First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy.
Front Immunol. 2020 Mar 23;11:485. doi: 10.3389/fimmu.2020.00485. eCollection 2020.
Inflammatory bowel disease (IBD), which comprises ulcerative colitis and Crohn's disease, is an immune-mediated, chronic-relapsing, disabling disorder which is associated with increased mortality and poor patients' quality of life. Patients with IBD are at increased risk of infections for many reasons. In fact, IBD often requires a lifelong immunosuppressive and/or biologic therapy, both commonly associated with respiratory and opportunistic infections, but also gastrointestinal, urinary tract infections, and sepsis. Moreover, impaired spleen function has been found in a considerable proportion of IBD patients, further increasing the risk of developing infections sustained by encapsulated bacteria, such as , and . Finally, comorbidities and surgery represent additional risk factors for these patients. Despite the availability of vaccinations against the most common serotypes of encapsulated bacteria, uncertainties still exist regarding a proper vaccination strategy and the actual effectiveness of vaccinations in this particular setting. Aim of this narrative review is to focus on the broad topic of vaccinations against encapsulated bacteria in IBD patients, discussing the clinical impact of infections, predisposing factors, vaccinations strategies, and unmet research and clinical needs.
炎症性肠病(IBD)包括溃疡性结肠炎和克罗恩病,是一种免疫介导的、慢性复发性、致残性疾病,与死亡率增加和患者生活质量下降有关。由于多种原因,IBD 患者感染的风险增加。事实上,IBD 通常需要终生免疫抑制和/或生物治疗,这两者都常与呼吸道和机会性感染相关,也与胃肠道、尿路感染和败血症相关。此外,相当一部分 IBD 患者发现脾功能受损,进一步增加了感染囊膜细菌的风险,如 、 和 。最后,合并症和手术是这些患者的额外危险因素。尽管有针对囊膜细菌最常见血清型的疫苗,但在适当的疫苗接种策略和这种特殊情况下疫苗的实际效果方面仍存在不确定性。本综述的目的是关注 IBD 患者接种囊膜细菌疫苗这一广泛主题,讨论感染的临床影响、易患因素、疫苗接种策略以及未满足的研究和临床需求。