The American College of Gastroenterology released updated preventive care guidelines for adults with inflammatory bowel disease, emphasizing vaccination timing and screening protocols for infections, cancers, and mental health.
The recently published guidance, addressed vaccine safety, immunogenicity, and screening recommendations in patients often treated with immune-modifying therapies.
Vaccination Recommendations
Patients with inflammatory bowel disease (IBD) are at elevated risk of infections due to both disease-related immune dysfunction and the use of immunosuppressive therapies, noted authors.
The guidelines strongly recommends pneumococcal vaccination with PCV20 or PCV21 in all adults with IBD aged 50 years and older with no prior pneumococcal vaccination (strong recommendation, low certainty). A conditional recommendation applies to younger adults (aged19 to 49 years) receiving immune-modifying therapy. Patients aged 65 and older or those aged 19 to64 years on immunosuppressants should follow CDC guidance for additional doses.
Herpes zoster (HZ) vaccination using the 2-dose recombinant zoster vaccine (RZV) is conditionally recommended for all patients aged 50 years and older and for those aged 19 years and above who are on or will begin immune-modifying therapies. A retrospective Veteran Affairs study showed lower risk of HZ in vaccinated patients with IBD aged 50to 60 years (0.00 vs 3.93 per 1,000 person-years) and those aged older than 60 years (1.80 vs 4.57 per 1,000 person-years).
Annual influenza vaccination is recommended for all adults with IBD. The live attenuated influenza vaccine is contraindicated in immunocompromised patients; the nonlive trivalent inactivated vaccine is preferred. “Patients receiving anti-TNF monotherapy should receive a HD influenza vaccine,” the guideline noted.
The authors conditionally recommended SARS-CoV-2 vaccination per national guidelines. Although patients with IBD are not at increased risk for COVID-19 complications, some therapies, including corticosteroids and anti-TNF agents, may attenuate the humoral vaccine response.
Respiratory syncytial virus (RSV) vaccination is recommended for all IBD patients aged 75 and older, and for patients aged 50 to 74 years with chronic conditions or immune suppression.
Vaccine Response in Immunosuppressed Patients
Patients receiving combination anti-TNF therapy with thiopurines or methotrexate have a lower immune response to several inactivated vaccines. A meta-analysis found that combination anti-TNF therapy was associated with the lowest vaccine-induced immune response.
By contrast, vedolizumab and ustekinumab did not reduce antibody responses to mRNA COVID-19 or influenza vaccines in small studies. Data on JAK inhibitors (e.g., tofacitinib) showed reduced responses to pneumococcal but not influenza vaccines. The guideline emphasized that vaccinations should not be delayed due to therapy schedules, and therapies should not be withheld solely to improve vaccine response.
Screening and Additional Preventive Care
Cervical cancer screening is conditionally recommended annually for women on immune-modifying therapies, beginning within a year of sexual activity and continuing yearly until three consecutive normal results are obtained.
Annual screening for melanoma is recommended for all patients with IBD regardless of biologic use. Nonmelanoma skin cancer screening is conditionally recommended annually for patients aged over 50 years using agents such as thiopurines, methotrexate, JAK inhibitors, or S1P receptor modulators.
Bone mineral density screening is advised at diagnosis and periodically thereafter in patients with conventional osteoporosis risk factors.
Mental health screening for depression and anxiety is recommended at baseline and annually. Smoking cessation counseling is strongly advised for all IBD patients who smoke.
Hepatitis and Varicella Vaccination
The guidelines recommends hepatitis B vaccination for all nonimmune adults with IBD. Serologic testing 1 to3 months post-vaccination is advised in immunosuppressed patients. The adjuvanted 2-dose Heplisav-B vaccine was associated with improved seroprotection rates compared with traditional 3-dose schedules.
Varicella immunity should be verified before initiating immune-modifying therapy. If history of chickenpox or prior vaccination is lacking, a 2-dose varicella vaccine series should be completed beforehand. The guidelines warns against relying on commercial antibody assays due to high false-negative rates.
Additional Vaccines and Household Considerations
Patients with IBD should follow Advisory Committee on Immunization Practices guidelines for Tdap, HPV, hepatitis A, and meningococcal vaccines. Meningitis incidence in patients with IBD was 27.6 per 100,000 person-years in Crohn's disease and 20.7 in ulcerative colitis, compared to 12.7 among non-IBD comparators.
Household contacts of immunosuppressed patients may receive most live vaccines, with precautions for varicella and rotavirus if rash or shedding occurs.
The authors emphasized collaboration among gastroenterologists, primary care clinicians, and other providers
These updated recommendations aim to reduce infection-related and cancer-related complications in the IBD population through more consistent and timely preventive care.
Full disclosures can be found in the published guideline.
Source: AJG