Chiarella-Redfern Helene, Lee Sangmin, Jubran Bellal, Sharifi Nastaran, Panaccione Remo, Constantinescu Cora, Benchimol Eric I, Seow Cynthia H
Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Alberta, Canada.
Inflamm Bowel Dis. 2022 Jan 5;28(1):79-86. doi: 10.1093/ibd/izab033.
Pregnant women with inflammatory bowel disease (IBD) are at increased risk of developing complications from vaccine-preventable infections. We investigated the factors influencing vaccine administration in pregnant women with IBD and their infants, in addition to the safety of vaccination in the infants.
This retrospective cohort study identified individuals from a tertiary referral clinic whose records were linked to a provincial vaccine database. We conducted χ 2 tests, Fisher exact tests, and logistic regression adjusting for age and disease duration to compare vaccine administration by medication class. Potential rotavirus vaccine adverse events were determined in infants of women with IBD.
We included 303 pregnant women and 262 infants. Vaccines were administered to women on biologic therapy as follows: hepatitis B virus (82.9%), diphtheria-tetanus-pertussis (82.1%), and hepatitis A virus (49.3%). The influenza vaccination was provided peripartum in 50.7% of patients. The measles-mumps-rubella-varicella vaccine was provided to 89.3% of women before biologic initiation. Women treated with a biologic (adjusted odds ratio, 2.50; 95% confidence interval, 1.39-4.35) or immunomodulator (adjusted odds ratio, 4.00; 95% confidence interval, 2.22-7.69) were more likely to receive the Prevnar 13 and Pneumovax 23 vaccines than were unexposed individuals, but the overall proportion vaccinated was low (Prevnar 13, 35.7%; Pneumovax 23, 39.3%). At least 90% of infants received the measles-mumps-rubella-varicella vaccine and inactivated vaccines. Fourteen biologic-exposed children (19.2%) received the live rotavirus vaccine with no significant differences in adverse events compared with biologic-unexposed infants (7.1% vs 8.2%, P = 0.99).
Better education surrounding vaccine recommendations is required for both health care providers and individuals with IBD given poor pneumococcal, hepatitis A virus, and influenza vaccination rates. Inadvertent administration of the rotavirus vaccine in biologic-exposed infants did not result in more adverse events, raising the possibility of safety.
患有炎症性肠病（IBD）的孕妇发生疫苗可预防感染并发症的风险增加。我们调查了影响IBD孕妇及其婴儿疫苗接种的因素，以及婴儿接种疫苗的安全性。
这项回顾性队列研究从一家三级转诊诊所中确定了与省级疫苗数据库相关联记录的个体。我们进行了χ²检验、Fisher精确检验以及对年龄和病程进行调整的逻辑回归分析，以比较不同药物类别下的疫苗接种情况。确定了IBD女性婴儿中潜在的轮状病毒疫苗不良事件。
我们纳入了303名孕妇和262名婴儿。接受生物治疗的女性接种疫苗的情况如下：乙型肝炎病毒疫苗（82.9%）、白喉 - 破伤风 - 百日咳疫苗（82.1%）和甲型肝炎病毒疫苗（49.3%）。50.7%的患者在围产期接种了流感疫苗。89.3%的女性在开始生物治疗前接种了麻疹 - 腮腺炎 - 风疹 - 水痘疫苗。接受生物制剂治疗的女性（调整后的优势比为2.50；95%置信区间为1.39 - 4.35）或免疫调节剂治疗的女性（调整后的优势比为4.00；95%置信区间为2.22 - 7.69）比未暴露个体更有可能接种沛儿13疫苗和肺炎球菌多糖疫苗23，但总体接种比例较低（沛儿13疫苗为35.7%；肺炎球菌多糖疫苗23为39.3%）。至少90%的婴儿接种了麻疹 - 腮腺炎 - 风疹 - 水痘疫苗和灭活疫苗。14名暴露于生物制剂的儿童（19.2%）接种了轮状病毒活疫苗，与未暴露于生物制剂的婴儿相比，不良事件无显著差异（7.1%对8.2%，P = 0.99）。
鉴于肺炎球菌、甲型肝炎病毒和流感疫苗接种率较低，医疗保健提供者和IBD患者都需要更好地了解疫苗接种建议。在暴露于生物制剂的婴儿中意外接种轮状病毒疫苗并未导致更多不良事件，这增加了安全性的可能性。
