Leidel rightly reminds us that the STIKO has not set out disease specific vaccination recommendations for patients with chronic inflammatory bowel disease—the column heading in Table 1 should have therefore said “Recommendation on the basis of STIKO” (1). The same is true for the recommendations of the Vaccination Committee for the State of Saxony (Sächsische Impfkommission, SIKO), whose chair was kind enough to help us in setting out the table. We thought that a vaccination table that could be implemented in practice would be more useful than the mere mention of the recommendations of the national and regional vaccination committees, and we mentioned the development of our disease specific vaccine recommendations as quality management module in the discussion section. The second comment by Leidel is also important: vaccination against pneumococci and influenza is indicated especially in IBD patients with pharmacological immunosuppression. Because the severity of pneumococcal infection in IBD patients is correlated with the intensity of the immunosuppressant medication (2) and pneumococcal vaccination loses its effectiveness with increasing immunosuppression (3), it may be useful to vaccinate patients with a potentially severe disease course before even starting immunosuppressant therapy. The final comment relates to footnote 14 in our Table 1 and constitutes an important further explanation.
In addition to chronic inflammatory disease, neoplastic disorders require pharmacologically induced immunosuppression in many patients. Christopeit and coauthors discuss in this context the problems associated with the effectiveness of the pneumococcal vaccine and remind us of the lack of studies of the vaccination of patients at high risk. We hope that our article (1) gave a new impulse with regard to this dilemma.
Hof and Bartel discuss the fact that the expectations and personal aura of the person asking the questions and ignorance or lack of interest on the part of the person being asked may present limitations of our study; this is unlikely in view of our pragmatic study protocol (copies of vaccination records and completed questionnaires). Discussing possible limitations of the collected results is a part of any serious scientific study—and not a sign of insecurity. Ultimately the correspondents recommend measuring antibody titers, rather than checking the vaccination records—for example, to tetanus. This recommendation is not consistent with the recommendations of the STIKO or the guidelines of the national specialist professional societies. As long as the vaccination status of IBD patients—as we showed in our article—is notably behind the STIKO’s recommendations, it is currently more useful to look at the vaccination records, rather than recommend measuring titers.
PD Dr. med. habil. Niels Teich
Internistische Gemeinschaftspraxis für Verdauungs-
Dr. med. Anke Liebetrau
Gesundheitsamt der Stadt Leipzig
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||Teich N, Klugmann T, Tiedemann A, et al.: Vaccination coverage in immunosuppressed patients—results of a regional health services research study. Dtsch Arztebl Int 2011; 108(7): 105–11. VOLLTEXT|
|2.||Ritz MA, Jost R: Severe pneumococcal pneumonia following treatment with infliximab for Crohn’s disease. Inflamm Bowel Dis. 2001; 7: 327. CrossRef MEDLINE|
|3.||Melmed GY, Agarwal N, Frenck RW, et al.: Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease. Am J Gastroenterol 2010; 105: 148–54. CrossRef MEDLINE|