Can patients with inflammatory bowel disease get the new crown vaccine?

It is only for medical professionals to read and refer to the first phase of "Medical Faces".
Doctors and patients face to face and talk about inflammatory bowel disease and vaccines.
Recently, residents from all over the world have made appointments to vaccinate the new crown vaccine.

Faced with the launch of the new crown vaccine, universal vaccination is free, and many patients with inflammatory bowel disease (IBD) are more concerned: can we get the new crown vaccine in this situation? Will the new crown vaccine affect treatment? At the special time of 519 World Inflammatory Bowel Disease Day, Ai Zai Yanchang Inflammatory Bowel Disease Foundation and the "medical community" invited Dr.
Zhang Xinmei, Department of Gastroenterology, Nanjing First Hospital, and Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine Dr.
Xu Dingting and Mr.
Yan Weiliang, a patient with IBD, started a dialogue between doctors and patients with “medical” face-to-soul.
The topic of discussion was the vaccination of patients with inflammatory bowel disease.

Scan the QR code of the poster to watch the replay.
Should IBD patients get the new crown vaccine? Moderator: We all know that recently, residents everywhere have made appointments and vaccinated against the new crown.

May I ask Dr.
Zhang, should IBD patients get the new crown vaccine? How safe is the vaccine? Dr.
Zhang Xinmei: The new crown virus is equal to the general public, and you will not be pardoned just because you are an IBD patient.
IBD patients, like ordinary people, should be vaccinated against the new crown virus.

At present, the types of new coronavirus vaccines in my country include inactivated vaccines, adenovirus vector vaccines and recombinant subunit vaccines.

According to international consensus, these three types of vaccines are safe for patients with IBD.
However, due to the lack of clinical application data, according to the guidelines of my country's Health Commission, it is more recommended to use inactivated vaccines or recombinant subunit vaccines.

However, it should be noted that in foreign countries, some countries use live attenuated vaccines, and all IBD patients must completely avoid the use of live attenuated vaccines.

Can patients who are using biological agents receive the new crown vaccine? Moderator: Personally, I am currently using infliximab for treatment on a regular basis.
I would like to ask Dr.
Zhang, biological preparations have some immunomodulatory effects.
Can a new crown vaccine be given when using biological preparations? Will it affect the efficacy of the vaccine? Dr.
Zhang Xinmei: The biologics currently on the market in my country include infliximab, adalimumab, vedelizumab, and usnumab.
Biological agents have immunosuppressive effects on the human body and patients who are using biological agents , The immune system is weaker than ordinary people.

Patients who are using biological agents are vaccinated with the new crown vaccine, and it is recommended to give priority to inactivated vaccines or recombinant subunit vaccines.

So, in fact, some patients will ask, "If I am going to get biologics tomorrow, can I get the vaccine today?" It is recommended that if time permits, the time of vaccination can be placed between the two biological agents.

If discomfort occurs, the clinician can have time to judge and deal with it.

Can patients in the active stage of the disease be vaccinated against the new crown vaccine? Moderator: Can the new crown vaccine be vaccinated during the active period of the disease or under some symptoms? Will the vaccine cause the onset of IBD? Dr.
Zhang Xinmei: A few days ago, the "New Coronavirus Vaccination Technical Guidelines (First Edition)" issued by the National Health Commission pointed out that patients with chronic diseases can be vaccinated against the new crown virus if their condition is stable under drug control.

If it is in the active stage of the disease, or in the case of an acute attack, for example, patients with IBD have obvious abdominal pain, diarrhea or worsening blood in the stool, or even high fever, and require hospitalization or surgery.
It is recommended that the IBD condition be controlled first and stabilized before choosing a time to go.
Community vaccination.

In addition to the situations just mentioned, it may not be suitable for immediate vaccination.
There are also some situations, including the possibility of encountering some acute diseases that are not related to IBD, such as acute respiratory infections, fever or acute allergic reactions.
In this case, it is not recommended to vaccinate the new crown vaccine.

In addition, the following people are not recommended to receive the new crown vaccine immediately: 1.
Patients during pregnancy; children under the age of 2.
18.
At present, my country does not recommend the new crown vaccine for children under 18 years of age. Should elderly patients over 60 years old be vaccinated against the new crown vaccine? It is currently believed that elderly patients over 60 years of age who are in stable condition and have no other major diseases can also be vaccinated against the new crown vaccine.

What should I do if I have symptoms of discomfort before the second vaccination? Moderator: Most of the new crown vaccines are injected in divided doses.
If the first injection is finished and the disease relapses or symptoms occur before the second injection, what should be done? Dr.
Zhang Xinmei: This problem is relatively complicated.
In fact, any kind of vaccine, not only the new crown vaccine, has a certain incidence of adverse reactions in the population, and some people may show gastrointestinal reactions.

If you do have such symptoms within a short period of time after the new crown vaccination, it is recommended to consult a doctor first.
You can first go to your IBD doctor to determine whether such symptoms mean disease activity.
The doctor will carry out the IBD condition.
Assess, if it is really due to IBD disease activity, then, for this disease, we will first adjust the drug plan to control the disease.
After the disease has stabilized, we can decide whether to carry out the next vaccination.

If it is some mild gastrointestinal reaction, after the doctor’s judgment, it is found that there is no basis for IBD disease activity, then we suspect that it may be an adverse reaction caused by the vaccine.
At this time, you can consult a vaccination professional in the community.
Let them provide reasonable advice on whether to continue vaccination or not suitable for vaccination.

