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Health care maintenance is an important part of treating Crohn's disease and ulcerative colitis. Here are our recommendations regarding vaccinations and other routine preventative health measures. Please contact your primary care provider for vaccinations and to update your health care maintenance status.
Patients should follow vaccination recommendations for their age group. IBD patients should receive non-live vaccines according to their age group. All patients should get the annual Flu vaccine (which is non-live), however should avoid the intra-nasal as that is live, Pnemococcal vaccine series and Shingrix vaccine (non-live for Herpes Zoster).
* Patients on biologics (e.g. Remicade, Humira, Cimzia, Simponi, Entyvio, Stelara), prednisone doses > 20mg per day, and immunomodulators (azathioprine/Imuran/6MP/mercaptopurine, methotrexate) should not receive live vaccines.
* If you are planning to travel outside the United states, please contact your provider as you should not receive any live vaccinations (ie yellow fever) while on immunosuppression.
|Infectious Agent||Who||Check Titre Before Immunization||Dosing Regimen|
|Diphtheria, Clostridium tetani, Bordatella pertussis||All patients||No||Single dose Tdap, then booster every 10 years|
|Hepatitis A||All patients||Yes||2 doses at 0 and 6 months|
|Hepatitis B||All patients||Yes||3 doses at 1, 1-2 and 4-6 months; check titres 1 month after last dose, if no response revaccinate, double dose HBV vaccine or combined HAV/HBV vaccine|
|HPV||F/M 11-26 years old||No||3 doses at 0, 2 and 6 months|
|Neisseria Meningitis||High risk adults*||No||2 or 3 doses depending on vaccine|
|Influenza||All patients||No||Annual immunization|
|Streptococcus Pneumonia||All patients||No||If no prior vaccination, PCV13 followed by dose of PPSV23 after 2-12 months.|
|Herpes Zoster||Age > 50, starting Tofa||No||Shingrix - 2 doses (2-6 months apart), now preferred Zoster vaccine|
Reference: Health Maintenance in Inflammatory Bowel Diseases, Crohn's & Colitis Foundation
Reference: 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host, Oxford Academic Journals
Patients on immunosuppressants and biologics are at increased risk for melanomas and non-melanoma skin cancers. We recommend patients have their skin checked annually and limit sun exposure. They should use appropriate sun protection at all times and reapply.
Colon Cancer Surveillance
After 8 years of disease, patients with Ulcerative colitis and patients with Crohn's colitis should have surveillance colonoscopies every 1-5 years with biopsies or chromoendoscopy based on risk factors, disease activity and dysplasia history. The risk of colorectal cancer increases in patients who have had the disease at a younger age, and based on extent of disease, duration of disease, and family history of colorectal cancer. A history of primary sclerosing cholangitis also increases risk and these patients need annual colonoscopy from diagnosis.
American Congress of Obstetricians and Gynecologists recommends yearly pap smear for women who are receiving immunosuppression including anti-TNF, methotrexate or immunomodulators. Men and women at risk should also have anal pap smears, espeically with perianal disease history.
* If you are a female of child-bearing age, please remember to discuss any pregnancy-related issues with your Gastroenterologist, Obstetrician and Primary Care Physician.
Bone Density Scans
This is recommended for patients with exposure to corticosteroids (> 600mg of total exposure) and nontraumatic fractures as well as IBD patients over the age of 50.
Consider yearly Opthalmology examination as 10-43% of patients with Inflammatory Bowel Disease may develop eye issues.
Smoking has numerous negative impacts on Crohn's disease including an increased risk of the penetrating or stricturing Crohn's disease behaviors, which are the more aggressive behaviors of Crohn's disease. These behaviors are also associated with a greater likelihood of needing escalation of therapy to treat Crohn's disease, as well as surgery. Additionally, smoking can decrease the effectiveness of certain Crohn's disease medications by up to 50%. Please discuss with your primary care provider and support system means to facilitate smoking cessation.