Desalermos Athanasios, Pimienta Michael, Kalligeros Markos, Shehadeh Fadi, Diamantopoulos Leonidas, Karamanolis George, Caldera Freddy, Farraye Francis A
University of Massachusetts Medical School, Center for Digestive Wellness, Worcester, MA, USA.
The Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.
Inflamm Bowel Dis. 2022 Sep 1;28(9):1430-1442. doi: 10.1093/ibd/izab266.
Patients with inflammatory bowel disease (IBD) have low vaccination rates for vaccine-preventable diseases. Fear of adverse reactions (AEs) appear to negatively affect vaccination efforts. We aimed to systemically review the risks for AEs following immunization for patients with IBD.
We searched PubMed and Embase until April 15, 2020, for studies evaluating the safety of vaccinations among patients with IBD. The primary outcome was the incidence of systemic and local AEs among vaccinated patients. Secondary outcome was the rate of IBD flare following immunization. We utilized a random effects meta-analysis of proportions using the DerSimonian-Laird approach to estimate the safety of immunizations.
A total of 13 studies with 2116 patients was included in our analysis after fulfilling our inclusion criteria. Seven studies examined the influenza vaccine, 4 the pneumococcal vaccine, 1 the recombinant zoster vaccine, and 1 the hepatitis B vaccine. Follow-up of patients was up to 6 months. The majority of AEs were local, with a pooled incidence of 24% (95% CI, 9%-42%) for all vaccines. Systemic AEs were mostly mild, without resulting in hospitalizations or deaths, with a pooled incidence of 16% (95% CI, 6%-29%) for all vaccines. Flare of inflammatory bowel disease after vaccination found with a pooled incidence of 2% (95% CI, 1%-4%) and we include in the analysis data from all immunizations examined.
Our study demonstrated that AEs after vaccination are mainly local or mildly systemic and do not differ significantly from the expected AE after recommended immunizations for the general population. Thus, gastroenterologists should reinforce that vaccines are safe in patients with IBD.
炎症性肠病（IBD）患者对于疫苗可预防疾病的接种率较低。对不良反应（AE）的恐惧似乎对疫苗接种工作产生了负面影响。我们旨在系统评价IBD患者免疫接种后发生AE的风险。
我们检索了PubMed和Embase数据库至2020年4月15日，以查找评估IBD患者疫苗接种安全性的研究。主要结局是接种疫苗患者中全身和局部AE的发生率。次要结局是免疫接种后IBD发作的发生率。我们采用DerSimonian-Laird方法对比例进行随机效应荟萃分析，以评估免疫接种的安全性。
在满足纳入标准后，我们的分析共纳入了13项研究中的2116例患者。7项研究检测了流感疫苗，4项检测了肺炎球菌疫苗，1项检测了重组带状疱疹疫苗，1项检测了乙型肝炎疫苗。对患者的随访长达6个月。大多数AE为局部性，所有疫苗的合并发生率为24%（95%CI，9%-42%）。全身AE大多为轻度，未导致住院或死亡，所有疫苗的合并发生率为16%（95%CI，6%-29%）。接种疫苗后炎症性肠病发作的合并发生率为2%（95%CI，1%-4%），我们将所有检测的免疫接种数据纳入了分析。
我们的研究表明，接种疫苗后的AE主要为局部或轻度全身性，与一般人群推荐免疫接种后预期的AE无显著差异。因此，胃肠病学家应强化IBD患者接种疫苗是安全的这一观点。
