Baseline evaluation of vaccine-preventable infections in pediatric patients with inflammatory bowel disease

Baseline evaluation*
Pathogen or vaccine	Review risk factors, vaccine records, and prior infections	Check serologic status	Offer vaccine if not up to date, or nonimmune, and age-appropriate	Subsequent annual evaluation
Haemophilus influenza type b	Yes	No	Yes	No
Hepatitis A virus	Yes	Consider	Yes	No
Hepatitis B virus	Yes	Yes (HBsAg, anti-HBc, and anti-HBs)	Yes	Repeat series once if inadequate serologic response; recheck anti-HBs (2 months after third dose)
HPV	Yes	Encourage gynecologic/anal examination if age-appropriate	Yes, minimum age 9 years	Yes, if appropriate
Influenza, inactivated vaccine	Yes	NA	Yes, annually	Yes
Inactivated polio vaccine	Yes	NA	Yes	No
MMR	Yes	Yes	Yes^¶^Δ	No
Meningococcal conjugate vaccine	Yes	No	Yes	Yes, if age-appropriate or risk factors^◊
PCV13	Yes	No	Yes^§	NA
PPSV23	Yes	No	Yes^¥	Booster once 5 years after first dose of PPSV23 (max 2 lifetime PPSV23 doses)
Tetanus, Td, Tdap	Yes	NA	Yes	After Tdap, Td booster every 10 years
Varicella-zoster virus	Yes	Yes^‡	Yes, if no evidence of immunity^¶^Δ	NA

This table outlines screening procedures for pediatric patients with inflammatory bowel disease. Whenever possible, this screening should be completed before initiating therapy with anti-TNF therapies such as infliximab or with newer biologic therapies as they become available.

HBsAg: hepatitis B surface antigen; anti-HBc: hepatitis B core antibody; anti-HBs: hepatitis B surface antibodies; HPV: human papillomavirus; N/A: not applicable; MMR: measles-mumps-rubella; PCV13: pneumococcal conjugate vaccine; PPSV23: pneumococcal polysaccharide vaccine; Td: diphtheria; Tdap: acellular pertussis; anti-TNF: anti-tumor necrosis factor; ACIP: Advisory Committee on Immunization Practices.
* Should include review of vaccine record and any prior testing/serologies.
¶ If not receiving immunosuppressive therapy (please refer to text, vaccine section for dosing). Immunosuppressive therapy includes prednisone in the past 30 days or any of the following in the past 3 months: 6-mercaptopurine, methotrexate, azathioprine, or any biologic agent, including anti-TNF-alpha therapy.
Δ Dispense if live virus vaccine can be administered ≥4 weeks before starting immunosuppressive therapy.
◊ Adolescents may require a booster dose of meningococcal conjugate vaccine, in accordance with the ACIP vaccine schedule. A vaccine may also be needed if there are identified risk factors such as travel to a country where meningococcal disease is epidemic or hyperendemic, or in patients with persistent complement deficiency, or functional or anatomic asplenia.
§ For children 6 to 18 years old, if no prior doses of PCV7 or PCV13, then give 1 dose of PCV13, followed 8 weeks later by PPSV23.
¥ If both PCV13 and PPSV23 are indicated, PCV13 should be given first, followed by PPSV23 given ≥8 weeks afterward.
‡ Send serology if evidence of immunity unknown; evidence of immunity is defined as: health care provider diagnosis of varicella disease or herpes zoster, laboratory confirmation of disease, serologic evidence of past disease, or documentation of having received vaccine series.

From: Ardura MI, Toussi SS, Siegel JD, et al. NASPGHAN clinical report: Surveillance, diagnosis, and prevention of infectious diseases in pediatric patients with inflammatory bowel disease receiving tumor necrosis factor-a inhibitors. J Pediatr Gastroenterol Nutr 2016; 63:130. DOI: 10.1097/MPG.0000000000001188. Copyright © 2016 ESPGHAN & NASPGHAN. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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