease Diagnosis ◽

Growth Delay ◽

Serological Response ◽

Paediatric Hospital ◽

Vaccine Preventable Diseases ◽

Immunization Status ◽

Inflammatory Bowel

Abstract Background Paediatric inflammatory bowel disease (PIBD) patients are especially prone to vaccine-preventable diseases and opportunistic infections. The aim was to evaluate the immunization and vaccination status in PIBD. Methods Descriptive and retrospective study that analyzes the immunization and/or vaccination for measles, mumps and rubella (MMR), hepatitis B virus (HBV), chickenpox, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) of PIBD patients in a tertiary paediatric hospital (Jan 2015- Oct 2019) in the first 6 months after diagnosis. Results Amongst 57 patients, 17 (30%) had ulcerative colitis (UC), 35 (61%) Crohn ́s disease (CD) and 5 (9%) unclassified IBD (uIBD). Up to 35 (61%) were male and the mean age at diagnosis was 10.2±4.1 years. A total of 18 (32%) were currently on biological treatment and 45 (79%) on immunosuppressants. The disease location in CD patients was L3 (Paris classification) in 22 (63%) and L4a in 13 (37%). Only 2 (6%) showed perianal involvement. From the UC patients, 11 (65%) were E4. A delayed growth was observed in 6 (10%), all CD patients. At diagnosis, 37 (65%) were HBV-vaccinated, 13 of them (35%) had a serological response and 22 (59%) had no response. 18 were re-vaccinated and 9 (50%) had a documented serological response. Up to 34 patients (60%) were MMR-vaccinated and 13 (38%) showed a complete response. Only 6 patients could be re-vaccinated. Up to 30 (52%) showed chickenpox immunization. Only 4 of the non-immunized patients could be vaccinated and all of them responded to a single dose. Regarding CMV and EBV, 17 and 16 patients (46 and 43%) were IgG positive respectively, all of them IgM negative. Patients with CD were more likely to need HBV re-vaccination than other IBDs (p< 0.05). Regarding chickenpox, CD patients without growth delay (G0) needed less re-vaccination than those whose growth was affected (G1) (p< 0.05). However, UC patients with extensive disease (E4) needed less re-vaccination than those with limited disease (p< 0.05). Male patients seemed to be less likely to need re-vaccination, with no significant differences. Conclusion The serological assessment of vaccine-preventable diseases immunization yielded poor results. A high percentage of HBV and MMR vaccinated patients showed no response. CD patients tended to more likely need revaccination, especially in the most severe cases (G1). Surprisingly, severity was not related with vaccination response in UC. Our results suggest that less than half of the patients had been previously infected by CMV or EBV. It seems reasonable to serologically check the immunization status in PIBD patients in order to, when appropriate, re-vaccinate before starting immunosuppressive therapies.

Download Full-text

P0648 CHRONIC T-CELL ASSOCIATED EPSTEIN-BARR VIRUS (EBV) INFECTION MIMICKING PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD)

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-200406001-00772 ◽

2004 ◽

Vol 39 (Supplement 1) ◽

pp. S303-S304

Author(s):

L. J. Smith ◽

D. Roth ◽

J. L. Robinson ◽

S. M. Gilmour ◽

A. Jones

Keyword(s):

Inflammatory Bowel Disease ◽

T Cell ◽

Bowel Disease ◽

Epstein Barr Virus ◽

Barr Virus ◽

Ebv Infection ◽

Pediatric Inflammatory Bowel Disease ◽

Inflammatory Bowel ◽

Epstein Barr

Download Full-text

Evaluation of EBV Status and Thiopurine Use in Pediatric Inflammatory Bowel Disease: Time to be a Standard of Care

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz327 ◽

2020 ◽

Vol 26 (3) ◽

pp. e21-e21

Author(s):

Massimo Martinelli ◽

Erasmo Miele

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Epstein Barr Virus ◽

Standard Of Care ◽

Barr Virus ◽

Pediatric Inflammatory Bowel Disease ◽

Inflammatory Bowel ◽

Epstein Barr

Epstein-Barr virus status is helpful in guiding physicians’ decision on thiopurine use in children with pediatric inflammatory bowel disease.

Download Full-text

Safety of Immunizations for the Adult Patient With Inflammatory Bowel Disease—A Systematic Review and Meta-analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab266 ◽

2021 ◽

Author(s):

Athanasios Desalermos ◽

Michael Pimienta ◽

Markos Kalligeros ◽

Fadi Shehadeh ◽

Leonidas Diamantopoulos ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Primary Outcome ◽

Meta Analysis ◽

Analysis Data ◽

Secondary Outcome ◽

Vaccine Preventable Diseases ◽

Vaccination Rates ◽

Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) have low vaccination rates for vaccine-preventable diseases. Fear of adverse reactions (AEs) appear to negatively affect vaccination efforts. We aimed to systemically review the risks for AEs following immunization for patients with IBD. Methods We searched PubMed and Embase until April 15, 2020, for studies evaluating the safety of vaccinations among patients with IBD. The primary outcome was the incidence of systemic and local AEs among vaccinated patients. Secondary outcome was the rate of IBD flare following immunization. We utilized a random effects meta-analysis of proportions using the DerSimonian-Laird approach to estimate the safety of immunizations. Results A total of 13 studies with 2116 patients was included in our analysis after fulfilling our inclusion criteria. Seven studies examined the influenza vaccine, 4 the pneumococcal vaccine, 1 the recombinant zoster vaccine, and 1 the hepatitis B vaccine. Follow-up of patients was up to 6 months. The majority of AEs were local, with a pooled incidence of 24% (95% CI, 9%-42%) for all vaccines. Systemic AEs were mostly mild, without resulting in hospitalizations or deaths, with a pooled incidence of 16% (95% CI, 6%-29%) for all vaccines. Flare of inflammatory bowel disease after vaccination found with a pooled incidence of 2% (95% CI, 1%-4%) and we include in the analysis data from all immunizations examined. Discussion Our study demonstrated that AEs after vaccination are mainly local or mildly systemic and do not differ significantly from the expected AE after recommended immunizations for the general population. Thus, gastroenterologists should reinforce that vaccines are safe in patients with IBD.

Download Full-text