To boost or not to boost: That is the question
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The body of knowledge around the COVID-19 pandemic is fast moving and always expanding. Fortunately, in most parts of the country, the recent “delta wave” seems to be subsiding. However, our patients still have many questions about COVID, especially around the topic of vaccination. This month’s cover story focuses on the need for an additional dose of vaccine.
We can reassure many of our inflammatory bowel disease patients, the ones on no medication or just mesalamine products, that they are not immunocompromised. On the other extreme, based on the well documented experience with organ transplant patients, who are often on three immunosuppressives, response to the vaccine may not always be robust. Fortunately, most IBD patients aren’t on triple immunosuppression and the vaccine response in the typical IBD patient is much better than what has been seen with the transplant recipients. However, there has been a suggestion of slightly diminished response relative to the general population and the response may not be as long-lasting; thus, the potential need for a booster. The body of data is rapidly changing and much of these data are in press or pre-print format. Vaccine-induced immunity is surprisingly difficult to assess because the totality of immune response to the vaccine cannot be measured by serologic response alone, and it still isn’t clear that differences in anti-spike protein antibody levels translate into differences in protection against the virus or against severe COVID.
We can also reassure our patients that the vaccines are safe. They are not live vaccines. Early data from the CORALE-IBD study suggests that the incidence of adverse events — such as fatigue, malaise, headache and fever — are similar to the general population, and the incidence of gastrointestinal side effects was low. Furthermore, they seem to be effective in the IBD population. In a Veteran’s Administration study, the vaccines reduced the risk of COVID infection by 70% among military veterans with IBD.
The CDC’s advisory committee for immunizations has recommended an additional dose in patients on more than 20 mg of prednisone daily, anti-TNF biologics or thiopurines/methotrexate. This seems like a prudent recommendation, and I have been encouraging all of my IBD patients to “get triple vaxxed.” For patients seeking more information, you could direct them to Crohn’s & Colitis Foundation’s Position Statements on vaccines and the additional dose.
- References:
- Botwin GJ, et al. Am J Gastroenterol. 2021;doi:10.14309/ajg.0000000000001342.
- COVID-19 Vaccines: Position statements. www.crohnscolitisfoundation.org/coronavirus/vaccine-position-statements. Accessed: Nov. 8, 2021.
- Khan N, et al. Gastroenterology. 2021;doi:10.1053/j.gastro.2021.05.044.
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