How should vaccination be in patients with Crohn's disease and other IBD?
Patients with IBD have a risk infection, and may have a serious evolution in patients with immunosuppression and malnutrition. It is in this context that prophylactic vaccination should be emphasized. In general, vaccine schedules should be followed by patients with IBD, however, live virus vaccines should be avoided in those receiving immunosuppressive therapy. There are three types of vaccines:
dead bacteria or virus
- live attenuated bacteria or virus
- proteins or sugars extracted from viruses or bacteria synthesized in the laboratory
- Live attenuated live vaccines are safe in healthy individuals . Immunocompromised patients may experience uncontrollable infection.
Moment of vaccination
Ideally, vaccines should be given prior to initiation of immunosuppressive therapy, about one month before the immunosuppressive, or two to three months after its interruption. If this scenario can not be met, vaccines of living organisms should not be administered. Vaccines from dead / inactive organisms may be recommended even in patients receiving immunosuppression
Recommendations for vaccination in patients with Intestinal Inflammatory Disease
Can be used in patients already receiving immunosuppression:
Influenza: once a year
- dT / DTP (Tetanus / Pertussis): administer if you have not received in the last 10 years
- Pneumococcal: once every five years
- Hepatitis A: two doses. The initial one and another after six to 12 months. Ten-year increments
- Hepatitis B: three doses in one, two, and six months
- Meningococcal: if not previously vaccinated
- HPV: Homosexual men and women 9-26 years
- Micro-Organisms Vivos
They should not be performed on patients receiving immunosuppression:
Varicella: check for titles. In case of no immunity, vaccinate. Wait four to 12 weeks before starting immunosuppression
- Herpes zoster: from the age of 50. Wait four to 12 weeks before immunosuppression
- Measles-Mumps-Rubella: check for titles. Wait four to 12 weeks before immunosuppression begins. Reinforcement at age 50
- Yellow fever: vaccinate in case of travel to endemic areas. The immunosuppressive interval should be four months
- BCG: contraindicated in immunosuppressed
Another very important care before starting treatment with biological immunosuppressants (Anti-TNF alfa) is to make sure the presence of mycobacterium tuberculosis (TB) in its latent form, which can be activated during immunosuppression and trigger tuberculosis in its typical form.
Therefore, the following tests should be performed before starting treatment with biological drugs: Patients with latent tuberculosis should be treated for six to nine months with isoniazid starting at least 30 days before anti-TNF alpha (Infliximab or Adalimumab) medicinal products. Patients with latent tuberculosis should be treated for six to nine months with isoniazid.
Research conducted at the University of Western Australia indicates that lack of oral hygiene is as bad for female fertility as obesity. According to the study, not taking proper care of mouth hygiene causes women to take an average of two months to get pregnant. The study was attended by more than 3,500 women, who were analyzed for diagnosis of gum problems.
According to a study by doctors at the Bichat Hospital in Paris, France, drinking more than two liters of water a day can help protect against hyperglycemia, a state in which blood The study lasted nine years and involved 3,600 people of both sexes who had normal blood sugar levels. The eating and behavioral habits of all volunteers were analyzed after the end of the study.