Vaccination strategies in pediatric inflammatory bowel disease

The incidence of pediatric inflammatory bowel disease (IBD) is rising, as is the use of immunomodulatory and biological drugs. IBD patients are vulnerable to infections owing to disease-related immunological alterations and drug-induced systemic immunosuppression. Although many infections are vaccine-preventable, vaccination coverage in IBD patients is insufficient. Current guidelines recommend that children with IBD follow the same routine immunization schedule as healthy children, avoiding live vaccines during immunosuppressive therapy. Immunization status should be checked at diagnosis, and patients should be immunized with the vaccines they need. Some studies have demonstrated a suboptimal immune response to vaccinations in IBD patients, but responsible mechanisms are poorly understood. In this manuscript, we provide a broad review of available data about vaccine coverage rates, immunogenicity and safety of both killed and live attenuated vaccinations in the pediatric IBD population; furthermore, we provide comprehensive information regarding current guidelines for immunization of children with IBD and their household contacts. A comprehensive search of published literature using the PubMed (http:// www.ncbi.nlm.nih.gov/pubmed/) database was carried out to identify all articles published in English from 1998 to March 2017, using the following key terms: "inflammatory bowel disease", "vaccination", "immunization", "immunogenicity", "safety" and "children".