Immunizations in Pediatric and Adult Patients with Inflammatory Bowel Disease: A Practical Case-based Approach

As the treatment of inflammatory bowel disease (IBD) becomes more complex and increasingly relies on combinations of immunosuppression in patients with moderate to severe ulcerative colitis or Crohn's disease, the provider must be aware of recommendations for the appropriate use of vaccines-both inactivated and live. The timing and type of vaccination required may be altered based on the underlying medical treatment for the IBD. In some instances, titers may be required to assess for vaccine response. Vaccination recommendations have changed dramatically over the past 5 years with direct implications for the protection of the patients with IBD. There are several newly licensed vaccines and new recommendations by the U.S. Advisory Committee on Immunization Practices and Infectious Diseases Society of America defining degrees of immunosuppression and the use of certain live vaccines based on these levels. This review provides a case-based approach to vaccinating the pediatric and adult patients with IBD, with an emphasis on practicality. Case scenarios include children and adults with newly diagnosed and chronic IBD. Recommendations for vaccine management in these scenarios are provided, including special circumstances such as pregnancy and infant vaccinations when the mother is receiving immunosuppressive medication.