What IBD patients need to know about COVID-19

coronavirus image courtesy of the CDC

As new COVID-19 (coronavirus) variants continue to effect people in the United States, we understand you may have concerns about how it impacts patients with Crohn’s disease or ulcerative colitis. The Foundation is here to help you make sense of the available information and understand the precautions recommended by the Centers for Disease Controls and Prevention (CDC). 

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COVID-19 & IBDCOVID-19 Vaccinations | Treatments for COVID-19

COVID-19 & IBD

There are many types of coronaviruses that can affect both humans and animals. In humans, some of these viruses are common and cause mild symptoms, like the common cold, while other types of human strains can be more severe. At the end of 2019, a new coronavirus affecting humans, named SARS-CoV-2, was identified. SARS-CoV-2 causes COVID-19. New variants and subvariants of COVID-19 continue to appear in our country, causing illness. Reported COVID-19 cases have ranged from mild to severe, including death. 

 

What are the best ways to prevent a COVID-19 infection?

The best ways to prevent COVD-19 include following healthy hygiene practices, such as washing your hands for at least 20 seconds, wearing a mask, especially in more crowded or indoor areas, and staying home when sick. For more tips and information on prevention of COVID-19, please visit the CDC’s website.

Do my IBD medications put me at an increased risk for severe infection?

Individuals at higher risk for severe infection include those who are immune compromised. It’s important to note that not all patients with IBD are inherently immune compromised. Those who take medications that suppress their immune system, like corticosteroids, may be at higher risk. However, most medications used to treat IBD (aside from corticosteroids) are not associated with an increased risk for severe COVID-19. You should continue to take your IBD medications as prescribed by your doctor. Any decision to change your IBD treatment plan should be done with the consultation with your healthcare team. If you have other pre-existing conditions that increase your risk for severe COVID-19, please be sure to discuss appropriate treatment options and preventative measures with your primary care physician or specialists for those conditions. Click here to find more information from the CDC.

What is “long COVID” and how common is it among IBD patients?

The CDC defines post-COVID conditions (PCC), also known as long COVID, as long-term effects that an individual may experience after infection with COVID-19. Long COVID requires more study, and there is insufficient evidence to conclude that patients with IBD are at greater risk for developing long COVID. 

Where can I learn more about COVID-19?

The CDC has a wealth of information about COVID-19 both for patients and healthcare professionals. Click here to view their resources. The Foundation will continue to post updates about any COVID-19 information that are specific to patients with Crohn’s disease and ulcerative colitis. You can return to this page or contact us if you have questions specifically about IBD and COVID-19 by contacting our IBD Help Center at 888-694-8872 extension 8, or emailing us at [email protected] 

What's going on in my area?

You can check for updates regarding COVID-19 and your county by finding your county and looking for weekly updates about prevention and community levels here.

COVID-19 Vaccination

There are several COVID-19 vaccinations approved for use by the U.S. Food & Drug Administration (FDA). Here are some frequently asked questions about the available vaccines and what people with IBD need to know.

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Updates on COVID-19 Vaccines

 

 

What COVID-19 vaccines are available?

The currently available COVID-19 vaccines include:

  • Pfizer BioNTech (two-dose series)
  • Moderna (two-dose series)
  • Novavax (two-dose series)
  • Johnson & Johnson (single dose)

Booster doses are also available for patients. To view all available vaccines, click here to be taken to the CDC's website for COVID-19 information. 

Which COVID-19 vaccines can children with IBD receive?

There are three COVID-19 vaccines currently available to children:

  • Pfizer BioNTech: This vaccine is available for children 6 months – 17 years of age. Different dosing levels are provided depending on the age of the child.  For children six months to four years of age, the primary series is three doses (the third dose is not considered a booster in this group).
  • Moderna: This vaccine is available for children 6 months – 17 years of age. 
  • Novavax: This vaccine is available for children 12 years and older.
Should IBD patients receive COVID-19 vaccines?

IBD patients are strongly recommended to receive a COVID-19 vaccine. You should always discuss any concerns related to IBD with your gastroenterologist and healthcare team. Your healthcare team will consider your specific needs, any allergies, or other concerns related to your health.

Are the COVID-19 vaccines safe for IBD patients?

Patients with IBD have similar rates of reactions and side effects after receiving a COVID-19 primary series or booster as seen in the general population. Furthermore, incidence of disease flares are low (2%) among patients with IBD who receive a COVID-19 vaccine.

Inflamm Bowel Dis. 2022 Aug 23;izac174. doi: 10.1093/ibd/izac174   
Inflamm Bowel Dis. 2021 Dec 6;izab302. doi: 10.1093/ibd/izab302

Are the COVID-19 vaccines effective in IBD patients?

Studies suggest that COVID- 19 vaccine effectiveness in patients with IBD is comparable to patients without IBD.

Reference: Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1263-e1282. doi: 10.1016/j.cgh.2021.12.026.  

