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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2015; 21(40): 11273-11281
Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11273
Immunogenicity and mechanisms impairing the response to vaccines in inflammatory bowel disease
Alicia C Marín, Javier P Gisbert, María Chaparro
Alicia C Marín, Javier P Gisbert, María Chaparro, Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, 28021 Madrid, Spain
Author contributions: Chaparro M selected the content of the review; Chaparro M and Gisbert JP reviewed the literature on immunogenicity of vaccines in patients with inflammatory bowel disease; and Marín AC reviewed articles related to mechanisms of response to vaccination; all the authors contributed to the drafting of the manuscript.
Conflict-of-interest statement: Gisbert JP and Chaparro M have served as speakers, consultants, and advisory board members for and have received research funding from MSD and AbbVie. AC Marín: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: María Chaparro, MD, PhD, Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Americio 17 portal E 2 ºC, 28021 Madrid, Spain. mariachs2005@gmail.com
Telephone: +34-91-3093911 Fax: +34-91-4022299
Received: April 29, 2015
Peer-review started: May 12, 2015
First decision: June 2, 2015
Revised: June 23, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: October 28, 2015
Abstract

Inflammatory bowel disease (IBD) is an immunological disorder that is usually treated with immunosuppressive therapy, potentially leading to increases in vulnerability to infections. Although many infections can be prevented by vaccination, vaccination coverage in these patients in clinical practice is insufficient. Therefore, the seroprotection condition should be verified, even for routine vaccines, such as hepatitis B or pneumococcus. Response to vaccines in IBD patients is thought to be impaired due to the immunological alterations generated by the disease and to the immunomodulatory treatments. The immunogenicity of hepatitis B, influenza, and pneumococcal vaccines is impaired in IBD patients, whereas the response to papillomavirus vaccine seems similar to that observed in the healthy population. On the other hand, data on the immunogenicity of tetanus vaccine in IBD patients are conflicting. Studies assessing the response to measles-mumps-rubella, varicella, and herpes zoster vaccines in IBD patients are scarce. The cellular and molecular mechanisms responsible for the impairment of the response to vaccination in IBD patients are poorly understood. Studies aiming to assess the response to vaccines in IBD patients and to identify the mechanisms involved in their immunogenicity are warranted. A better understanding of the immune response, specifically to vaccines, in patients with immune-mediated diseases (such as IBD), is crucial when developing vaccines that trigger more potent immunologic responses.

Keywords: Crohn’s disease, Inflammatory bowel disease, Tumor necrosis factor, Ulcerative colitis, Vaccine, Vaccination, Immunogenicity

Core tip: Inflammatory bowel disease (IBD) patients are vulnerable to infections owing to the underlying immunological disorder and to the immunosuppressive therapy used to treat the disease. Although some of these infections could be vaccine-preventable, IBD patients show impaired immunogenicity to some vaccines (such as hepatitis B or pneumococcal vaccines). In this review, the authors discuss available data on the immunogenicity of vaccines in IBD patients and summarize current knowledge on the mechanisms that could impair responses to vaccines.