Lax Prophylaxis: Vaccinating the Inflammatory Bowel Disease Patient

Excerpt

Inflammatory bowel disease (IBD) is a chronic medical condition affecting an estimated 1.5 million Americans, with 70,000 new cases added annually—a number that has been on the rise since the late twentieth century. The healthcare burden of IBD is largely reflected in the nearly 92,000 hospitalizations, 1,300,000 physician visits and 120,000 annual disabilities resulting in a $6.3 billion cost annually [1]. Disease progression is significant; traditionally, up to three quarters of Crohn’s disease (CD) and one quarter of ulcerative colitis (UC) patients require surgery in their lifetime [1]. Similarly, IBD patients have an 80% estimated lifetime probability for steroid therapy, 40% for immunomodulatory therapy, and 20% biologic therapy resulting in high likelihood of immunosuppression [2]. The rapid growth of healthcare research in the twenty-first century has led to an ever-increasing armamentarium of available remedies, of which infliximab and adalimumab have become the commonest prescribed medications for patients with moderate—severe IBD. Nevertheless, as effective as biologics are in achieving and maintaining clinical and histologic remission as well as improving patients’ quality-of-life, their use places recipients at a higher risk of infections. In this respect, the paper by Dr. Pham and colleagues [3] published in current issue of Digestive Diseases and Sciences yet again highlights an important issue of precautionary practices in the IBD population, examining the rates and predictors of vaccinations among IBD patients initiated on infliximab and adalimumab therapy in an integrated West Coast healthcare system. …