Are COVID-19 vaccinations in immunocompromised patients with IBD safe?
CDHF’s association – the Canadian Association of Gastroenterology (CAG) recently provided guidance for mRNA COVID-19 vaccinations in patients with Inflammatory Bowel Disease (IBD).
We have outlined the various recommendations. Read the summary of CAG’s recommendation from the article to date below:
Click here, for the full manuscript from CAG.
December 11th, 2020: the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Pfizer-BioNTech COVID-19 vaccine in persons aged 16 years and older for the prevention of COVID-19.
This was then followed by a recommendation for the use of this vaccine by the Centers for Disease Control and Prevention (CDC)’s advisory committee on Immunization Practices (ACIP).
December 18th, 2020: the FDA issued an emergency use authorization (EUA) for moderna COVID-19 Moderna vaccine in persons aged 18 years and older.
The CDC then issued guidance on vaccination of special populations including immunocompromised persons:
“Persons with HIV infection or other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. Data is not currently available to establish vaccine safety and efficacy in these groups. Persons with stable HIV infection were included in mRNA COVID-19 vaccine clinical trials, though data remain limited. Immunocompromised individuals may receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations. As well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19” Source here.
For patients with IBD not on immunosuppressive therapy, the Canadian Association of Gastroenterology (CAG) recommends the COVID-19 vaccine be given (strong recommendation, moderate-certainty of evidence).
For patients with IBD on immunosuppressive therapy, CAG suggests the COVID-19 vaccine be given (conditional recommendation, low-certainty of evidence).
A strong recommendation: CAG is confident that the benefits of following the recommendation clearly outweigh the harms, so the course of action should apply to most patients.
Conditional recommendation: means that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but CAG is not confident that these tradeoffs due to low or very low certainty of the evidence, uncertainty regarding the balance of benefits and harms, uncertainty in patient’s values and preferences or questionable cost-effectiveness. Therefore, conditional recommendations require shared decision-making as different choices will be appropriate for different patients.
** CAG mentions it’s important to note that there is no standard definition of immunosuppression. Patients with IBD who are not considered immunosuppressed at diagnosis, but subsequently may become immunocompromised due to IBD medications.
This will be published in the Journal of the Canadian Association of Gastroenterology. If new data emerges, their recommendations will be revised.
To learn more about COVID-19 and the immunocompromised, click here.