New ACG inflammatory bowel disease vaccination and screening guidelines call on primary care physicians as comanagers.
1. New Flu Guidelines. All adult patients with IBD should undergo annual vaccination against influenza. Those on immunosuppressive therapies and their household contacts should receive the non-live trivalent inactivated influenza vaccine but not the live inhaled influenza vaccine. Patients with IBD are at increased risk for influenza infection, especially when they are treated with immunosuppressive therapies. For some, hospitalization and co-infection with pneumonia are more likely.
2. Pneumococcal Notions. Adult patients with IBD receiving immunosuppressive therapy should receive pneumococcal vaccination with both the PCV13 and PPSV23, in accordance with national guidelines. Patients with IBD, including Crohn disease and ulcerative colitis, are at increased risk for pneumonia. The risk appears increased in patients being treated with narcotics, corticosteroids, biologics, thiopurines, and proton-pump inhibitors.
3. Herpes Zoster Suggestions. Adults with IBD over the age of 50 should consider vaccination against herpes zoster, including certain subgroups of immunosuppressed patients. Zoster, or a zoster-related diagnosis, will develop in about 1 in 3 persons in the general population. Debilitating postherpetic neuralgia may develop in as many as 10% to 18% of patients. Patients with IBD are at increased risk for herpes zoster infections, regardless of disease duration.
4. Varicella Vaccination. Adults with IBD should be assessed for prior exposure to varicella and vaccinated if naive before initiation of immunosuppressive therapy when possible. About 90% of susceptible close contacts will get varicella after exposure to persons with disease. Before the vaccine was available, about 4 million persons got chickenpox each year in the United States. Patient recall of chickenpox infection is not accurate for determining seropositivity.
5. Preventing Yellow Fever. Patients with IBD who are immunosuppressed and traveling to endemic areas for yellow fever should consult with a travel medicine or infectious disease specialist prior to travel. Yellow fever can be associated with significant morbidity and mortality. There is no specific treatment; management is based on treatment of symptoms. Steps to prevent yellow fever virus infection include using insect repellent, wearing protective clothing, and getting vaccinated.
6. Meningococcal Morbidity. Adolescents with IBD should receive meningococcal vaccination in accordance with routine vaccination recommendations. Each case of meningococcal disease may be life-threatening. Teens and young adults are at increased risk. Infection can cause sepsis and meningitis, resulting in permanent disabilities and, rarely, death. Vaccines are inactivated and can be administered to all patients with IBD regardless of immunosuppression. A variety of vaccines are available.
7. “Cocooning” for Household Members. Household members of immunosuppressed patients can receive live vaccines with certain precautions. A “cocooning” strategy encourages household members be vaccinated to reduce transmission to the immunocompromised patient. Those who live in a household with immunocompromised patients age ≥ 6 months should receive influenza vaccine annually.
8. Vaccination Before Immunosuppression. Adults with IBD should receive age-appropriate vaccinations before initiation of immune suppression when possible. Live vaccines should be administered ≥ 4 weeks before immunosuppression and should be avoided within 2 weeks of initiation of immunosuppression. Inactivated vaccines should be administered ≥ 2 weeks before immunosuppression.
9. Administering Non-live Vaccines. Vaccination against Tdap, HAV, HBV, and HPV should be administered as per Advisory Committee on Immunization Practice guidelines. Regardless of immunosuppression status, all adult patients with IBD should receive non-live vaccines, including hepatitis A, hepatitis B, Haemophilus influenza B, human papillomavirus, tetanus, and pertussis. Special attention should be given to assessing HBV status.
10. Other ACG Screening Recommendations. Screening is recommended for cervical cancer in women who are receiving immunosuppressive therapy, for depression and anxiety, for melanoma independent of the use of biologic therapy, for patients receiving immunomodulators for nonmelanoma skin cancer while using these agents, and for osteoporosis for patients with ulcerative colitis and CD who have conventional risk factors for abnormal BMD.
A new clinical guideline developed by the American College of Gastroenterology (ACG) outlines the preventive care that patients who have inflammatory bowel disease (IBD) require and recommends that gastroenterologists comanage this care with a multidisciplinary team, including primary care physicians.“To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team,” the guideline states.Most of the ACG recommendations offer guidance in providing vaccinations for patients with IBD, especially those who are receiving immunosuppressive therapy, but many address other concerns, such as screening for cancer, depression/anxiety, and osteoporosis, and encouraging patients to quit smoking.Scroll through the slides above for highlights of the vaccination and screening recommendations (guidelines in italics).Â SourcePreventive Care in Inflammatory Bowel Diseasehttp://gi.org/guideline/preventive-care-in-inflammatory-bowel-disease/Â