Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines

Jennifer L. Jones; Frances Tse; Matthew W. Carroll; Jennifer C. deBruyn; Shelly A. McNeil; Anne Pham-Huy; Cynthia H. Seow; Lisa L. Barrett; Talat Bessissow; Nicholas Carman; Gil Y. Melmed; Otto G. Vanderkooi; John K. Marshall; Eric I. Benchimol

doi:10.1053/j.gastro.2021.04.034

Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines

Jennifer L. Jones, Frances Tse, Matthew W. Carroll, Jennifer C. deBruyn, Shelly A. McNeil, Anne Pham-Huy, Cynthia H. Seow, Lisa L. Barrett, Talat Bessissow, Nicholas Carman, Gil Y. Melmed, Otto G. Vanderkooi, John K. Marshall, Eric I. Benchimol

Medicine

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

Background and Aims: The effectiveness and safety of vaccinations can be altered by immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD) itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on inactivated vaccines. Methods: Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative online platform, and voted on by a multidisciplinary group. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. Results: Consensus was reached on 15 of 20 questions. Recommendations address the following vaccines: Haemophilus influenzae type b, recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus, tetanus-diphtheria-pertussis, and human papillomavirus. Most of the recommendations for patients with IBD are congruent with the current Centers for Disease Control and Prevention and Canada's National Advisory Committee on Immunization recommendations for the general population, with the following exceptions. In patients with IBD, the panel suggested Haemophilus influenzae type b vaccine for patients older than 5 years of age, recombinant zoster vaccine for adults younger than 50 year of age, and hepatitis B vaccine for adults without a risk factor. Consensus was not reached, and recommendations were not made for 5 statements, due largely to lack of evidence, including double-dose hepatitis B vaccine, timing of influenza immunization in patients on biologics, pneumococcal and meningococcal vaccines in adult patients without risk factors, and human papillomavirus vaccine in patients aged 27–45 years. Conclusions: Patients with IBD may be at increased risk of some vaccine-preventable diseases. Therefore, maintaining appropriate vaccination status in these patients is critical to optimize patient outcomes. In general, IBD is not a contraindication to the use of inactivated vaccines, but immunosuppressive therapy may reduce vaccine responses.

Original language	English
Pages (from-to)	681-700
Number of pages	20
Journal	Gastroenterology
Volume	161
Issue number	2
DOIs	https://doi.org/10.1053/j.gastro.2021.04.034
Publication status	Published - Aug 2021

Bibliographical note

Funding Information:
Funding This guideline was supported through unrestricted grants to the Canadian Association of Gastroenterology (CAG) by the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes, and CANImmunize who had no involvement in any aspect of the guideline development or manuscript preparation. Eric I Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, Crohn's and Colitis Canada, and CAG. He was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program.

Funding Information:
The Canadian Association of Gastroenterology (CAG) would like to thank the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes for its generous support of the guideline process. The consensus group would like to thank the following people for their contributions: Dr Dionne Duncan and Karen Sparkes (CAG representatives: administrative and technical support, and logistical assistance). The consensus group would also like to thank their patient/patient advocates, Claudia Tersigni, Thea Ewert, and Sara Croke, for their thoughtful input into the guideline process. Writing assistance: The consensus group would like to thank Pauline Lavigne and Steven Portelance (unaffiliated) who provided medical writing services on their behalf, supported by funds from the CAG. Author contributions: The co-chairs (Eric I. Benchimol, Jennifer L. Jones), steering committee (Anne Pham-Huy, Cynthia H. Seow, Jennifer C. deBruyn, and Shelly A. McNeil), and GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodologists (Frances Tse, Matthew W. Carroll) reviewed the literature and drafted the PICO (patient population, intervention, comparator, and outcome) questions. Frances Tse and Matthew W. Carroll assessed the evidence and provided GRADE evaluations. All members of the consensus group helped develop and voted on the direction and strength of the recommendations. The manuscript was initially drafted by the co-chairs (Eric I. Benchimol, Jennifer L. Jones) and Frances Tse, after which it was revised based on input from all members of the consensus group and the moderator (John K. Marshall). In addition, 2 adult patients with IBD reviewed the PICO questions and provided input on the final manuscript.

Funding Information:
Funding This guideline was supported through unrestricted grants to the Canadian Association of Gastroenterology ( CAG ) by the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes, , and CANImmunize who had no involvement in any aspect of the guideline development or manuscript preparation. Eric I Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, , Crohn’s and Colitis Canada, and CAG . He was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program .

