Corona virus (COVID-19) update and information for IBD patients
Last Updated: 30/07/2021
Knowledge about the Corona virus (COVID-19) is still accumulating during this global epidemic. The virus causes special concern for patients with IBD (Crohn's disease and ulcerative colitis). Here are some useful facts and tips to help you make the best decisions during these times and also help you should you be traveling
What are the symptoms of Corona virus infection?
In the majority of infected people there will be no symptoms or flu-like symptoms of fever, cough or shortness of breath, and some may experience muscle pain, sore throat, loss of taste/smell's sense and sometimes diarrhea. However, in the minority of patients the disease may become severe and life-threatening.
How does the virus spread and what can I do to protect myself?
The Corona virus spreads by respiratory droplets produced when an infected person coughs or sneezes, but the virus has also been isolated in stool of infected persons and remains viable on physical surfaces. Thus, fecal-oral spread and physical-contact spread may potentially be plausible as well. You should maintain frequent hand washing, avoid close (<2meter) contact with other persons and any contact with sick persons, avoid social gatherings, and adhere to other local recommendation by your national health authorities. As there have been several established reports of re-infection with COVID-19 in patients who previously recovered from the disease, these precautions should be adhered to regardless if you previously had COVID-19 disease. Vaccinating against COVID-19 should also be strongly considered as prime mode of protection (see below). The implications of newly discovered mutations of the virus are still being evaluated. It appears that the new Delta virus variant (L452R) is able to infect also some vaccinated persons, although there is preliminary indication that such previously-vaccinated infected persons are partially protected from developing a severe disease.
Can I take COVID-19 vaccine if I have IBD? Can I take it if I am using immune-suppressants or biologics?
Several vaccines have been developed for COVID-19. At the time of this update, approved vaccines include two mRNA-based vaccines (by Pfizer and Moderna companies), a non-replicating adenovirus vector vaccine (Janssen, AstraZeneca and the Russian Gamaleya institute) and inactivated (‘dead’) virus vaccine, or viral protein vaccine (by Sinovac & SinoPharm companies). Although not all these vaccines have been approved and/or are available in all countries, they have all been shown to lack an infective potential and they were not found to exacerbate an underlying immune-disease, Therefore, all these vaccines are generally considered sate also for patients with IBD, including those taking immune-suppressants or biologics. The two adenovirus based vaccines by Janssen and by Astra-Zeneca have been reported to associate with extremely rare cases of blood-clotting (thrombotic events). As the benefits of preventing COVID-19 disease far outweigh these very rare events, both these vaccines are still approved both in the U.K and in the USA although the AstraZeneca vaccine has been suspended in some other countries. Therefore, you need to consult with your physician about local recommendations and restrictions applying to these two vaccines.
In general, however, all IBD expert Societies, such as IOIBD, CCFA, ECCO and more, recommend that patients with IBD receive one of the aforementioned approved COVID-19 vaccines, as per their country’s guidelines and vaccine availability, as all are non-infective. If you are scheduled to receive a vaccine other than these, you will have to check with your physician to ensure the safety (non-live composition) of any such vaccine different that the ones on the list above.
Will a COVID-19 vaccine be effective for me if I have IBD or if I’m using immune-suppressants or biologics?
In general, vaccine efficacy is not different if you have IBD. However, some studies suggest that the efficacy of the vaccine may be slightly lower in patients treated with anti-TNFs such as infliximab or adalimumab, or in patients treated with immune-modulators (azathioprine or 6-mercaptopurine) or high-dose steroids. Nevertheless, even with these drugs, the majority of patients developed protective anti-COVID19 antibodies after the second vaccine dose. The timing of the vaccination in relation to the timing of the biologic infusion/injection was not found to impact immunity acquired by vaccination, so you can get the vaccine at any time throughout your biologic treatment. Preliminary studies with administering a third dose of the Astra Zeneca vaccine indicate an increased anti-viral antibody level after this booster dose. At the time of this update it was reported that several companies are seeking regulatory approval for a third-dose booster, which may be especially relevant for patients receiving corticosteroids, immune-modulators or anti-TNF biologics. However, as this field is rapidly changing, you need to follow your local health authorities’ notifications and guidance.
Does my IBD or my medications put me at greater risk to have a severe disease if I do get infected with Corona virus ? Should I therefore stop my medications?
Elderly people, people with hypertension, diabetes or chronic lung or heart diseases, overweight persons and smokers may be at increased risk for a more severe Corona virus disease. IBD patients as a whole, including Crohn’s disease and ulcerative colitis, were not found in any of the reports so far to have increased risk to contract the disease or to have a more severe disease.
An international registry of IBD patients infected with the COVID-19 Corona virus has been established under the name SECURE-IBD (https://covidibd.org/). This registry now comprises data on thousands of IBD patients that were infected with IBD, while being immune-suppressed or not. Patients taking corticosteroids, azathioprine, 6-Mercaptopurine, methotrexate, tofacitinib, or biologic drugs are considered to be immune-suppressed.
The current SECURE-IBD registry data as well as studies reported from the USA and elsewhere show that severe disease or death do not occur more often in patients taking immune-suppressive or biologic drugs when compared to IBD patients not taking these drugs. The only factors found to predispose to higher risk for having a more severe COVID-19 disease in patients who contracted the virus was concurrent use of corticosteroids when infected by the virus. It is also possible that IBD patients with uncontrolled activity of IBD are also at higher risk, but this has not been decisively determined by all studies.
Overall, the data to date does not show that IBD patients have higher risk to contract Corona virus or to develop a severe disease because of their medications, and patients should recognize the risks of stopping IBD medications and experiencing disease flare and complications. Therefore, expert gastroenterology societies including the American Gastroenterology Association and European Crohn’s & Colitis Organization (ECCO) recommend to continue medications for Crohn’s disease and ulcerative colitis.
However, patients receiving two types of immune-suppressive drugs, such as a biologic and an immunomodulator, and those on corticosteroids, should discuss with their doctor if one of these drugs can be safely discontinued.
Should I stop the medication if I was exposed to a sick person or if I am sick myself?
In general, exposure to a sick person is not considered a reason to stop or suspend your medications, but individualized decision should be taken with your doctor. If you do develop flu-like symptoms, whether diagnosed with Corona virus or not, than as recommended during any flu or other active infection disease, you should contact your IBD team and stop immune-suppressive drugs until symptoms resolve. Non immuno-suppressive drugs such as mesalamine need not be stopped.
Should I avoid going to the hospital, to the clinic or to the infusion center at these times?
Non-essential clinic visits may be re-considered, after proper advice from your team. Some visits to the clinic may be replaced by tele-medicine consults if these are available. Essential visits such as ER visits for severe IBD exacerbation or getting your biologic infusions at infusion centers should not be avoided.
I got stranded in another country while travelling, and I’m running out of my IBD medications. What can I do until I can fly back home?
If flights blocks have forced you to extend your stay away from your home country, we suggest you look at our ‘IBD Network’ webpage where you can find details of over 330 IBD centers around the world that have joined us to provide care and help with administering biologics to IBD patients abroad (you need to be registered user of IBD Passport to access this network). We suggest you approach the center where you are at, for getting local help in medication provision. If there is no center yet in our network in the country where you are at, you can send us an email at info@IBDpassport.com and we will try to help using our global connections, but please be aware that our response may be slightly delayed due to overwhelming numbers of queries and requests at these times.