The Pulse | Monday, June 21, 2021

Advocating for Vaccination of IBD Patients: What GI Nurses Should Know

Varun Jain and Esteban Figueroa

The COVID-19 pandemic has radically altered the health care landscape. Now, over a year after the initial stages of the pandemic, the U.S. has three vaccines available to patients. As of early June, approximately 40% of Americans are fully vaccinated per the CDC’s guidance. Health care workers have the responsibility to advocate for patients to get their vaccine, as well as serve as a reliable source for questions about the safety and efficacy of vaccines. Often, nurses are on the front lines of the patient care team and serve as the primary point of contact for a patient. This unique position provides a ripe opportunity to positively impact patient care.

There is data indicating that patients with inflammatory bowel disease (IBD) are less likely to receive appropriate vaccinations, including the influenza and pneumonia vaccines, compared to the general population.¹ During the COVID-19 pandemic, this issue has become even more important. Common vaccine related patient concerns include misconceptions about whether the new vaccines are “live virus” vaccines, which are contraindicated in patients on biologic therapies; whether vaccination can trigger a flare of their IBD; and what is the overall safety and efficacy of the newly available SARS-CoV-2 vaccines in patients with IBD.

None of the currently available FDA approved vaccines against SARS-CoV-2 are “live virus” vaccines, and their administration should be encouraged to all patients with IBD — even those on immunosuppressants. There seems to be no more adverse events reported in patients with IBD compared to people without IBD.² As for the concern whether the vaccine can trigger a flare in IBD, this is still unclear, but no data points to this being the case.

Gastrointestinal symptoms after vaccination are known side effects that have been reported in the clinical trials with all three FDA approved SARS-CoV-2 vaccines. Experts from the University of Chicago and Cedars-Sinai IBD centers have been monitoring patients after vaccination, and at this time it does not appear vaccination is a risk for IBD relapse. If and when GI symptoms occur shortly after vaccination, they tend to be short lived.

In December 2020, the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) released COVID-19 vaccination recommendations for patients with IBD.³ The group of 64 leading IBD gastroenterologists recommend that all patients with IBD should be vaccinated as soon as possible, regardless of vaccine type or immunosuppressant status. They caution that patients who are taking systemic corticosteroids at time of vaccination may see reduced vaccine efficacy, which is based on data from influenza vaccine studies.

It is important to note that, at the time of the recommendations, these experts had to provide their guidance without the benefit of real-world data and, in the coming months, there may be updates and changes. Highlighting this uncertainty often garners trust from the patient, which can be difficult in this current environment of widespread distrust toward the medical and science community as they relate to the COVID 19 pandemic.

Many groups have conducted studies specifically looking at the efficacy of SARS-CoV-2 vaccines in patients with IBD. One of largest studies, the CLARITY IBD study, suggests that patients with IBD receiving infliximab therapy have a mildly reduced efficacy of the Pfizer and the AstraZeneca vaccines after one dose, compared to patients not taking an anti-TNF biologic.⁴

An important and often overlooked component from this study is that patients who received a second dose, or had a prior SARS-CoV-2 infection, had an appropriate immune response to the vaccine. Another smaller study based out of Mount Sinai in New York found that patients with IBD receiving biologic therapy mounted adequate immune responses following vaccination with either of the currently available mRNA vaccines (Pfizer & Moderna).⁵

At this time, there is no clear data on the single dose Johnson & Johnson vaccine, but ongoing IBD patient registries across the world will hopefully shed light on this in the coming months. 

As gastroenterology nurses continue to advocate for their patients, it is pertinent to encourage patients with IBD to receive their vaccinations in a timely manner and provide reliable, up-to-date information on this important topic. Despite some of the unknowns about the efficacy, duration of protection and complete safety profile, the benefit of vaccination with SARS-CoV-2 vaccines far outweigh the risks to patients with IBD, regardless of the type of therapy they are on.

For more resources for patients and providers, see below.

 

Recommended Resources:

1. International Organization for IBD https://ioibd.org/publications/
2. Crohns & Colitis Foundation Patient Information https://www.crohnscolitisfoundation.org/coronavirus/what-ibd-patients-should-know
3. Crohns & Colitis Foundation Provider Information https://www.crohnscolitisfoundation.org/coronavirus/professional-resources
4. CDC COVID 19 resources https://www.cdc.gov/coronavirus/2019-nCoV/index.html

References

1. Malhi G, Rumman A, Thanabalan R, et al. Vaccination in Inflammatory Bowel Disease Patients: Attitudes, Knowledge, and Uptake. Journal of Crohn's and Colitis. 2015;9(6):439-444. doi:10.1093/ecco-jcc/jjv064
2. Botwin GJ, Li D, Figueiredo J, et al. Adverse Events After SARS-CoV-2 mRNA Vaccination Among Patients With Inflammatory Bowel Disease. American Journal of Gastroenterology. 2021;Publish Ahead of Print. doi:10.14309/ajg.0000000000001342
3. Siegel CA, Melmed GY, McGovern DPB, et al. SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting. Gut. 2021;70(4):635-640. doi:10.1136/gutjnl-2020-324000
4. Kennedy NA, Goodhand JR, Bewshea C, et al. Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab. Gut. 2021;70(5):865-875. doi:10.1136/gutjnl-2021-324388
5. Wong S-Y, Dixon R, Martinez Pazos V, et al. Serologic Response to Messenger RNA Coronavirus Disease 2019 Vaccines in Inflammatory Bowel Disease Patients Receiving Biologic Therapies. Gastroenterology. 2021. doi:10.1053/j.gastro.2021.04.025