How many doses of the COVID-19 vaccine do IBD patients need (including boosters)?

All patients with IBD should receive the primary COVID-19 vaccine series of one of the available vaccines. Studies show that the primary two-dose series is effective among people with IBD. The CDC currently recommends the following, found on their website here:

  • People ages 6 months through through 4 years should get all COVID-19 primary series doses.
  • People ages 5 years and older should get all primary series doses, and the booster dose recommended for them by CDC, if eligible.
  • People ages 6 months through 11 years old are currently recommended to get a bivalent booster.
  • People ages 12 years and older are recommended to receive one updated Pfizer or Moderna (bivalent) booster.

At this time, people aged 12 years to 17 years can only receive the updated Pfizer bivalent booster.

The new recommendations of bivalent booster will replace all previous booster recommendations. 

I recently had COVID-19; when should I get my booster dose?

Patients with IBD who recently had COVID-19 can consider delaying receiving a booster by three months after the start of symptoms or their positive test. Studies suggest that increased time between infection and vaccination may result in an improved immune response to the vaccination.  A low risk of reinfection has been observed in the weeks to months following infection. You can find more information on the CDC's website here.

Should pregnant women with IBD receive the COVID-19 vaccine?

COVID-19 infection during pregnancy is linked with increased risk of severe illness, intensive care admissions, preeclampsia, pre-term birth, and other serious, and potentially fatal, complications for mother and baby. For these reasons, it is strongly recommended that pregnant patients receive a COVID-19 vaccination. The American College of Obstetrics and Gynecology (ACOG) and the Society for Maternal Fetal Medicine (SMFM) offer best practices for vaccination among pregnant patients. Click here to visit their website to view these recommendations.

Can I still get sick with COVID-19 after receiving a vaccine?

The COVID-19 vaccine does not prevent you from getting sick – it helps to protect you from severe illness and hospitalization. It is possible to still be infected with COVID-19 even after vaccination (this is commonly known as a breakthrough infection); however, the vaccines help protect you against severe illness, ICU admission, and death. There is mounting data to suggest that the vaccine also prevents against long COVID symptoms if you were to get infected. Therefore, it’s important to stay up-to-date on your COVID-19 vaccines and boosters. Click here to learn more about the COVID-19 vaccine and breakthrough infections. 

Is it safe for people to receive other vaccines together with a COVID-19 vaccine?

You can receive COVID-19 vaccines and other vaccines on the same day. The only exception is if you are receiving an orthopoxvirus (monkeypox) vaccine, such as ACAM2000, which has a known risk of heart inflammation, and JYNNEOS vaccine, which has an unknown risk for this condition. Adolescents or young adults may consider waiting four weeks after a monkeypox vaccination before receiving a Moderna, Novavax, or Pfizer-BioNTech COVID-19 vaccine. Click here to learn more about monkeypox.

COVID-19 Treatment

If you test positive for COVID-19, there are several treatments available that you may be eligible to receive depending on the severity of your illness and your risk of severe disease.

 

Are COVID-19 treatments safe for people with IBD?

There are several treatments available for COVID-19 infection. Some treatments may be used among patients who are hospitalized and experiencing severe illness. Other antiviral medications may be used for patients who are not hospitalized but may be experiencing mild-to-moderate COVID-19 and are at high risk of severe disease (such as age, immunosuppression, or other chronic conditions). Your doctor will discuss and recommend the best treatment option for your needs based on risk factors, underlying conditions, and other considerations that are important in your health.

Some of the medications used in patients who are not hospitalized include:

  • Paxlovid: an oral pill for patients 12 and older who are at high risk for developing severe COVID-19 infection that must be taken within five days of symptom onset. One study found that paxlovid lowers the risk of hospitalization and death in patients with inflammatory bowel disease.* 
  • Remdesivir: intravenous (IV) infusions over three days for adults and children within seven days of symptoms at high risk of developing severe COVID-19.
  • Bebtelovimab: single IV injection for adults and children within seven days of symptoms at high risk of developing severe COVID-19.
  • Molnupiravir: oral pill for patients 18 years of age and older within five days of developing symptoms who are at high risk for progressing to severe COVID-19 infection. 

We recommend discussing with your provider before starting any of these therapies. Rebound symptoms and positive tests are possible and you should contact your doctor if this were to happen after stopping the medication. 

References:
Hashash JG, Desai A, Kochhar GS, Farraye FA, Efficacy of Paxlovid and Lagevrio for COVID-19 Infection in patients with Inflammatory Bowel Disease: A Propensity Matched Study, Clinical Gastroenterology and Hepatology (2022), doi: https://doi.org/10.1016/j.cgh.2022.09.011.

 

The content on this page was reviewed and created the Crohn’s & Colitis Foundation’s COVID-19 Taskforce, consisting of members of the Foundation's National Scientific Advisory Committee. This content was last updated on 12/14/22.

 

This resource is generously supported, in part, by:

Takeda