Current Treatment Options in Gastroenterology

, Volume 16, Issue 4, pp 548–560 | Cite as

Update on Vaccinating the Patient With Inflammatory Bowel Disease

  • Jennifer Coukos
  • Francis A. FarrayeEmail author
Intractable Disease in the Elderly: When Conventional Therapy Fails (S Katz, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Intractable Disease in the Elderly: When Conventional Therapy Fails


Purpose of review

Patients with inflammatory bowel disease (IBD) are at increased risk of infectious diseases independent of their immunosuppression status, and yet, studies suggest that this population is not receiving standard vaccinations at the same rate as the general population. This review seeks to understand why IBD patients may not be receiving recommended immunizations and to provide guidelines on vaccinating this vulnerable population.

Recent findings

Inactive vaccines are recommended for patients with IBD regardless of immunosuppression status due to the increased risk for many vaccine-preventable illnesses. Certain live vaccines can be administered to the immunocompromised patient with IBD. Additionally, many patients with IBD will be immunosuppressed some time in their disease course, further increasing their risk for infection. Despite this understanding, patients with IBD have poor vaccination rates. Inadequate knowledge, limited time with patients, and lack of consensus as to who is responsible for identifying and administering vaccinations are some of the most important barriers to vaccinating the patient with IBD.


In this review, we discuss guidelines for vaccinating both the immunocompetent and immunosuppressed patient with IBD as well as provide vaccine-specific recommendations. The evidence suggests that patients with IBD are not receiving recommended vaccinations because of misconceptions on the part of patients as well as a paucity of knowledge by their health care team. Educational programs can be successfully implemented to increase knowledge about appropriate vaccinations and can ultimately increase vaccine uptake among patients with IBD. In the end, gastroenterologists and primary care physicians must work together with their patients with IBD to ensure that recommended vaccinations are administered.


Inflammatory bowel disease Immunocompromised Preventative health Vaccination PPSV23 PCV 13 Hepatitis A Hepatitis B Varicella Zoster HPV Travel 


