COVID-19 Vaccines: High-Risk Populations

Current data1,2,3,4 shows that most IBD patients are not inherently at increased risk for severe illness from the coronavirus. However, you may be considered high-risk if you have IBD and other risk factors including:

  • 60 years or older
  • Treatment with steroids
  • Underlying health condition like heart disease, lung disease (including asthma), diabetes, chronic kidney disease, chronic liver disease, endocrine and metabolic disorders, neurological, neurologic and neurodevelopment conditions
  • Pregnancy or recent pregnancy
  • Weakened immune system (for example: if you had a solid organ transplant and are on immunosuppression medication)

If you fall into any of these categories, you may be interested in the information below from the Advisory Committee on Immunization Practices (ACIP). You can read the full ACIP COVID-19 vaccine report by visiting the Centers for Disease Control and Prevention (CDC) website. We encourage you to discuss the risk and benefits of vaccination with your healthcare providers. The information below will help you facilitate a discussion with your provider. 

Older IBD patients

According to the CDC, the risk for severe illness with COVID-19 increases with age, with older adults at the highest risk. Older adults are also at the greatest risk of requiring hospitalization or dying if diagnosed with COVID-19. 

The CDC has recommended that older adults be prioritized for vaccine distribution. People aged 74 and older are in Phase 1b (along with frontline essential workers) and people aged 65-74 are in Phase 1c. 

IBD patients using steroids

If you have IBD and are currently taking steroids ( >20mg/day), you are considered high-risk. If you are actively taking steroids as part of your IBD management plan, please talk to your healthcare provider about getting vaccinated. In addition, discuss with your health care team the option to reduce the dose of steroids < 20 mg/day.

IBD patients with comorbidities

If you have IBD and a comorbidity like diabetes, heart disease, or lung issues, you can receive the vaccine during Phase 1 as having these conditions makes you high-risk.

If you have one or more of these medical conditions in addition to IBD, we encourage you to talk to your healthcare provider and review state guidance on your eligibility for the vaccine.  The Kaiser Family Foundation has compiled a list of state resources to access your state distribution plans easily. For more information on high-risk conditions and who is receiving priority in Phase 1, please visit the CDC's COVID-19 resources.

Pregnancy

ACIP recommends that pregnant women who are healthcare professionals or are essential workers, as defined by the CDC, should receive the COVID-19 vaccine. If you fall into this category, it’s important that you have a conversation with your healthcare provider  to assist with decision-making regarding the use of vaccines approved under Emergency Use Authorization (EUA) to prevent COVID-19. ACIP recommends pregnant women consider the following when deciding on the COVID-19 vaccine:

  1. Level of COVID-19 transmission in your community
  2. Your personal risk of contracting COVID-19 
  3. The risks of COVID-19 to you and potential risks to your fetus
  4. The efficacy, side effects of the vaccine, and the lack of data about the vaccine during pregnancy.     

The American College of Obstetrics and Gynecology (ACOG) recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP recommended priority groups. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there is no data indicating that the vaccines should be contraindicated.

Those who are trying to become pregnant do not need to avoid pregnancy after COVID-19 vaccination.

Lactation guidance 

There is no data on the safety of COVID-19 vaccines in lactating people or the effects of mRNA vaccines on breastfed infants or milk production or excretion. According to the CDC, mRNA vaccines are not thought to be a risk to the breastfeeding infant. If you are breastfeeding and part of a priority group recommended to receive a COVID-19 vaccine (e.g., healthcare personnel), you may choose to be vaccinated.

Fertility

If you are considering starting a family, you should get the COVID-19 vaccine when it becomes available. It’s important that you coordinate the timing of pregnancy and discuss getting vaccinated with your healthcare providers.

Pediatrics

Please see our COVID-19 vaccine resources for pediatrics.

You can find more information in the Foundation's position statement and by viewing our vaccines video. If you have additional questions about the COVID-19 vaccine, please discuss them with your healthcare provider.

 

References

1. Allocca, M., Chaparro, M., Gonzalez, H. A., Bosca-Watts, M. M., Palmela, C., D’Amico, F., . . . Fiorino, G. (2020). Patients with Inflammatory Bowel Disease Are Not at Increased Risk of COVID-19: A Large Multinational Cohort Study. Journal of Clinical Medicine, 9(11), 3533. doi:10.3390/jcm9113533

2. Brenner, E. J., Ungaro, R. C., Gearry, R. B., Kaplan, G. G., Kissous-Hunt, M., Lewis, J. D., . . . Kappelman, M. D. (2020). Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology, 159(2). doi:10.1053/j.gastro.2020.05.032

3. Derikx, L. A., Lantinga, M. A., Jong, D. J., Dop, W. A., Creemers, R. H., Römkens, T. E., . . . Hoentjen, F. (2020). Clinical Outcomes of Covid-19 in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study. Journal of Crohn's and Colitis. doi:10.1093/ecco-jcc/jjaa215

4. Papa, A., Gasbarrini, A., & Tursi, A. (2020). Epidemiology and the Impact of Therapies on the Outcome of COVID-19 in Patients With Inflammatory Bowel Disease. American Journal of Gastroenterology, 115(10), 1722-1724. doi:10.14309/ajg.0000000000000830


Center for Disease Control (CDC), COVID-19 Vaccine: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html, accessed 1/10/21

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html

 

Kaiser Family Foundation (KFF), States Are Getting Ready to Distribute COVID-19 Vaccines. What Do Their Plans Tell Us So Far? Josh Michaud Follow @joshmich on TwitterJennifer Kates Follow @jenkatesdc on TwitterRachel Dolan Follow @_rachel_dolan on Twitter, and Jennifer Tolbert
Published: Nov 18, 2020 https://www.kff.org/report-section/states-are-getting-ready-to-distribute-covid-19-vaccines-what-do-their-plans-tell-us-so-far-state-plans/, accessed 1/10/21

 

Advisory Committee on Immunization Practices (ACIP), COVID-19 ACIP Vaccine Recommendations, https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html, accessed 1/10/21

 

American College of Obstetrics and Gynecology (ACOG)

https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-pregnant-and-lactating-patients-against-covid-19, accessed 1/21/21

 

Siegel CA, et al. SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting. Gut Month 2021 Vol 0 No 0

 

Last updated January, 2021