A 65-year-old woman with a known history of Crohn's disease comes to the physician to receive the influenza and pneumonia vaccines. She has never received these vaccines in the past. She has no current complaints. She denies abdominal pain, diarrhea, vomiting, and weight loss. Her other medical problems include hypertension and osteoarthritis.
Her surgical history includes hysterectomy for fibroids, partial small bowel resection, and cholecystectomy. Her last colonoscopy was 9 months ago, which showed mild inflammation. She quit smoking 2 years ago and has 30 pack-year smoking history. Her medications include hydrochlorothiazide, omeprazole, naproxen, sulfasalazine, azathioprine, and infliximab.
Which of the following is the most appropriate course of action?

Question

A 65-year-old woman with a known history of Crohn's disease comes to the physician to receive the influenza and pneumonia vaccines.  She has never received these vaccines in the past.  She has no current complaints.  She denies abdominal pain, diarrhea, vomiting, and weight loss.  Her other medical problems include hypertension and osteoarthritis.
Her surgical history includes hysterectomy for fibroids, partial small bowel resection, and cholecystectomy.  Her last colonoscopy was 9 months ago, which showed mild inflammation.  She quit smoking 2 years ago and has 30 pack-year smoking history.  Her medications include hydrochlorothiazide, omeprazole, naproxen, sulfasalazine, azathioprine, and infliximab.
Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

Patients with inflammatory bowel disease (IBD) taking immunosuppressive medications such as anti-TNF agents (infliximab) and antimetabolites (azathioprine) should receive the standard adult vaccinations. However, live vaccines (e.g., intranasal influenza) should not be given with anti-TNF therapy (Choice D). In addition, vaccines ideally should be given before starting anti-TNF therapy. Patients with hepatitis B risk factors should also receive the hepatitis B vaccine. (Choices B and C) This patient qualifies for both vaccines and should receive both the intramuscular influenza and pneumococcal vaccines. (Choice E) Patients requiring live vaccines (e.g., varicella, zoster, etc.) should hold their immunosuppressants for 2-3 months before vaccination. However, this patient can be vaccinated with the inactivated influenza vaccine instead of the intranasal form. Educational objective: Inflammatory bowel disease (IBD) patients taking anti-TNF therapy should not receive live vaccines, but they should receive the standard adult immunizations. Intramuscular influenza and pneumococcal vaccines are recommended for IBD patients on anti-TNF therapy. __________ References: Vaccines and inflammatory bowel disease (http://www.ncbi.nlm.nih.gov/pubmed/20926882)

A 65-Year-Old Woman with a Known History of Crohn's Disease