This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Flu vaccines are recommended for people with inflammatory bowel disease (IBD). Researchers found that during the 2018 – 2019 flu season, among people with IBD:
- flu vaccine uptake was low and most who were vaccinated received them late
- vaccination was associated with a reduction in death from any cause
- vaccination was not associated with IBD flares.
The researchers say there is a need to promote timely flu vaccination among people with IBD.
More information on flu vaccines and inflammatory bowel disease can be found on the NHS website.
The issue: how common is flu vaccination in people with inflammatory bowel disease?
More than 540,000 people in the UK have inflammatory bowel disease (IBD), which means their immune system attacks their gut and causes painful sores (ulcers) and inflammation. IBD includes Crohn's disease (inflammation can be anywhere in the gut, from mouth to bottom) or ulcerative colitis (inflammation is in the large bowel only). Symptoms include severe stomach pain and diarrhoea.
Medications that dampen the immune response can improve IBD symptoms; however, they can also leave people more vulnerable to infections. Flu vaccines are recommended for people with IBD on immune-suppressing drugs, but research suggests that uptake is low. This could be due to the belief that flu vaccines cause IBD flares, or because of the lack of data on their effectiveness in people with IBD.
This study investigated the uptake of flu vaccines in people with IBD, how effective they are in this population, and whether they are associated with IBD flares.
What’s new?
The researchers examined the patient records of 13,631 adults with inflammatory bowel disease (IBD) on immune-supressing drugs (or 5-aminosalicylates) during the September 2018 – September 2019 flu season. Half were men; participants’ average age was 53 years.
The researchers found that:
- overall, half (50%) received a flu vaccine, with few (32%) vaccinated before the flu circulated in the community
- vaccination was associated with fewer deaths from any cause (27% less)
- vaccination was not associated with reduced hospital admissions for pneumonia, or with primary care visits for flu-like illness or respiratory tract infections.
Few (33%) people at low risk of ill health (those aged 64 or under with no other long-term conditions) were vaccinated. More (69%) people at high risk (those aged 65 or over and those with additional conditions) were vaccinated. Being older, female, or having additional conditions were linked with higher vaccine uptake.
The researchers examined data for 1,076 people who had a disease flare during the study period. They found that vaccination was not linked with flares.
Why is this important?
This study shows that relatively few people with inflammatory bowel disease (IBD) are vaccinated against flu, particularly when they need it most (before flu spreads in the community). The study also provides reassurance that flu vaccines are not associated with IBD flares, and may reduce deaths.
The researchers call for promotion of timely flu vaccine uptake among people with IBD, particularly those with extra risks (other long-term conditions and older age).
Flu vaccination rates increased after the COVID-19 pandemic. The researchers say that vaccination rates among people with IBD may be higher now than when this research was carried out
Vaccination was not linked with a reduction in flu-like illness. This could be because people were infected by viruses other than flu, which the vaccine does not protect against.
What’s next?
The research team is producing patient information leaflets and infographics to highlight the benefit of vaccination for those with inflammatory conditions, including IBD.
You may be interested to read
This is a summary of: Nakafero G, and others. Uptake, safety and effectiveness of inactivated influenza vaccine in inflammatory bowel disease: a UK-wide study. BMJ Open Gastroenterology 2024; 11. DOI:10.1136/bmjgast-2024-001370.
Information and support from Crohn’s and Colitis UK.
An NIHR Evidence Collection on promoting vaccine uptake in different populations.
Information on taking part in NIHR research on IBD.
Funding: This study was funded by the NIHR Research for Patient Benefit programme.
Conflicts of Interest: Some authors received fees and funding from pharmaceutical companies. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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