Lower Sustained Diphtheria and Pertussis Antibody Concentrations in Inflammatory Bowel Disease Patients
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Patients with inflammatory bowel disease (IBD) are often immunosuppressed, and those patients receiving anti-tumor necrosis factor α (TNF) therapy can have lower antibody responses to vaccines. Pertussis cases are at their highest levels in the post-vaccine era. There is little data regarding responses to the Tdap (tetanus, diphtheria, and acellular pertussis) vaccine in IBD patients.
The aim of this study was to compare sustained vaccine-induced Tdap antibody concentrations in a cohort of IBD patients stratified by medication regimens with healthy controls (HC) who had received an adult Tdap booster.
We performed a cross-sectional study evaluating antibody responses to Tdap vaccine among IBD patients compared to HC. Our study consisted of three patient groups: adults with IBD stratified by maintenance medication regimen: (1) thiopurine monotherapy; (2) anti-TNF monotherapy; and (3) combination therapy (anti-TNF and immunomodulator (thiopurine or methotrexate)).
Ninety IBD patients and 20 HC participated. Pertussis pertactin antibody concentrations were significantly lower in IBD patients (p = 0.021) compared to HC, and those on anti-TNF agents (monotherapy or combination) had lower antibody concentrations compared to those on thiopurine monotherapy (p = 0.028). Diphtheria antibody concentrations were also lower in IBD patients (p < 0.001), and those on anti-TNF agents (monotherapy or combination) had lower antibody concentrations compared to the thiopurine monotherapy group (p < 0.001).
IBD patients on anti-TNF agents had lower antibody concentrations to diphtheria and pertussis. These findings suggest a need for different Tdap booster schedules for IBD patients on anti-TNF therapy.
Clinical Trials Registry NCT02434133.
KeywordsTetanus Diphtheria Pertussis Immunization Inflammatory bowel disease
The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
This work was supported by the Sal Family Foundation, University of Wisconsin Division of Gastroenterology and Hepatology and the University of Wisconsin School of Pharmacy.
Compliance with ethical standards
Conflict of interest
Drs. Caldera, Wald and Reichelderfer and Ms. McCrone, Ms. Garmoe, Mr. Megna, and Ms. Ley declare that they have no competing interests/financial disclosures. Dr. Hayney serves on the speakers’ bureau for Sanofi Pasteur Vaccines. Dr. Saha is a consultant with UCB Biosciences.
- 1.Terdiman JP, Gruss CB, Heidelbaugh JJ, Sultan S, Falck-Ytter YT. American gastroenterological association institute guideline on the use of thiopurines, methotrexate, and anti–TNF-α biologic drugs for the induction and maintenance of remission in inflammatory Crohn’s disease. Gastroenterology. 2013;145:1459–1463.CrossRefPubMedGoogle Scholar
- 7.Hammarlund E, Thomas A, Poore EA, et al. Durability of vaccine-induced immunity against tetanus and diphtheria toxins: a cross-sectional analysis clinical infectious. Diseases. 2016;62:1111–1118.Google Scholar
- 8.Centers for Disease Control and Prevention. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommend Rep.Google Scholar
- 9.Center for Disease Control. Pertussis cases by year (1922–2015). Available at: https://www.cdc.gov/pertussis/surv-reporting/cases-by-year.html; Accessed 31.10.17.
- 10.European Centre for Disease Prevention and Control. Annual epidemiological report pertussis 2014 data reported on July 7 2016. Available at: http://ecdc.europa.eu/en/healthtopics/pertussis/Pages/Annual-epidemiological-report-2016.aspx; 2017 Accessed 31.10.17.
- 17.Wisconsin Department of Health Services. Wisconsin Immunization Registry (WIR). Available at: https://www.dhs.wisconsin.gov/immunization/wir.htm; 2017 Accessed 31.10.17.
- 22.Dominicus R, Galtier F, Richard P, Baudin M. Immunogenicity and safety of one dose of diphtheria, tetanus, acellular pertussis and poliomyelitis vaccine (Repevax®) followed by two doses of diphtheria, tetanus and poliomyelitis vaccine (Revaxis®) in adults aged ≥ 40 years not receiving a diphtheria- and tetanus-containing vaccination in the last 20 years. Vaccine. 2014;32:3942–3949.CrossRefPubMedGoogle Scholar
- 23.John T, Voysey M, Yu LM, et al. Immunogenicity of a low-dose diphtheria, tetanus and acellular pertussis combination vaccine with either inactivated or oral polio vaccine compared to standard-dose diphtheria, tetanus, acellular pertussis when used as a pre-school booster in UK children: a 5-year follow-up of a randomised controlled study. Vaccine. 2015;33:4579–4585.CrossRefPubMedGoogle Scholar
- 27.Euopean Centre for Disease Prevention and Control. Vaccine Schedule. Available at: http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspx; 2017 Accessed 31.10.17.