Risk of Serious Infection

Anti-TNF therapy is effective for inducing and maintaining remission in both pediatric Crohn's disease and ulcerative colitis patients; however, adverse effects, such as serious infection and lymphoma, are of concern. A recent study has indicated that anti-TNFα therapy in patients aged ≥50 years is associated with significantly increased rates of serious infections; therefore, physicians should pay careful attention to detect the development of infections in elderly patients treated with this therapy. Patients with inflammatory bowel disease (IBD) should be considered for the five following vaccines: the varicella zoster, human papillomavirus, influenza, hepatitis B, and pneumococcal vaccines. Because IBD patients often fail to recognize whether they have previously had a vaccine-preventive illness, such as varicella zoster virus infection, antibodies for varicella zoster virus should be measured as early as possible after diagnosis of IBD, and vaccination might be considered for patients who do not have antibodies before anti-TNFα agents are used.