Long-Term Study Confirms Safety of Pneumococcal Vaccination in Pediatric Patients With Inflammatory Bowel Syndrome

A 2-year prospective study provided critical evidence that may finally dismantle one of the most persistent barriers to vaccinating pediatric patients with inflammatory bowel disease (IBD), as there is a fear of triggering a disease flare. Published in Expert Review of Vaccines, the multicenter cohort study followed 279 children and adolescents aged 4 to 18 years to determine if the 13-valent pneumococcal conjugate vaccine (PCV13) impacted disease activity over a 24-month period.¹

“Despite the important clinical implications of vaccine safety in pediatric IBD patients, no studies have assessed long-term effects,” the study authors said.¹ “Our study aims to evaluate the impact of PCV13 on disease activity in children and adolescents with IBD over a 24-month period following vaccination.”

The researchers found that a single dose of PCV13 did not increase the number of exacerbations or elevate disease activity scores compared with unvaccinated peers, regardless of whether the patients were on 5-ASA derivatives, immunosuppressants, or biologic therapies. This finding is particularly significant for pharmacists, who often serve as the frontline of clinical counseling and vaccine administration for this vulnerable population.^1,2

The challenge of vaccinating patients with IBD—which includes Crohn disease and ulcerative colitis—stems from the complex nature of the disease itself. IBD is characterized by chronic inflammation in the gastrointestinal tract where an overactive immune system mistakenly attacks the body's own tissues. Because many patients are treated with immunosuppressants, steroids, or biologics to dull this immune response, they are at a significantly higher risk for infections like Streptococcus pneumoniae, the most frequent cause of bacterial pneumonia. In fact, research indicates that IBD patients are at an increased risk of invasive pneumococcal infection both before and after their diagnosis, potentially due to malnutrition, genetic factors, or damage to the gastrointestinal mucosa.^2,3

Despite this elevated risk, vaccination rates among IBD patients remain alarmingly low compared with the general population. Many parents and caregivers of pediatric patients express hesitation, citing concerns that the immune stimulation required by a vaccine might inadvertently restart a cycle of bowel inflammation. The results of this 24-month study directly counter that rhetoric, showing that the control group of unvaccinated patients actually experienced numerically higher rates of disease activity and exacerbations at several time points than those who received the vaccine, though the difference was not statistically significant. For the clinical pharmacist, these data provide a powerful tool for patient education, reinforcing that protecting against infection does not come at the cost of intestinal stability.^1,2

Although the pediatric study focused on PCV13, the landscape of pneumococcal prevention is rapidly evolving for adult populations, presenting new complexities for pharmacists to manage. The Advisory Committee on Immunization Practices (ACIP) recently updated its recommendations to include 2 new conjugate vaccines, PCV15 and PCV20, for patients 19 years and older who have never received a conjugate vaccine or whose history is unknown.²

These newer formulations provide broader serotype coverage than PCV13, which is being phased out in many adult protocols. Pharmacists must stay abreast of these shifting guidelines, as they are often responsible for ensuring that the correct series—such as a single dose of PCV20 or a dose of PCV15 followed by the 23-valent polysaccharide vaccine (PPSV23)—is properly executed for immunocompromised adults.²

The role of the pharmacist also extends to the delicate timing of these injections in relation to IBD therapy. Experts recommend that whenever possible, patients should be evaluated for vaccination at the time of diagnosis and ideally receive their shots before initiating intensive immunosuppression to ensure a more robust immune response. For those already on therapy, it is advised to wait at least 2 weeks after administering a nonlive vaccine before starting new immunosuppressive agents, though this should not delay essential treatment if the patient’s condition is urgent.³

“The current literature examining the impact of vaccination on disease activity in IBD and rheumatic diseases remains limited, with most studies restricted to short-term post-vaccination observation periods,” the study authors said.¹ “Despite methodological differences in disease activity assessment and predominant focus on adult populations, findings are generally consistent.”

Ultimately, the goal of increasing vaccination rates in the IBD community is to prevent the severe outcomes associated with pneumonia, sepsis, and other invasive diseases. Studies have shown that proper vaccination with conjugate and polysaccharide vaccines can reduce the risk of severe pneumococcal disease by 5-fold in IBD patients. By combining the long-term safety data from the latest pediatric research with an understanding of current adult ACIP guidelines, pharmacists can play a pivotal role in shifting patient attitudes. Through proactive collaboration with gastroenterologists and primary care providers, pharmacists can ensure that both children and adults with IBD are shielded from preventable infections without fear of compromising their long-term disease management.^1,2

READ MORE: Pneumococcal Resource Center

Are you ready to elevate your pharmacy practice? Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips straight to your inbox.

REFERENCES

1. Neścioruk M, Kowalska-Duplaga K, Grzybowska-Chlebowczyk U, Sieczkowska A, Banaszkiewicz A. The impact of a pneumococcal vaccination on disease activity in children and adolescents with inflammatory bowel disease: a 2-year prospective study. Expert Rev Vaccines. Published online March 27, 2026. doi:10.1080/14760584.2026.2652921

2. Crosby S, Schuh MJ, Becker M, Ivanov M, Caldera F, Farraye FA. New Pneumococcal Vaccines for Prevention of Invasive Pneumococcal Disease in Adult Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis. 2023;29(4):661-664. doi:10.1093/ibd/izac150

3. American Gastroenterological Association. Inflammatory bowel disease (IBD): Vaccine recommendations. June 2022. Accessed March 30, 2026. https://patient.gastro.org/ibd-vaccine-recommendations/