Compliance with ethical standards

Conflict of Interest

Francis Farraye reports personal fees from Braintree Labs, Ferring, Janssen, and Merck and personal fees from Pfizer, Takeda, Lilly, Mesoblast, Protagonist, Theravance, and Innovation Pharmaceuticals, outside the submitted work. Jennifer Coukos declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Melmed GY, Ippoliti AF, Papadakis KA, Tran TT, Birt JL, Lee SK, et al. Patients with inflammatory bowel disease are at risk for vaccine-preventable illnesses. Am J Gastroenterol. 2006;101(8):1834–40.CrossRefGoogle Scholar
  2. 2.
    Selby L, Kane S, Wilson J, Balla P, Riff B, Bingcang C, et al. Receipt of preventive health services by IBD patients is significantly lower than by primary care patients. Inflamm Bowel Dis. 2008;14(2):253–8.CrossRefGoogle Scholar
  3. 3.
    • Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017;112(2):241–58 These guidelines by the ACG address the safety and appropriate timing of vaccinations in IBD patients. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system is used to evaluate the strength of each recommendation.CrossRefGoogle Scholar
  4. 4.
    Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2006;55(RR-15):1–48.PubMedGoogle Scholar
  5. 5.
    Wasan SK, Baker SE, Skolnik PR, Farraye FA. A practical guide to vaccinating the inflammatory bowel disease patient. Am J Gastroenterol. 2010;105(6):1231–8.CrossRefGoogle Scholar
  6. 6.
    • Reich J, Wasan S, Farraye FA. Vaccinating patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2016;12(9):540–6 In addition to outlining appropriate vaccinations, this article discusses strategies for improving vaccination rates among patients with IBD.Google Scholar
  7. 7.
    Rubin L, Levin M, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309–18.CrossRefGoogle Scholar
  8. 8.
    • Greveson K, Shepherd T, Mulligan JP, et al. Travel health and pretravel preparation in the patient with inflammatory bowel disease. Frontline Gastroenterol. 2016;7(1):60–5 This study showed that only a minority of patients with IBD seek pretravel advice and many providers do not feel comfortable providing this advice. A majority of clinicians would refer to a specialty clinic regardless of their confidence level. This article suggests that there still exists a need for greater education of patients with IBD prior to foreign travel.CrossRefGoogle Scholar
  9. 9.
    Wasan SK, Coukos JA, Farraye FA. Vaccinating the inflammatory bowel disease patient: deficiencies in gastroenterologists knowledge. Inflamm Bowel Dis. 2011;17(12):2536–40.CrossRefGoogle Scholar
  10. 10.
    Yeung JH, Goodman KJ, Fedorak RN. Inadequate knowledge of immunization guidelines: a missed opportunity for preventing infection in immunocompromised IBD patients. Inflamm Bowel Dis. 2012;18(1):34–40.CrossRefGoogle Scholar
  11. 11.
    • Gurvits GE, Lan G, Tan A, Weissman A. Vaccination practices in patients with inflammatory bowel disease among general internal medicine physicians in the USA. Postgrad Med J. 2017;93(1100):333–7 This study demonstrates that primary care physicians have a poor understanding and comfort in regards to appropriate vaccinations for patients with IBD.CrossRefGoogle Scholar
  12. 12.
    Christensen KR, Steenholdt C, Buhl SS, Ainsworth MA, Thomsen OØ, Brynskov J. Systematic information to health-care professionals about vaccination guidelines improves adherence in patients with inflammatory bowel disease in anti-TNFα therapy. Am J Gastroenterol. 2015;110(11):1526–32.CrossRefGoogle Scholar
  13. 13.
    Reich JS, Miller HL, Wasan SK, Noronha A, Ardagna E, Sullivan K, et al. Influenza and pneumococcal vaccination rates in patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2015;11(6):396–401.Google Scholar
  14. 14.
    Wasan SK, Calderwood AH, Long MD, Kappelman MD, Sandler RS, Farraye FA. Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement. Inflamm Bowel Dis. 2014;20(2):246–50.CrossRefGoogle Scholar
  15. 15.
    Sands BE, Cuffari C, Katz J, Kugathasan S, Onken J, Vitek C, et al. Guidelines for immunizations in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2004;10(5):677–92.CrossRefGoogle Scholar
  16. 16.
    Melmed GY. Vaccination strategies for patients with inflammatory bowel disease on immunomodulators and biologics. Inflamm Bowel Dis. 2009;15(9):1410–6.CrossRefGoogle Scholar
  17. 17.
    • Tinsley A, Navabi S, Williams ED, et al. Increased risk of influenza and influenza-related complications among 140,480 patients with inflammatory bowel disease. Inflamm Bowel Dis. 2018; This is the first study designed to evaluate the incidence and severity of influenza in patients with IBD.
  18. 18.