Publisher Copyright:
© 2021 AGA Institute

ASJC Scopus Subject Areas

Hepatology
Gastroenterology

PubMed: MeSH publication types

Journal Article
Practice Guideline
Research Support, Non-U.S. Gov't
Systematic Review

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1053/j.gastro.2021.04.034

Cite this

Jones, J. L., Tse, F., Carroll, M. W., deBruyn, J. C., McNeil, S. A., Pham-Huy, A., Seow, C. H., Barrett, L. L., Bessissow, T., Carman, N., Melmed, G. Y., Vanderkooi, O. G., Marshall, J. K., & Benchimol, E. I. (2021). Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines. Gastroenterology, 161(2), 681-700. https://doi.org/10.1053/j.gastro.2021.04.034

Jones, JL, Tse, F, Carroll, MW, deBruyn, JC, McNeil, SA, Pham-Huy, A, Seow, CH, Barrett, LL, Bessissow, T, Carman, N, Melmed, GY, Vanderkooi, OG, Marshall, JK & Benchimol, EI 2021, 'Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines', Gastroenterology, vol. 161, no. 2, pp. 681-700. https://doi.org/10.1053/j.gastro.2021.04.034

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title = "Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines",

abstract = "Background and Aims: The effectiveness and safety of vaccinations can be altered by immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD) itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on inactivated vaccines. Methods: Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative online platform, and voted on by a multidisciplinary group. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. Results: Consensus was reached on 15 of 20 questions. Recommendations address the following vaccines: Haemophilus influenzae type b, recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus, tetanus-diphtheria-pertussis, and human papillomavirus. Most of the recommendations for patients with IBD are congruent with the current Centers for Disease Control and Prevention and Canada's National Advisory Committee on Immunization recommendations for the general population, with the following exceptions. In patients with IBD, the panel suggested Haemophilus influenzae type b vaccine for patients older than 5 years of age, recombinant zoster vaccine for adults younger than 50 year of age, and hepatitis B vaccine for adults without a risk factor. Consensus was not reached, and recommendations were not made for 5 statements, due largely to lack of evidence, including double-dose hepatitis B vaccine, timing of influenza immunization in patients on biologics, pneumococcal and meningococcal vaccines in adult patients without risk factors, and human papillomavirus vaccine in patients aged 27–45 years. Conclusions: Patients with IBD may be at increased risk of some vaccine-preventable diseases. Therefore, maintaining appropriate vaccination status in these patients is critical to optimize patient outcomes. In general, IBD is not a contraindication to the use of inactivated vaccines, but immunosuppressive therapy may reduce vaccine responses.",

author = "Jones, {Jennifer L.} and Frances Tse and Carroll, {Matthew W.} and deBruyn, {Jennifer C.} and McNeil, {Shelly A.} and Anne Pham-Huy and Seow, {Cynthia H.} and Barrett, {Lisa L.} and Talat Bessissow and Nicholas Carman and Melmed, {Gil Y.} and Vanderkooi, {Otto G.} and Marshall, {John K.} and Benchimol, {Eric I.}",

note = "Funding Information: Funding This guideline was supported through unrestricted grants to the Canadian Association of Gastroenterology (CAG) by the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes, and CANImmunize who had no involvement in any aspect of the guideline development or manuscript preparation. Eric I Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, Crohn's and Colitis Canada, and CAG. He was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Funding Information: The Canadian Association of Gastroenterology (CAG) would like to thank the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes for its generous support of the guideline process. The consensus group would like to thank the following people for their contributions: Dr Dionne Duncan and Karen Sparkes (CAG representatives: administrative and technical support, and logistical assistance). The consensus group would also like to thank their patient/patient advocates, Claudia Tersigni, Thea Ewert, and Sara Croke, for their thoughtful input into the guideline process. Writing assistance: The consensus group would like to thank Pauline Lavigne and Steven Portelance (unaffiliated) who provided medical writing services on their behalf, supported by funds from the CAG. Author contributions: The co-chairs (Eric I. Benchimol, Jennifer L. Jones), steering committee (Anne Pham-Huy, Cynthia H. Seow, Jennifer C. deBruyn, and Shelly A. McNeil), and GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodologists (Frances Tse, Matthew W. Carroll) reviewed the literature and drafted the PICO (patient population, intervention, comparator, and outcome) questions. Frances Tse and Matthew W. Carroll assessed the evidence and provided GRADE evaluations. All members of the consensus group helped develop and voted on the direction and strength of the recommendations. The manuscript was initially drafted by the co-chairs (Eric I. Benchimol, Jennifer L. Jones) and Frances Tse, after which it was revised based on input from all members of the consensus group and the moderator (John K. Marshall). In addition, 2 adult patients with IBD reviewed the PICO questions and provided input on the final manuscript. Funding Information: Funding This guideline was supported through unrestricted grants to the Canadian Association of Gastroenterology ( CAG ) by the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes, , and CANImmunize who had no involvement in any aspect of the guideline development or manuscript preparation. Eric I Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, , Crohn{\textquoteright}s and Colitis Canada, and CAG . He was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program . Publisher Copyright: {\textcopyright} 2021 AGA Institute",

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doi = "10.1053/j.gastro.2021.04.034",

language = "English",

volume = "161",

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T1 - Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2

T2 - Inactivated Vaccines

AU - Jones, Jennifer L.

AU - Tse, Frances

AU - Carroll, Matthew W.

AU - deBruyn, Jennifer C.

AU - McNeil, Shelly A.

AU - Pham-Huy, Anne

AU - Seow, Cynthia H.

AU - Barrett, Lisa L.

