Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2017; 23(42): 7644-7652
Published online Nov 14, 2017. doi: 10.3748/wjg.v23.i42.7644
Vaccinations in immunosuppressive-dependent pediatric inflammatory bowel disease
Huyen-Tran Nguyen, Phillip Minar, Kimberly Jackson, Patricia C Fulkerson
Huyen-Tran Nguyen, Patricia C Fulkerson, Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
Phillip Minar, Kimberly Jackson, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
Author contributions: Nguyen HT, Minar P, Jackson K, and Fulkerson PC designed the project. Nguyen HT, Minar P and Jackson K acquired data; Nguyen HT and Fulkerson PC analyzed and interpreted the data; all authors contributed to the drafting and revision of the manuscript; all authors also read and approved the final manuscript; all authors are native-English speakers.
Conflict-of-interest statement: All authors have no competing interests to declare.
Data sharing statement: De-identified data are available from the corresponding author at Patricia.Fulkerson@cchmc.org. This project was IRB approved (Study #2015-9400). The research was determined to be no more than minimal risk to participants so consent was waived. The data are anonymized and risk of identification is low.
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: Patricia C Fulkerson, MD, PhD, Assistant Professor, Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH 45229, United States. patricia.fulkerson@cchmc.org
Telephone: +1-513-8030973 Fax: +1-513-6363310
Received: July 6, 2017
Peer-review started: July 6, 2017
First decision: July 28, 2017
Revised: August 14, 2017
Accepted: August 25, 2017
Article in press: August 25, 2017
Published online: November 14, 2017
Processing time: 129 Days and 6.7 Hours
Abstract
AIM

To determine the vaccination rates in pediatric immunosuppression-dependent inflammatory bowel disease (IBD) and review the safety and efficacy of vaccinations in this population.

METHODS

The electronic medical records from October 2009 to December 2015 of patients diagnosed with IBD at 10 years of age or younger and prescribed anti-tumor necrosis factor alpha (anti-TNF-α) therapy were reviewed for clinical history, medication history, vaccination history, and hepatitis B and varicella titers. Literature discussing vaccination response in IBD patients were identified through search of the MEDLINE database and reviewed using the key words “inflammatory bowel disease”, “immunization”, “vaccination”, “pneumococcal”, “varicella”, and “hepatitis B”. Non-human and non-English language studies were excluded. Search results were reviewed by authors to select articles that addressed safety and efficacy of immunizations in inflammatory bowel disease.

RESULTS

A total of 51 patients diagnosed with IBD prior to the age of 10 and receiving anti-TNF-α therapy were identified. Thirty-three percent of patients (17/51) had incomplete or no documentation of vaccinations. Sixteen case reports, cohort studies, cross-sectional studies, and randomized trials were determined through review of the literature to describe the safety and efficacy of hepatitis B, pneumococcal, and varicella immunizations in adult and pediatric patients with IBD. These studies showed that patients safely tolerated the vaccines without significant adverse effects. Importantly, IBD patients receiving immunosuppressive medications, particularly anti-TNF-α treatment, have decreased vaccine response compared to controls. However, the majority of patients are still able to achieve protective levels of specific antibodies.

CONCLUSION

Immunizations have been shown to be well-tolerated and protective immunity can be achieved in patients with IBD requiring immunosuppressive therapy.

Keywords: Vaccination; Immunosuppression; Early-onset inflammatory bowel disease; Very early-onset inflammatory bowel disease

Core tip: Chronic immunosuppression and immune defects can contribute to increased susceptibility to infections in pediatric inflammatory bowel disease (IBD). Immunization rates among IBD patients are low due to concerns about vaccine efficacy while on immunosuppression and disease exacerbation with administration. The aim of this review was to determine the vaccination rates in pediatric immunosuppression-dependent IBD and the safety and efficacy of immunizations in this population.