    • Grohskopf LA, Sokolow LZ, Fry AM, et al. Update: ACIP recommendations for the use of quadrivalent live attenuated influenza vaccine (LAIV4)—United States, 2018–19 influenza season. MMWR Morb Mortal Wkly Rep. 2018;67:643–5 The updated ACIP guideline states that despite changing recommendation over the past few years, the live attenuated influenza vaccine (LAIV4) is an effective option for flu protection during the 2018–2019 season.CrossRefGoogle Scholar
  19. 19.
    Andrisani G, Frasca D, Romero M, Armuzzi A, Felice C, Marzo M, et al. Immune response to influenza a/H1N1 vaccine in inflammatory bowel disease patients treated with anti TNF-α agents: effects of combined therapy with immunosuppressants. J Crohns Colitis. 2013;7(4):301–7.CrossRefGoogle Scholar
  20. 20.
    • DeBruyn J, Fonseca K, Ghosh S, et al. Immunogenicity of influenza vaccine for patients with inflammatory bowel disease on maintenance infliximab therapy: a randomized trial. Inflamm Bowel Dis. 2016;22(3):638–47 Response to influenza vaccine is reduced in patients on infliximab. However, this study demonstrated that the timing of vaccine relative to infliximab infusion did not affect the achievement of serologic protection.CrossRefGoogle Scholar
  21. 21.
    Melmed GY. Vaccinations while on thiopurines: some protection is better than none. Am J Gastroenterol. 2012;107(1):141–2.CrossRefGoogle Scholar
  22. 22.
    Matsumoto H, Ohfuji S, Watanabe K, Yamagami H, Fukushima W, Maeda K, et al. Booster influenza vaccination does not improve immune response in adult inflammatory bowel disease patients treated with immunosuppressives: a randomized controlled trial. J Gastroenterol. 2015;50(8):876–86.CrossRefGoogle Scholar
  23. 23.
    Long MD, Martin C, Sandler RS, Kappelman MD. Increased risk of pneumonia among patients with inflammatory bowel disease. Am J Gastroenterol. 2013;108(2):240–8.CrossRefGoogle Scholar
  24. 24.
    Kantsø B, Simonsen J, Hoffmann S, Valentiner-Branth P, Petersen AM, Jess T. Inflammatory bowel disease patients are at increased risk of invasive pneumococcal disease: a nationwide Danish cohort study 1977-2013. Am J Gastroenterol. 2015;110(11):1582–7.CrossRefGoogle Scholar
  25. 25.
    Kobayashi M, Bennett NM, Gierke R, Almendares O, Moore MR, Whitney CG, et al. Intervals between PCV13 and PPSV23 vaccines: recommendations of the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep. 2015;64(34):944–7.CrossRefGoogle Scholar
  26. 26.
    Melmed GY, Agarwal N, Frenck RW, Ippoliti AF, Ibanez P, Papadakis KA, et al. Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease. Am J Gastroenterol. 2010;105(1):148–54.CrossRefGoogle Scholar
  27. 27.
    Visvanathan S, Keenan GF, Baker DG, Levinson AI, Wagner CL. Response to pneumococcal vaccine in patients with early rheumatoid arthritis receiving infliximab plus methotrexate or methotrexate alone. J Rheumatol. 2007;34(5):952–7.PubMedGoogle Scholar
  28. 28.
    Bhatia J, Bratcher J, Korelitz B, Vakher K, Mannor S, Shevchuk M, et al. Abnormalities of uterine cervix in women with inflammatory bowel disease. World J Gastroenterol. 2006;12(38):6167–71.CrossRefGoogle Scholar
  29. 29.
    Kane S, Khatibi B, Reddy D. Higher incidence of abnormal pap smears in women with inflammatory bowel disease. Am J Gastroenterol. 2008;103(3):631–6.CrossRefGoogle Scholar
  30. 30.
    Allegretti JR, Barnes EL, Cameron A. Are patients with inflammatory bowel disease on chronic immunosuppressive therapy at increased risk of cervical high-grade dysplasia/cancer? A meta-analysis. Inflamm Bowel Dis. 2015;21(5):1089–97.CrossRefGoogle Scholar
  31. 31.
    Petrosky E, Bocchini JA Jr, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64(11):300–4.PubMedPubMedCentralGoogle Scholar
  32. 32.
    • Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2016;65:1405–8 The ACIP guidelines continue to recommend a 3-dose vaccine series for HPV if the vaccine is given at ages 15 through 26 years and for immunocompromised patients. However, the updated guidelines now support a 2-dose series if the vaccine is given at ages 9 through 14 years.CrossRefGoogle Scholar
  33. 33.
    Jacobson DL, Bousvaros A, Ashworth L, Carey R, Shrier LA, Burchett SK, et al. Immunogenicity and tolerability to human papillomavirus-like particle vaccine in girls and young women with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(7):1441–9.CrossRefGoogle Scholar
  34. 34.
    Hou JK, Velayos F, Terrault N, Mahadevan U. Viral hepatitis and inflammatory bowel disease. Inflamm Bowel Dis. 2010;16(6):925–32.CrossRefGoogle Scholar
  35. 35.
    Tolentino YF, Fogaca HS, Zaltman C, et al. Hepatitis B virus prevalence and transmission risk factors in inflammatory bowel disease patients at Clementino Fraga Filho university hospital. World J Gastroenterol. 2008;14(20):3201–6.CrossRefGoogle Scholar
  36. 36.
