Effects of immunosuppression on immune response to pneumococcal vaccine in inflammatory bowel disease: A prospective study

Gionata Fiorino, Laurent Peyrin-Biroulet, Patrizia Naccarato, Hajnalka Szabò, Orsola R. Sociale, Stefania Vetrano, Walter Fries, Alessandro Montanelli, Alessandro Repici, Alberto Malesci, Silvio Danese

Research output: Contribution to journalArticle


Background: Since immunomodulators and antitumor necrosis factor (TNF) agents are increasingly used to treat inflammatory bowel disease (IBD), it is recommended to administer antipneumococcal vaccination to prevent opportunistic pneumonia. There is some evidence that concomitant immunosuppression may impair the immune response to vaccination. We aimed to evaluate the response rates to pneumococcal vaccination in four different treatment groups (mesalamine, azathioprine, infliximab, infliximab plus azathioprine). Methods: In all, 96 patients with IBD (54 with Crohn's disease; 42 with ulcerative colitis) were administered a 23-valent polysaccharide pneumococcal vaccine (PSV-23). The levels of antipneumococcal antibodies were measured prior to and at least 3 weeks after vaccination. Response rates and risk factors for impaired immunosuppression were investigated. Patients on mesalamine were used as a control group. Results: Patients administered infliximab or the combination immunosuppressive therapy had significantly lower response rates to vaccination (57.6% and 62.5%, respectively) compared with the group on mesalamine (88.6%; P <0.05 for both comparisons). Azathioprine alone did not influence the response rate to vaccination (78.9%; P = 0.43 vs. mesalamine group). Mean antibody titers after vaccination were significantly lower in patients under infliximab or combined immunosuppression than controls (P <0.05). Immunosuppression with infliximab or combination therapy significantly decreased the likelihood of responding to vaccination (odds ratio [OR] = 0.17, 95% confidence interval [CI] 0.04-0.64, P = 0.009, and OR = 0.21, 95% CI 0.05-0.91, P = 0.038, respectively). Pneumococcal vaccination was generally safe and well tolerated. Conclusions: Anti-TNF therapy alone or in combination with azathioprine impairs the response to pneumococcal vaccination in patients with IBD. All patients with IBD should therefore be vaccinated before starting anti-TNF therapy.

Original languageEnglish
Pages (from-to)1042-1047
Number of pages6
JournalInflammatory Bowel Diseases
Issue number6
Publication statusPublished - Jun 2012


  • Crohn's disease
  • inflammatory bowel disease
  • pneumococcal
  • ulcerative colitis
  • vaccination

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

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