The Question: To do or not to do?

Inflammatory bowel disease (IBD) is a term that refers to two intestinal diseases: ulcerative colitis (UC), and Crohn’s disease. Ulcerative colitis affects only the innermost layer of the intestinal wall in the large bowel (colon). Crohn’s disease can affect any area along the small or large intestine. Unlike UC, Crohn’s disease can penetrate multiple layers of the intestinal wall. Both diseases generally present with symptoms such as diarrhea, which is often bloody, as well as abdominal pain.

The influenza vaccination works by making the patient slightly ill with the influenza virus, allowing their immune system to build a defence against the virus and therefore destroy it on subsequent (real life) exposure. Many persons with IBD take immunosuppressive agents to reduce their symptoms. While taking these medications, the patient’s immune system capabilities are diminished, which increases their chance of infection. Therefore, immunization could cause concern for those who have compromised immune systems, fearing that they might be unable to fight off the initial exposure to the vaccine.

However, a recent study conducted at McMaster University Medical Centre in Hamilton, Ontario, published in The Canadian Journal of Gastroenterology, found that persons with inflammatory bowel disease who are undergoing immunosuppressive therapies are not at risk from the influenza vaccine. The study further showed that these individuals are at a greater risk than the general population of conducting the virus itself. This means that it is highly recommended that all IBD patients be vaccinated.

The researchers note that as with anything, there are some minor risks, but the pros of receiving the influenza vaccine outweigh the cons, especially because those taking immunosuppressive medications are more likely to experience serious complications from the infection.

The Answer: To Do!

First published in the Inside Tract® newsletter issue 174 – 2010
Neeraj Narula MD et al, Should my patient with inflammatory bowel disease on immunosuppressive therapy be vaccinated against influenza virus? The Canadian Journal of Gastroenterology. 2010;121-125.