    Xunrong L, Yan AW, Liang R, Lau GK. Hepatitis B virus (HBV) reactivation after cytotoxic or immunosuppressive therapy--pathogenesis and management. Rev Med Virol. 2001;11(5):287–99.CrossRefGoogle Scholar
  37. 37.
    Pérez-Alvarez R, Díaz-Lagares C, García-Hernández F, Lopez-Roses L, Brito-Zerón P, Pérez-de-Lis M, et al. Hepatitis B virus (HBV) reactivation in patients receiving tumor necrosis factor (TNF)-targeted therapy: analysis of 257 cases. Medicine (Baltimore). 2011;90(6):359–71.CrossRefGoogle Scholar
  38. 38.
    Esteve M, Saro C, González-Huix F, Suarez F, Forné M, Viver JM. Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease patients: need for primary prophylaxis. Gut. 2004;53(9):1363–5.CrossRefGoogle Scholar
  39. 39.
    Morisco F, Castiglione F, Rispo A, Stroffolini T, Sansone S, Vitale R, et al. Effect of immunosuppressive therapy on patients with inflammatory bowel diseases and hepatitis B or C virus infection. J Viral Hepat. 2013;20(3):200–8.CrossRefGoogle Scholar
  40. 40.
    Michel M, Duvoux C, Hezode C, Cherqui D. Fulminant hepatitis after infliximab in a patient with hepatitis B virus treated for an adult onset Still’s disease. J Rheumatol. 2003;30(7):1624–5.PubMedGoogle Scholar
  41. 41.
    • Jiang HY, Wang SY, Deng M, et al. Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: a systematic review and meta-analysis. Vaccine. 2017;35(20):2633–41 This meta-analysis demonstrated poor serological response to hepatitis B vaccine in patients with IBD and provided several predictive variables for level of immune response.CrossRefGoogle Scholar
  42. 42.
    Cekic C, Aslan F, Krc A, et al. Evaluation of factors associated with response to hepatitis B vaccination in patients with inflammatory bowel disease. Medicine (Baltimore). 2015;94(22):e940.CrossRefGoogle Scholar
  43. 43.
    Altunöz ME, Senateş E, Yeşil A, et al. Patients with inflammatory bowel disease have a lower response rate to HBV vaccination compared to controls. Dig Dis Sci. 2012;57(4):1039–44.CrossRefGoogle Scholar
  44. 44.
    • Schillie S, Harris A, Link-Gelles R, et al. Recommendations of the advisory committee on immunization practices for use of a hepatitis B vaccine with a novel adjuvant. MMWR Morb Mortal Wkly Rep. 2018;67(15):455–8 In July 2017, the FDA approved a new 2-dose hepatitis B vaccine (Heplisav-B, Dynavax) which can be given over one month compared to the 3-dose series over 6 months required for the older hepatitis B vaccines.CrossRefGoogle Scholar
  45. 45.
    Cardell K, Akerlind B, Sällberg M, Frydén A. Excellent response rate to a double dose of the combined hepatitis a and B vaccine in previous nonresponders to hepatitis B vaccine. J Infect Dis. 2008;198(3):299–304.CrossRefGoogle Scholar
  46. 46.
    Urganci N, Kalyoncu D. Immunogenecity of hepatitis a and B vaccination in pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;56(4):412–5.CrossRefGoogle Scholar
  47. 47.
    Park SH, Yang SK, Park SK, Kim JW, Yang DH, Jung KW, et al. Efficacy of hepatitis a vaccination and factors impacting on seroconversion in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2014;20(1):69–74.CrossRefGoogle Scholar
  48. 48.
    Radzikowski A, Banaszkiewicz A, Łazowska-Przeorek I, Grzybowska-Chlebowczyk U, Woś H, Pytrus T, et al. Immunogenecity of hepatitis a vaccine in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(5):1117–24.CrossRefGoogle Scholar
  49. 49.
    Patton ME, Stephens D, Moore K, MacNeil JR. Updated recommendations for use of MenB-FHbp serogroup B meningococcal vaccine—advisory committee on immunization practices, 2016. MMWR Morb Mortal Wkly Rep. 2017;66:509–13.CrossRefGoogle Scholar
  50. 50.
    Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2018;67(RR-2):1–44.CrossRefGoogle Scholar
  51. 51.
    • Caldera F, Saha S, Wald A, et al. Lower sustained diphtheria and pertussis antibody concentrations in inflammatory bowel disease patients. Dig Dis Sci. 2018;63(6):1532–40 This study is first to evaluate sustained protection against diphtheria and pertussis in patients with IBD.CrossRefGoogle Scholar
  52. 52.
    Dezfoli S, Horton HA, Thepyasuwan N, Berel D, Targan SR, Vasiliauskas EA, et al. Combined immunosuppression impairs immunogenicity to tetanus and pertussis vaccination among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(8):1754–60.CrossRefGoogle Scholar
  53. 53.
    Gupta G, Lautenbach E, Lewis JD. Incidence and risk factors for herpes zoster among patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4(12):1483–90.CrossRefGoogle Scholar
  54. 54.
    Long MD, Martin C, Sandler RS, Kappelman MD. Increased risk of herpes zoster among 108 604 patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37(4):420–9.CrossRefGoogle Scholar
  55. 55.
