What is the best way to manage screening for infections and vaccination of inflammatory bowel disease patients?

Abstract

The use of biological agents and immunomodulators for inflammatory bowel disease (IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination in those patients with IBD, which are candidate for biologic therapy. Available strategies to screen, diagnose and prevent bacterial and viral infections in patients with IBD prior to start biological therapy are discussed in this review.

Keywords: Inflammatory bowel disease; Opportunistic infections; Immunomodulators; Corticosteroids; Anti-tumor necrosis factor agents

Core tip: The increasing use of biologics as a mainstay of therapy in inflammatory bowel disease (IBD) is associated with an increased risk for a variety of infections, many of which are preventable by prior screening and vaccination. While immunocompetent IBD patients can be vaccinated using standard vaccination schedule, special guidelines need to be followed for IBD patients getting immunosuppressive therapy (IST). This article provides a review of the issues surrounding immunizations in the IBD patient and a practical guide for clinicians regarding the appropriate screening for infections and vaccinations to administer both before and during IST.