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The Inflammatory Bowel Disease content has been developed by CHEO Inflammatory Bowel Disease Centre in partnership with CANImmunize.

Inflammatory Bowel Disease (IBD)

If you or your child is living with inflammatory bowel disease (IBD) that is, Crohn’s disease or ulcerative colitis, you’re not alone. Approximately 1 in 140 Canadians haveIBD, including 7000 children under 18 years old, and rates are rising rapidly. By2030, it is estimated that 1 in 100 Canadians will have IBD, including almost14,000 children. IBD is most often diagnosed during adolescence or early adulthood, and some medications used to treat IBD can put patients at risk for serious infections. It can be diagnosed at even younger ages, at a time when routine immunizations are due.

Between learning about your or your child’s disease, seeing different healthcare providers, and following up on treatment plans, living with a chronic condition is not easy. Keeping track of your immunizations on top of everything else is another challenge. CANImmunize is a tool you can use to help you keep track of immunization schedules, and which is another important aspect of your and your child’s health.

I am an Adult with IBD

IBD is characterized by inflammation of the intestines generated by the immune system. As such, many of the medications used to treat Crohn’s disease or ulcerative colitis are designed to stop the active inflammation. However, by doing so, the immune system’s response that causes inflammation in the intestines may also be diminished.While stopping intestinal inflammation is important to manage symptoms and prevent serious complications from IBD, it can also reduce your ability to fight off infections, including vaccine-preventable diseases. Therefore, getting vaccinated is crucial for everyone living with IBD. It is one of the safest and most effective ways to prevent infections.

If you are NOT RECEIVING medications that impact your immune system, then it is recommended that you receive the same routine immunizations as those without IBD. This includes a tetanus vaccine every 10 years. In addition, adolescents should receive the pertussis vaccine. Adults who did not receive a pertussis booster as a teenager should also receive a pertussis vaccine.  Even if you or your child are/is not currently receiving medications that impacts the immune system, it is possible that in the future you/your child might receive them.  This is the best time to ensure that you are up to date with your immunizations.  

If you WILL REQUIRE treatments affecting the immune system, your doctor may recommend additional helpful immunizations while it is safe to receive them and when it will have the best immune response.

If you are ALREADY RECEIVING treatments affecting the immune system, you can still receive most vaccines. However, depending on the medications you are receiving, it may not be safe to receive live vaccines, since you are immunosuppressed. Live vaccines include the measles, mumps and rubella (MMR), Zostavax shingles, and intranasal influenza vaccines, as well as some travel vaccines like the vaccine against yellow fever. Additional vaccinations, such as the pneumococcal and shingles vaccines, may be recommended to prevent serious infections. Vaccination requirements can vary depending on your medications and disease status, so be sure to talk to your healthcare provider about what’s best for you and when you should receive vaccines. 

If you are not already up-to-date with your immunizations, you should discuss timing of immunizations with your healthcare provider. Some treatments used to treat IBD may suppress the body’s response to immunizations, so your doctor may ask you to wait before receiving a vaccine. On the other hand, the sooner immunity against vaccine-preventable diseases is achieved, the lower the risk that you will catch a preventable infection. 

Yes. Canadian guidelines recommend that everyone with Crohn’s disease and ulcerative colitis receive the flu vaccine every year, especially if they are on medications affecting the immune system. Recent Canadian research has shown that the flu shot does not cause flares of Crohn’s disease or ulcerative colitis, but getting a viral infection may contribute to flares of IBD. Patients with IBD who are taking medication that suppresses their immune system should receive the injectable flu vaccine, not the live nasal vaccine. 

One third of adults will get shingles (herpes zoster) and patients with IBD are more likely to get it than people without IBD. Some medications used to treat IBD are associated with a higher risk of shingles. Current guidelines recommend that all adults over the age of 50 be vaccinated against shingles. If possible, the shingles vaccine should be given prior to starting therapy that will suppress the immune system. Tofacitinib (Xeljanz™) may increase the risk of shingles and you should therefore be vaccinated if you are using this medication, or prior to starting it.

There are two types of shingles vaccines: Zostavax and Shingrix. Zostavax is a live attenuated vaccine but is safe for people receiving low doses of methotrexate (<0.4mg/kg/week), azathioprine (<3.0 mg/kg/day), or 6-mercaptopurine (<1.5mg/kg/day). There is some evidence suggesting Zostavax is also safe in patients receiving anti-TNF therapy, but more research is underway to determine its safety and effectiveness in these patients. On the other hand, Shingrix is are combinant vaccine, meaning that it is not live, and therefore safe for patients who are on immunosuppression. Shingrix is the preferred shingles vaccine, both for people with and without IBD, and it has been demonstrated to prevent shingles more effectively. However, not all provincial health plans will pay for Shingrix, and you may have to use private insurance, or payout-of-pocket. 

