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Checklist
Vaccination and systematic work-up to consider before introducing immunomodulators or biologic therapy
1.1. Detailed interview
Ideally the medical history should cover:
1.2. Physical examination
General physical examination best includes a search for features that often pass without comment, because they are of minor significance in people who are generally healthy, but which may have substantial implications when immunosuppressed:
1.3. Laboratory tests
Many opportunistic infections are preventable and the potential for severe infection during immunosuppression can be ameliorated if thought is given to identifying risks before starting immunomodulator therapy. Ideally, baseline tests, potentially performed at diagnosis, should include:
1.4. Screening for tuberculosis
Screening for tuberculosis should be considered before using high dose corticosteroids or immunomodulators other than anti-TNF therapy, although it is considered mandatory for the latter group.
If any of the above 1, 2 or 3 is positive, the patient should be referred for assessment to a specialist with an interest in TB. If IGRA is indeterminate or equivocal, it could be repeated after 2-3 weeks and if still indeterminate or equivocal- the patient should be referred for assessment to a specialist with an interest in Tb
1.5. Vaccination
Vaccines are best given before introduction of immunomodulators therapy. Consideration could reasonably be given to a vaccination programme at diagnosis of IBD, since around 80% of patients will be treated with corticosteroids, 40% with thiopurines and 20% with anti-TNF therapy.
As in the general population, the immunisation status of patients with inflammatory bowel disease should be checked and vaccination considered for routinely administered vaccines: tetanus, diphtheria, poliomyelitis. In addition, every patient with IBD should be considered for the five following vaccines, ideally at diagnosis for the reasons above:
Vaccines for patients on immunomodulators travelling in developing countries or frequently travelling around the world should be discussed with an appropriate specialist.
1.6 Other precautions
Ref:
http://www.ecco-ibd.eu/images/stories/docs/guidelines/oi_eccoconsensus.pdf
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