Résumé
Background & Aims: Patients with inflammatory bowel disease (IBD) may be at increased risk of some vaccine-preventable diseases. The effectiveness and safety of vaccinations may be altered by immunosuppressive therapies or 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 live 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 process and voted on by a multidisciplinary panel. 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: Three good practice statements included reviewing a patient's vaccination status at diagnosis and at regular intervals, giving appropriate vaccinations as soon as possible, and not delaying urgently needed immunosuppressive therapy to provide vaccinations. There are 4 recommendations on the use of live vaccines. Measles, mumps, rubella vaccine is recommended for both adult and pediatric patients with IBD not on immunosuppressive therapy, but not for those using immunosuppressive medications (conditional). Varicella vaccine is recommended for pediatric patients with IBD not on immunosuppressive therapy, but not for those using immunosuppressive medications (conditional). For adults, recommendations are conditionally in favor of varicella vaccine for those not on immunosuppressive therapy, and against for those on therapy. No recommendation was made regarding the use of live vaccines in infants born to mothers using biologics because the desirable and undesirable effects were closely balanced and the evidence was insufficient. Conclusions: Maintaining appropriate vaccination status in patients with IBD is critical to optimize patient outcomes. In general, live vaccines are recommended in patients not on immunosuppressive therapy, but not for those using immunosuppressive medications. Additional studies are needed to evaluate the safety and efficacy of live vaccines in patients on immunosuppressive therapy.
| Langue d'origine | English |
|---|---|
| Pages (de-à) | 669-680.e0 |
| Journal | Gastroenterology |
| Volume | 161 |
| Numéro de publication | 2 |
| DOI | |
| Statut de publication | Published - août 2021 |
Note bibliographique
Funding Information:Acknowledgments The Canadian Association of Gastroenterology (CAG) would like to thank the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes for their 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, a patient with IBD reviewed the PICO questions and 2 patients 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. Acknowledgments The Canadian Association of Gastroenterology (CAG) would like to thank the Canadian Institutes of Health Research, Institute of Nutrition, Metabolism and Diabetes for their 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, a patient with IBD reviewed the PICO questions and 2 patients 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
ASJC Scopus Subject Areas
- Hepatology
- Gastroenterology
PubMed: MeSH publication types
- Journal Article
- Practice Guideline
- Research Support, Non-U.S. Gov't
- Systematic Review
ODD de l’ONU
Cette action contribue à la réalisation des objectifs de développement durable suivants