Travelling abroad can put you at risk of contracting a disease that may not be common in Canada, especially if you are taking medication that suppresses your immune system. More information about vaccine-preventable diseases that may pose a risk to international travellers can be found here. Some vaccines used to prevent travel-related diseases are live and may not be safe if you are taking medication to suppress your immune system. At least three months before you travel, talk to your doctor, nurse or travel health clinic about your travel vaccinations. To learn more about staying healthy while you travel, click here. 

If you have recently been diagnosed, we encourage you to discuss your immunization needs with your gastroenterologist and family doctor. Taking initiative and an active role in your health ensures you receive the best possible care!

My child has IBD

IBD is characterized by inflammation of the intestines generated by the immune system. As such, many of the medications used to treat children with Crohn’s disease or ulcerative colitis are designed to stop the active inflammation. However, by doing so, the immune system’s response that causes inflammation in the intestines may also be diminished. While stopping intestinal inflammation is important to manage your child’s symptoms and prevent serious complications from IBD, it can also reduce their ability to fight off infections, including vaccine-preventable diseases.Therefore, getting vaccinated is crucial for children living with IBD. It is one of the safest and most effective ways to prevent infections.

If your child is NOT RECEIVING medications that impact the immune system, then using the same routine immunization schedule as children without IBD is recommended.

If your child WILL REQUIRE treatments affecting the immune system, your doctor may recommend additional helpful immunizations while it is safe to receive them.

If your child IS ALREADY RECEIVING treatments affecting the immune system, it is recommended that they follow the routine immunization schedule but do not receive live vaccines, because they are considered immunosuppressed. Live vaccines include the measles, mumps and rubella vaccine (MMR), varicella (chicken pox) vaccine, and intranasal influenza vaccine, as well as some travel vaccines like the vaccine against yellow fever. Additional vaccinations may be recommended to prevent serious infections. Vaccination requirements can vary depending on your child’s medications and disease status, so be sure to talk to your health care provider about what’s best for them and when best to receive them.

If your child is not already up-to-date with their immunizations, you should discuss timing of immunizations with your healthcare provider. Some treatments used to treat your child’s IBD may suppress the body’s response to immunizations, so your doctor may ask your child to wait before getting vaccinated. On the other hand, the sooner immunity against vaccine-preventable diseases is achieved, the lower the risk your child will catch a preventable infection.  Your doctor might even suggest to get certain vaccines ahead of the provincial or territorial scheduled time, in order to maximize response and protection for your child.

Yes. Canadian guidelines recommend that children with Crohn’s disease and ulcerative colitis receive the flu vaccine every year, especially if they are on medications affecting the immune system. Recent Canadian research has shown that the flu shot does not cause flares of Crohn’s disease or ulcerative colitis, but getting a viral infection may contribute to flares of IBD.

If your child has recently been diagnosed, we encourage you to discuss their immunization needs with your gastroenterologist. Taking initiative and an active role in your child’s health ensures they receive the best possible care!

I have IBD and am pregnant or breastfeeding

Immunization provides protection against disease that can cause serious harm. An expectant mother who is up-to-date with recommended vaccines not only protects herself but also passes on the protection to her baby. The protection continues to be shared with the baby through breastfeeding. Staying up to date on your immunizations and getting immunized during pregnancy is especially important to prevent diseases that can cause complications. Talk to your health care provider about your immunization status and the vaccines that may be recommended for you. More information on immunization and pregnancy can be found here.

Infants whose mother’s take medications that suppress the immune system, either during pregnancy or while breastfeeding, can safely receive most vaccines. If a mother with IBD is being treated with anti-TNF or other biologic therapy that crosses the placenta, current Canadian clinical practice guidelines recommend delaying live vaccines until the infant is 6 months of age. Based on current provincial immunization schedules, the rotavirus vaccine is the only live vaccine recommended in infants less than 6 months. The rotavirus vaccine is therefore the only vaccine that should be delayed in these infants.  The impact of medications depends on which medication you are taking, so be sure to talk to your health care provider as well as your child’s health care provider about how your medication might impact your baby’s immunizations.  

A Member of my Household has IBD

IBD is characterized by inflammation of the intestines generated by the immune system. As such, many of the medications used to treat Crohn’s disease or ulcerative colitis are designed to decrease the immune system’s response and stop the active inflammation. However, by doing so, the immune system’s response to infection may also be diminished, including its response vaccine-preventable diseases. Therefore, getting vaccinated is crucial for protecting your family member with IBD, especially if they are receiving medications that suppress their immune system. Vaccines are one of the safest and most effective ways to prevent infections.

Most vaccines are safe for you to receive. All inactivated vaccines are safe for you to receive. Most live vaccines are also safe for you to receive, however, you should be cautious if you receive the rotavirus and varicella (chickenpox) vaccines. When receiving the rotavirus vaccine, traces of rotavirus may be present in stool. Transmission to family members can be prevented with proper hand hygiene (washing your hands regularly with soap and water or hand sanitizer, especially after using the bathroom). A small percentage of people receiving the varicella vaccines may develop a rash. If you develop a rash, avoid contact with your family member who has IBD and see your doctor.

Last updated: 14/05/2019

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