Esposito Susanna, Antoniol Giulia, Labate Marialuisa, Passadore Lucrezia, Alvisi Patrizia, Daccò Valeria, Ghizzi Chiara, Colombo Carla, Principi Nicola
Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Pediatric Gastroenterology Unit, Maggiore Hospital, 40133 Bologna, Italy.
Vaccines (Basel). 2021 May 11;9(5):487. doi: 10.3390/vaccines9050487.
Incidence of inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), is increasing worldwide. Children with IBDs have a dysfunctional immune system and they are frequently treated with immunomodulating drugs and biological therapy, which significantly impair immune system functions and lead to an increased risk of infections. Vaccines are essential to prevent at least part of these infections and this explains why strict compliance to the immunization guidelines specifically prepared for IBD patients is strongly recommended. However, several factors might lead to insufficient immunization. In this paper, present knowledge on the use of vaccines in children with IBDs is discussed. Literature review showed that despite a lack of detailed quantification of the risk of infections in children with IBDs, these children might have infections more frequently than age-matched healthy subjects, and at least in some cases, these infections might be even more severe. Fortunately, most of these infections could be prevented when recommended schedules of immunization are carefully followed. Vaccines given to children with IBDs generally have adequate immunogenicity and safety. Attention must be paid to live attenuated vaccines that can be administered only to children without or with mild immune system function impairment. Vaccination of their caregivers is also recommended. Unfortunately, compliance to these recommendations is generally low and multidisciplinary educational programs to improve vaccination coverage must be planned, in order to protect children with IBD from vaccine-preventable diseases.
包括克罗恩病（CD）和溃疡性结肠炎（UC）在内的炎症性肠病（IBD）在全球范围内的发病率正在上升。患有IBD的儿童免疫系统功能失调，他们经常接受免疫调节药物和生物疗法治疗，这会显著损害免疫系统功能并导致感染风险增加。疫苗对于预防至少部分此类感染至关重要，这也解释了为何强烈建议严格遵守专门为IBD患者制定的免疫接种指南。然而，有几个因素可能导致免疫接种不足。本文讨论了关于IBD患儿疫苗使用的现有知识。文献综述表明，尽管缺乏对IBD患儿感染风险的详细量化，但这些患儿可能比年龄匹配的健康儿童更频繁地发生感染，并且至少在某些情况下，这些感染可能更为严重。幸运的是，如果仔细遵循推荐的免疫接种时间表，大多数此类感染是可以预防的。给IBD患儿接种的疫苗通常具有足够的免疫原性和安全性。必须注意减毒活疫苗，这类疫苗只能接种给免疫系统功能无损害或仅有轻度损害的儿童。还建议对其照顾者进行疫苗接种。不幸的是，对这些建议的依从性普遍较低，因此必须制定多学科教育计划以提高疫苗接种覆盖率，从而保护IBD患儿免受疫苗可预防疾病的侵害。