AU - Bessissow, Talat

AU - Carman, Nicholas

AU - Melmed, Gil Y.

AU - Vanderkooi, Otto G.

AU - Marshall, John K.

AU - Benchimol, Eric I.

N1 - Funding Information: Funding This guideline was supported through unrestricted grants to the Canadian Association of Gastroenterology (CAG) by the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes, and CANImmunize who had no involvement in any aspect of the guideline development or manuscript preparation. Eric I Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, Crohn's and Colitis Canada, and CAG. He was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Funding Information: The Canadian Association of Gastroenterology (CAG) would like to thank the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes for its generous support of the guideline process. The consensus group would like to thank the following people for their contributions: Dr Dionne Duncan and Karen Sparkes (CAG representatives: administrative and technical support, and logistical assistance). The consensus group would also like to thank their patient/patient advocates, Claudia Tersigni, Thea Ewert, and Sara Croke, for their thoughtful input into the guideline process. Writing assistance: The consensus group would like to thank Pauline Lavigne and Steven Portelance (unaffiliated) who provided medical writing services on their behalf, supported by funds from the CAG. Author contributions: The co-chairs (Eric I. Benchimol, Jennifer L. Jones), steering committee (Anne Pham-Huy, Cynthia H. Seow, Jennifer C. deBruyn, and Shelly A. McNeil), and GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodologists (Frances Tse, Matthew W. Carroll) reviewed the literature and drafted the PICO (patient population, intervention, comparator, and outcome) questions. Frances Tse and Matthew W. Carroll assessed the evidence and provided GRADE evaluations. All members of the consensus group helped develop and voted on the direction and strength of the recommendations. The manuscript was initially drafted by the co-chairs (Eric I. Benchimol, Jennifer L. Jones) and Frances Tse, after which it was revised based on input from all members of the consensus group and the moderator (John K. Marshall). In addition, 2 adult patients with IBD reviewed the PICO questions and provided input on the final manuscript. Funding Information: Funding This guideline was supported through unrestricted grants to the Canadian Association of Gastroenterology ( CAG ) by the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes, , and CANImmunize who had no involvement in any aspect of the guideline development or manuscript preparation. Eric I Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, , Crohn’s and Colitis Canada, and CAG . He was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program . Publisher Copyright: © 2021 AGA Institute

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N2 - Background and Aims: The effectiveness and safety of vaccinations can be altered by immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD) itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on inactivated vaccines. Methods: Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative online platform, and voted on by a multidisciplinary group. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. Results: Consensus was reached on 15 of 20 questions. Recommendations address the following vaccines: Haemophilus influenzae type b, recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus, tetanus-diphtheria-pertussis, and human papillomavirus. Most of the recommendations for patients with IBD are congruent with the current Centers for Disease Control and Prevention and Canada's National Advisory Committee on Immunization recommendations for the general population, with the following exceptions. In patients with IBD, the panel suggested Haemophilus influenzae type b vaccine for patients older than 5 years of age, recombinant zoster vaccine for adults younger than 50 year of age, and hepatitis B vaccine for adults without a risk factor. Consensus was not reached, and recommendations were not made for 5 statements, due largely to lack of evidence, including double-dose hepatitis B vaccine, timing of influenza immunization in patients on biologics, pneumococcal and meningococcal vaccines in adult patients without risk factors, and human papillomavirus vaccine in patients aged 27–45 years. Conclusions: Patients with IBD may be at increased risk of some vaccine-preventable diseases. Therefore, maintaining appropriate vaccination status in these patients is critical to optimize patient outcomes. In general, IBD is not a contraindication to the use of inactivated vaccines, but immunosuppressive therapy may reduce vaccine responses.

AB - Background and Aims: The effectiveness and safety of vaccinations can be altered by immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD) itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on inactivated vaccines. Methods: Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative online platform, and voted on by a multidisciplinary group. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. Results: Consensus was reached on 15 of 20 questions. Recommendations address the following vaccines: Haemophilus influenzae type b, recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus, tetanus-diphtheria-pertussis, and human papillomavirus. Most of the recommendations for patients with IBD are congruent with the current Centers for Disease Control and Prevention and Canada's National Advisory Committee on Immunization recommendations for the general population, with the following exceptions. In patients with IBD, the panel suggested Haemophilus influenzae type b vaccine for patients older than 5 years of age, recombinant zoster vaccine for adults younger than 50 year of age, and hepatitis B vaccine for adults without a risk factor. Consensus was not reached, and recommendations were not made for 5 statements, due largely to lack of evidence, including double-dose hepatitis B vaccine, timing of influenza immunization in patients on biologics, pneumococcal and meningococcal vaccines in adult patients without risk factors, and human papillomavirus vaccine in patients aged 27–45 years. Conclusions: Patients with IBD may be at increased risk of some vaccine-preventable diseases. Therefore, maintaining appropriate vaccination status in these patients is critical to optimize patient outcomes. In general, IBD is not a contraindication to the use of inactivated vaccines, but immunosuppressive therapy may reduce vaccine responses.

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Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

UN SDGs

Access to Document

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