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Vaccinations and Inflammatory Bowel Disease

Patients with Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease) are often under-vaccinated because of concerns that the vaccination may make them ill or the vaccination will not be effective because they are immuno-compromised.

 The issues are:

  1. Are some vaccinations unsafe for individuals with Inflammatory Bowel Disease (IBD)?
  2. If the individual with IBD is immuno-compromised, is it safe to be vaccinated and will the vaccination be effective?
  3. Can household or family members be vaccinated without risk to the patient with IBD?
  4. Will being vaccinated cause the IBD to become more active?

Are there some vaccinations that are not safe?

Dead Vaccines

Vaccinations can be divided into those vaccines that are “dead” or inactivated, common examples would be Diphtheria, Pertussis, Human Papilloma Virus (the virus associated with cervical cancer), intramuscular influenza or “flu”, pneumococcus, Hepatitis Meningococcus.  These vaccinations are inactivated and dead and therefore pose no risk to individuals with IBD whether or not they are immuno-compromised.

Live Vaccines

Some vaccinations are “live” but they are changed or altered to a certain degree so that in individuals with normal immune systems, it will not make them sick but it will cause them to become immune to the virus.  Common examples of this are the mumps, measles and rubella vaccinations that we receive in childhood, the flu virus that is given nasally (through the nose), chicken pox or varicella zoster virus and other vaccines that are given to individuals who travel such as Typhoid, Yellow Fever and the Polio vaccine given orally.  In individuals with a normal immune system, these vaccines pose no significant threat, however if the individual is immuno-compromised then there is a concern that they could become ill from the live virus even though it is attenuated or has been weakened. 

Who is an immuno-compromised IBD patient? 

If an IBD patient has been on Prednisone greater than 20 mg per day for two weeks or more, or has stopped Prednisone in the past three months, if they are on 6 MP, Azothioprine, Methotrexate or Infleximab/Remicade these individuals are considered immuno-compromised and should not receive the live virus as mentioned above.  As well, if an individual with IBD is severely malnourished they are considered immuno-compromised and should not receive live vaccinations.

Individuals who are immuno-compromised are often concerned that the vaccination may be ineffective.  Fortunately this rarely bears out and in most individuals with IBD who are immuno-compromised and vaccinated will mount an effective response and be immune to the virus being vaccinated.

Can household contacts or family members be vaccinated with live viruses and what is the risk to the individual who is considered immuno-compromised?  

Evidence suggests that household contacts/family members can receive live viruses without significant risk to the immuno-compromised IBD patient.   The only exception or proviso is if the individual who is vaccinated has a rash then they should avoid contact with the immuno-compromised individual, but this is rare. 

Will being vaccinated cause the IBD to become more active?

There is no convincing evidence that vaccination causes IBD activity to worsen.