Esteve Comas Maria, Loras Alastruey Carme, Fernandez-Bañares Fernando
Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, University of Barcelona, ES-08221 Terrassa, Barcelona, Spain.
Dig Dis. 2009;27(3):370-4. doi: 10.1159/000228576. Epub 2009 Sep 24.
The mortality in inflammatory bowel disease (IBD) has been reported similar or slightly increased as compared to that of the general population. However, deaths related to infectious and parasitic diseases have been repeatedly reported in clinical trials, open series and registries. The IBD patients are exposed to the same infections affecting the community, added to opportunistic infectious related to the immunosuppression. Some of these infectious diseases may be prevented by the appropriate use of a vaccination program. Thus, vaccination status should be assessed at IBD diagnosis, and from time to time, and vaccination should be updated to every patient as soon as possible, since deaths due to preventable diseases should never occur. Present recommendations include vaccination for influenza (annually), for pneumococcal disease with the 23-valent strain (every 5 years), for hepatitis B virus (in patients with no detectable hepatitis B surface antibodies), combined vaccination against tetanus, diphtheria and inactivated poliomyelitis (every 10 years). The role of human papillomavirus vaccine preventing cervical dysplasia and neoplasia in IBD women taking immunosuppressive are at present unknown. In patients lacking varicella immunization, specific vaccination should be considered. Nevertheless, it should be taken into account that varicella vaccine contains live attenuated virus that cannot be administered in patients taking immunosuppressive. The same consideration should be kept in mind for patients travelling to endemic areas for yellow fever. Finally, IBD patients on immunosuppressive may have an altered response to vaccine immunization. Decreased response has been reported for hepatitis B and pneumoccocal vaccination. In those cases, testing for serological responses to vaccine should be performed and booster doses may be required.
据报道，炎症性肠病（IBD）患者的死亡率与普通人群相似或略有增加。然而，在临床试验、开放系列研究和登记处中，反复报告了与感染性和寄生虫病相关的死亡病例。IBD患者面临着与普通人群相同的社区感染，此外还存在与免疫抑制相关的机会性感染。通过适当使用疫苗接种计划，可以预防其中一些传染病。因此，应在IBD诊断时评估疫苗接种状况，并定期进行评估，应尽快为每位患者更新疫苗接种情况，因为绝不应发生因可预防疾病导致的死亡。目前的建议包括每年接种流感疫苗、每5年接种23价肺炎球菌疫苗、对乙肝表面抗体检测不到的患者接种乙肝疫苗、每10年接种破伤风、白喉和灭活脊髓灰质炎联合疫苗。目前尚不清楚人乳头瘤病毒疫苗在预防接受免疫抑制治疗的IBD女性宫颈发育异常和肿瘤方面的作用。对于未接种水痘疫苗的患者，应考虑进行特异性接种。然而，应考虑到水痘疫苗含有减毒活病毒，不能用于接受免疫抑制治疗的患者。对于前往黄热病流行地区的患者也应考虑同样的问题。最后，接受免疫抑制治疗的IBD患者对疫苗接种的反应可能会改变。据报道，乙肝疫苗和肺炎球菌疫苗的反应会降低。在这些情况下，应进行疫苗血清学反应检测，可能需要接种加强针。
