Patients with inflammatory bowel disease should be vaccinated against pneumococcus and influenza despite immunosuppressive therapy

Abstract Background Patients with inflammatory bowel disease (IBD) have a high risk for infection. Pneumonia related to influenza and pneumococcal infection is one of the most common infection-related complication in IBD. Our aim was to evaluate the immunogenicity of pneumococcal and influenza vaccination in patients with IBD receiving different treatment. Methods We searched four databases for studies evaluating seroprotection and seroconversion rates after influenza or pneumococcal vaccination in IBD. In meta-analysis, odds ratios (OR) were calculated with 95% confidence intervals (CI). Results Twelve studies (1429 patients) were included in this meta-analysis. The seroconversion rate after pneumococcal vaccination was significantly lower in the immunosuppressed group and in the subgroup of patients with anti-TNF mono- or combination therapy compared to the non-immunosuppressed patients (OR = 0.38, 95% CI: 0.23–0.62, OR = 0.28, 95% CI: 0.15–0.53, and OR = 0.27, 95% CI: 0.15–0.49, p < 0.001, respectively). Following influenza vaccination there was no significant difference in the seroprotection rate between immunosuppressed and non-immunosuppressed patients (OR = 0.59, 95% CI: 0.34–1.03, p = 0.065). Seroprotection rate was not significantly reduced in patients with immunomodulator compared to anti-TNF monotherapy or combination therapy (OR = 1.45, 95% CI: 0.62–3.38, p = 0.84 and OR = 0.91 95% CI: 0.37–2.22, p = 0.391, respectively). Following both vaccinations, the seroresponse was not significantly reduced in patients treated with immunomodulator monotherapy compared to non-immunosuppressed patients. Conclusion Our results suggest that response rate is reduced in patients treated with anti-TNF therapy but not in patients treated with immunomodulator monotherapy. Patients treated with immunosuppressive treatment should be vaccinated against pneumococcus and influenza despite immunosuppressive therapy.