Get COVID-19 vaccine ASAP and think about boosters, IBD patients urged at GESA meeting

IBD

By Natasha Doyle

8 Sep 2021

Vaccinate ASAP and already start thinking about a booster — that is the key message from the ‘IBD in the era of COVID’ presentation at GESA AGW 2021.

The ‘State-of-the-Art’ session saw Royal Melbourne Hospital’s Head of Inflammatory Bowel Disease Service Associate Professor Britt Christensen urge gastroenterologists to get their IBD patients vaccinated against COVID-19 immediately, particularly in outbreak areas.

It comes after recent data showed the Pfizer and AstraZeneca COVID-19 vaccines were effective and did not cause disease flares in IBD patients.

Although IBD patients are not at higher risk for COVID-19, they will need the minimum two doses to get a real benefit from the vaccine, Associate Professor Christensen told the meeting.

In the general population, Pfizer and AstraZeneca vaccines only offer 31% and 39% symptomatic protection against the delta variant after one dose, versus 88% and 67% after two, respectively, she noted.

The two doses also offer 96% (Pfizer) and 92% (AstraZeneca) protection against hospitalisation from COVID-19, comparable to that provided against the Alpha variant, said Prof Christensen.

Booster dose needed?

In the near future, IBD patients will likely need a third dose, preferably with an mRNA vaccine, said Professor Christensen.

This would apply to patients on therapies such as anti-TNFs, anti-metabolites, immunosuppressive or immunomodulatory biologic agents or high dose steroids (prednisone ≥20 mg/d or equivalent for ≥2 weeks), she suggested, citing CDC and Joint Committee on Vaccination and Immunisation (JCVI) recommendations, though time to third dose is currently in contention.

All other individuals should get a booster eight months after their second mRNA vaccination, she said.

“Israel has actually stated that you are not fully vaccinated anymore if you’ve had more than six months from your second dose, so they are now mandating third doses in all people after six months,” she said.

While third and booster doses are not yet recommended or available in Australia, Associate Professor Christensen believes IBD patients will be able to access them once vaccine supply increases.

Vax ASAP

“In areas with outbreaks, vaccinate ASAP. Do not wait for getting off steroids, people are going to get booster vaccines, we just need our patients vaccinated,” was her take home message, adding that there is evidence that timing medication administration and vaccination makes “zero difference at all”.

“The only caveat on that would be . . . perhaps if you’re weaning off steroids, you might wait until they’re below 20 mg/d of steroids to vaccinate, but in NSW and Victoria, do not wait to get off the steroids, just give them the vaccine.”

Pregnant patients and those who have been infected with COVID-19 should also be vaccinated, she advised.

COVID-19 has been associated with pre-eclampsia, pre-term birth and still-birth, so “our pregnant women need to be protected”, she said.

Meanwhile, previously-infected IBD patients will have some immunity, but won’t be as well protected as if they’d had the vaccine. This is the case for the general population as well, noted Prof Christensen.

These patients “may have slightly more side effects with the vaccination, so you can warn them about that, but 100% give them the vaccine,” she concluded.

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