By Dr. Brian Bressler and Christina Pears, RN

An Overview of Immunizations and Recommendations for Patients on Biologics and Immunosuppressants

Many treatments for Crohn’s Disease and Ulcerative Colitis involve the use of immunosuppressants and/or biologics which include medications such as prednisone, Azathioprine (Imuran), 6-MP, Methtrexate, Humira, and Remicade.

These medications are effective because they work by reducing inflammation by manipulating the body’s immune system. Because of this activity, the susceptibility to infections may be increased. However, many of these infections can be prevented by utilizing appropriate immunization strategies.

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Influenza (The Flu Vaccine)
This immunization helps protect against the seasonal flu. Because the flu virus is always changing, these vaccines are updated yearly. It is recommended that this vaccine is obtained once a year.

Pneumococcal Polysaccharid (PPV) Vaccine
This immunization helps protect against meningitis, pneumonia, and certain blood infections. It is recommended for all patients on an immunosuppressant and/or a biologic.

Hepatitis B
This vaccine protects against Hepatitis B. This involves a series of 3 injections over at least 4 months. If you have not received the vaccination series, it is recommended for those with potential risk factors including travelers, high-risk sexual behaviour, and individuals working in health care.

Meningococcal Vaccine
In general, individuals taking immunosuppressants are not considered at an increased risk for meningococcemia. However, this vaccine should be considered for college/university students living in a dormitory.

The Tetanus toxoid (Td) vaccine is typically given in BC as part of the recommended childhood immunizations. A booster shot should be given every 10 years thereafter. Although a tetanus infection is considered rare, regular booster shots should be obtained in all individuals.

The vaccines Cervarix and Gardasil help protect against the Human Papillomavirus that causes cervical cancer. Gardasil also protects against some viruses that cause genital warts. Vaccinations involve a series of 3 injections over a 6 month period. Women with Crohn’s disease and ulcerative colitis have a higher risk for HPV and abnormal pap smears. It is recommended that all women between the ages of 14 and 26 obtain this vaccine.

Vaccinations to Avoid

Live Vaccines
Live bacterial or viral vaccines should be avoided when you are on an immunosuppressant and/or biologic due to the risk of vaccine related infections. This includes Yellow Fever, Oral typhoid, Oral polio, Tuberculosis BCG, Anthrax vaccine, small pox vaccine and the flu vaccine that is given as a nasal spray (Flumist).

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