    Khan N, Patel D, Trivedi C, et al. Overall and comparative risk of herpes zoster with pharmacotherapy for inflammatory bowel diseases: A nationwide cohort study. Clin Gastroenterol Hepatol 2018. CrossRefGoogle Scholar
  56. 56.
    • Yun H, Yang S, Chen L, et al. Risk of herpes zoster in autoimmune and inflammatory diseases: implications for vaccination. Arthritis Rheumatol. 2016;68(9):2328–37 This study found that younger patients with IBD have higher rates of shingles compared to older, healthy controls.CrossRefGoogle Scholar
  57. 57.
    • Dooling KL, Guo A, Patel M, et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines. MMWR Morb Mortal Wklyl Rep. 2018;67:103–8 The updates ACIP guidelines include the use of the recombinant zoster vaccine (Shingrix) that was approved in October 2017. This recombinant vaccine can be used in immunosuppressed patients unlike the live vaccine (Zostavax) which is contraindicated in patients on high level immunosuppression.CrossRefGoogle Scholar
  58. 58.
    Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2008;57:1–30.PubMedGoogle Scholar
  59. 59.
    • Wasan SK, Zullow S, Berg A, et al. Herpes zoster vaccine response in inflammatory bowel disease patients on low-dose immunosuppression. Inflamm Bowel Dis. 2016;22(6):1391–6 This study demonstrated that while patients with IBD on low-dose immunosuppression have a reduced response to the herpes zoster vaccine, they are not at an increased risk for serious adverse events.CrossRefGoogle Scholar
  60. 60.
    Tsai SY, Yang TY, Lin CL, Tsai YH, Kuo CF, Kao CH. Increased risk of varicella zoster virus infection in inflammatory bowel disease in an Asian population: a nationwide population-based cohort study. Int J Clin Pract. 2015;69(2):228–34.CrossRefGoogle Scholar
  61. 61.
    Marin M, Güris D, Chaves SS, et al. Prevention of varicella: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2007;56(RRA-4):1–40.PubMedGoogle Scholar
  62. 62.
    • Cleveland NK, Rodriquez D, Wichman A, et al. Many inflammatory bowel disease patients are not immune to measles or pertussis. Dig Dis Sci. 2016;61(10):2972–6 This study was the first to assess measles immunity and the largest study to assess pertussis titers in patients with IBD. The results revealed that a significant number patients with IBD lack immunity to measles and pertussis.CrossRefGoogle Scholar
  63. 63.
    McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2013;62(4):1–34.PubMedGoogle Scholar
  64. 64.
    Loubet P, Verger P, Abitbol V, Peyrin-Biroulet L, Launay O. Pneumococcal and influenza vaccine uptake in adults with inflammatory bowel disease in France: results from a web-based study. Dig Liver Dis. 2018;50(6):563–7.CrossRefGoogle Scholar
  65. 65.
    Cornerstones Health, Inc. IBD checklist for monitoring & prevention. Version 1.5. Revised March 10, 2017. Accessed August 12, 2018.
  66. 66.
    Crohn’s & Colitis Foundation. Health maintenance checklist for adult IBD patients. Version 3. Revised January 2018. Accessed August 12, 2018.
  67. 67.
    Parker S, Chambers White L, Spangler C, Rosenblum J, Sweeney S, Homan E, et al. A quality improvement project significantly increased the vaccination rate for immunosuppressed patients with IBD. Inflamm Bowel Dis. 2013;19(9):1809–14.PubMedGoogle Scholar
  68. 68.
    Elder KG, Lemon SK, Costello TJ. Increasing compliance with national quality measures for stroke through use of a standard order set. Am J Health Syst Pharm. 2015;72(11 Suppl 1):S6–S10.CrossRefGoogle Scholar
  69. 69.
    Khoury L, Dangodara AA, Lee JA, Lovejoy M, Amin AN. Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures. Hosp Pract (1995). 2014;42(5):89–99.CrossRefGoogle Scholar
  70. 70.
    Karr JR, Lu JJ, Smith RB, Thomas AC. Using computerized physician order entry to ensure appropriate vaccination of patients with inflammatory bowel disease. Ochsner J. 2016;16(1):90–5.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Malhi G, Rumman A, Thanabalan R, Croitoru K, Silverberg MS, Hillary Steinhart A, et al. Vaccination in inflammatory bowel disease patients: attitudes, knowledge, and uptake. J Crohns Colitis. 2015;9(6):439–44.CrossRefGoogle Scholar
  72. 72.
    Coenen S, Weyts E, Jorissen C, de Munter P, Noman M, Ballet V, et al. Effects of education and information on vaccination behavior in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(2):318–24.CrossRefGoogle Scholar
  73. 73.
    Apte M, Reich J, Zahorian T, Farraye FA. Improving vaccination rates for IBD patients through the use of local pharmacies. Inflamm Bowel Dis. 2018.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Section of Gastroenterology, Boston Medical CenterBoston University School of MedicineBostonUSA

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