Ulcerative Colitis Blog

You've probably seen the signs at your doctor's office, the pharmacy, and even the grocery store that flu vaccines are available now. The big question is - "Did you get your flu vaccine this year?" A recent study showed that of over 80% of IBD patients at risk for influenza, only 20% received vaccination to prevent the disease (Melmed G, American Journal of Gastroenterology 2006; 101(8)1834-40).

Fast facts about influenza:
What is influenza?
- Influenza is a virus that travels worldwide
- The virus changes every year and that is why yearly vaccination is recommended
- It is transmitted from person to person by secretions in sneezes and coughs
- The disease typically peaks between December and March (this is why people need to
get vaccinated in the Fall)
- Flu symptoms can include: fever (temperature > 100.5 degrees F), muscle aches, cough,
sore throat, runny nose, headache. eye pain, and chest discomfort

Who should be vaccinated for influenza? (From the Center for Disease Control, Atlanta, GA)
- Children aged 6 months until their 5th birthday
- Pregnant women
- People 50 years of age and older
- People of any age with certain chronic medical conditions
- People who live in nursing homes and other long term care facilities
- Household contacts of persons at high risk for complications from the flu
- Household contacts and out of home caregivers of children less than 6 months of age
(these children are too young to be vaccinated)
- Healthcare workers

Why is influenza vaccination important to IBD patients?- Patients with IBD are considered to have a chronic condition and are therefore at higher risk
of contracting the illness
- Patients on immune suppressive agents may be at higher risk of disease

What time of the year are influenza vaccines available?- Flu vaccines are available from October through mid-November

Is there any reason not to be vaccinated? People who should not be vaccinated (per CDC):
- People who have a severe allergy to chicken eggs
- People who have had a severe reaction to an influenza vaccination in the past
- People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an
influenza vaccine previously
- Influenza vaccine is not approved for use in children less than 6 months of age
- People who have a moderate or severe illness with a fever should wait to get vaccinated
until their symptoms lessen

Where are influenza vaccines given?
- Doctor's offices - primary care facilities and gastroenterology offices
- Pharmacies (Check with your local chain)
- Grocery stores (Check with your local chain)
- Occupational health at your place of employment
- Student health centers
- Local Department of Public Health (Check your public listing)

The most common reason I hear that people are afraid of getting a flu shot is the concern that they will contract full symptoms of the illness. Because of my high risk as a health care worker, I had vaccinations for influenza, diphtheria, tetanus, and pertussis done through my hospital all on the same day. My arms were a little sore for a couple days, but that was the worst of it. I did not develop symptoms of any of the illnesses I was vaccinated for.

If you have not yet been vaccinated for influenza this year, please contact your physician to discuss your risk factors and need for immunization.

I am posting this blog from south Florida, site of the 2007 national meeting of the Crohn’s and Colitis Foundation. Several provocative presentations have been made, some of which I will summarize over the next several days.

Researchers from Johns Hopkins, the Mayo Clinic, and Kaiser Permanente (Hutfless S, et al) studied the risk of cervical cancer in patients with inflammatory bowel disease (IBD). Using a large database including 30% of the population in the San Francisco Bay area the authors identified eight cases of cervical cancer out of 1841 patients with IBD and a pap smear. The risk of cervical cancer in IBD patients was 1.7 times greater than in healthy controls, but this difference was not quite statistically significant. When the results were broken down by medication, there was no increased risk of cervical cancer in patients taking corticosteroids, immune modulators (methotrexate or azathioprine), or 5-aminosalicylates, while patients on infliximab had an eleven-fold increase in risk.

An even larger study would be required to better determine the risk of cervical cancer in various treatment groups. Fortunately, the pap smear is an effective screening test for cervical cancer and all IBD patients, especially those on infliximab should have appropriate and regular screening. Furthermore, girls and young women with IBD should receive the HPV vaccine to reduce their risk of cervical cancer.