In addition to the new crown vaccine, the vaccination of other vaccines in daily life is also a concern for IBD patients.

What vaccines are recommended for patients with IBD? Moderator: IBD treatment often requires the use of immune suppression drugs, such as hormones, azathioprine, methotrexate, biological agents, etc.
, which may increase the risk of opportunistic infections.

Therefore, necessary and reasonable immunization can help prevent the occurrence of infection.

May I ask Dr.
Xu, what vaccines are recommended for patients with IBD? What should be paid attention to during the vaccination process? Dr.
Xu Dingting: Currently, the vaccines we recommend for patients with IBD mainly include hepatitis B vaccine, influenza vaccine, human papilloma virus (HPV) vaccine, and varicella vaccine. Before all vaccinations are given, two questions need to be asked.
Does the first one need to be vaccinated? Because some patients have been vaccinated a long time ago, or have been infected with related viruses, such as chickenpox when they were young.

Then, patients in this situation do not necessarily need to be vaccinated.

Therefore, it is recommended that before vaccination with chickenpox vaccine, the patient needs to check the chickenpox antibody and inform the doctor of the history of chickenpox; before vaccination, you need to check the third line of hepatitis B to see if there is hepatitis B antibody or have been infected with hepatitis B.

After determining the need for vaccination, the second question is immediately followed.
Is it suitable for vaccination now? The first mainly depends on the current medication situation.
Dr.
Zhang has already said that our vaccines include inactivated vaccines and live attenuated vaccines.
If some drugs are being used to suppress immunity, they are not suitable for injecting live attenuated vaccines.

Among the several vaccines I just suggested, the varicella vaccine is a live attenuated vaccine, so patients who are using immunosuppressive agents or biological agents cannot receive this vaccine.

Second, it depends on whether IBD is suitable for vaccination.

When is the vaccination of IBD patients? Moderator: Regarding the timing of vaccination, this issue is also of great concern to our patients.
Therefore, I would like to ask Dr.
Xu whether the use of drugs that affect immunity during the treatment will affect the efficacy of the vaccine? How do IBD patients manage the time of vaccination? Dr.
Xu Dingting: Well, there is a certain reason for the patient's concern.

All patients who use immunosuppressants or biological agents have their immune system suppressed, and the principle of vaccine action is to make the body's immune system react to produce antibodies against these viruses.

Therefore, when these drugs are used, the response to the vaccination will indeed be weaker, and it may not achieve the effect of the general population's vaccination.

Therefore, the best time to vaccinate patients with IBD is when they do not use drugs that suppress immunity, but the reality is often that the disease does not allow patients to have this buffer time.
At this time, we need to make some choices.
The first is definitely to control Illness, not that IBD treatment is delayed for the sake of a vaccine. For example, if the patient has not been vaccinated with chickenpox before, and patients who need to be vaccinated with chickenpox, if the condition permits, they can be treated for IBD 4 weeks after the vaccination; but if the condition cannot wait for such a long time, they can only give up at this time.
Live attenuated vaccines, and then try to avoid contact with sources of infection.

If it is an inactivated vaccine, it can still be injected after using drugs that suppress immunity, but the effect will be weaker.

At this time, the patient's condition should also be given priority.
If the condition permits, hepatitis B vaccine can be injected first.
If the condition does not allow, the condition should be treated first, and then hepatitis B vaccine should be injected during the treatment process.

During the medication period, if you inject the hepatitis B vaccine, you can discuss with the injection doctor whether there is a pointer to use 2 to 3 unit doses to achieve better results.

If it is influenza vaccine and HPV vaccine, there is no problem with injection during the period of drug use, and the dose can be injected as usual.

Precautions for vaccination in emergencies Moderator: In fact, in addition to the preventive vaccines mentioned by Dr.
Xu, some accidents, such as animal bites or trauma, may require rabies vaccine or tetanus vaccine.
.

So I would like to ask Dr.
Xu, for patients with IBD, if this kind of emergency and special situation occurs, is it possible to get a vaccine? Will it have an impact if it is in the active stage of the disease or is using biological agents? Dr.
Xu Dingting: The two diseases, rabies and tetanus, have a very high mortality rate once they occur, and there is currently no effective medicine to treat them.

Therefore, if there is an emergency situation such as being bitten by an animal or trauma, it is recommended to see a doctor immediately and get a vaccine.

Rabies vaccine is an inactivated vaccine, and patients who are using immunosuppressive agents or biological agents can be safely injected.

When injecting rabies vaccine, it is best to inject rabies immunoglobulin at the same time to enhance the ability to prevent the disease; if necessary, rabies virus neutralizing antibody response can be tested 2-4 weeks after vaccination to assess whether additional vaccination is needed.

Tetanus vaccine is a toxoid vaccine and is relatively safe in people with low immunity.

At the end of the program, the two doctors sent sincere blessings to IBD patients, and recommended and encouraged family members who are in close contact with IBD patients to actively vaccinate the new crown vaccine, and jointly build a virus-free or low-risk living environment for IBD patients .

 Expert profile Xu Dingting, deputy chief physician of the Department of Gastroenterology, the Second Affiliated Hospital of Zhejiang University School of Medicine, MD Zhang Xinmei, member of the Zhejiang Second Inflammatory Bowel Disease Diagnosis and Treatment Center Specializing in the diagnosis and treatment of inflammatory bowel disease, there is a health science novel "Spring Grace-Out of the Deserted City of Inflammatory Bowel Disease"