Sustained Immune Response to Measles, Mumps and Rubella in Immunosuppressed Inflammatory Bowel Disease Patients

Abstract

Introduction: Patients with inflammatory bowel disease (IBD) are routinely immunosuppressed, and those on anti-TNF therapy can have a lower sustained antibody response to vaccines. Recent measles and mumps outbreaks have occurred in those not receiving measles, mumps and rubella (MMR) vaccine. There is a paucity of data regarding response to the MMR vaccine in IBD patients. Methods: We performed a cross sectional study measuring antibody concentrations to MMR vaccine among IBD patients compared to healthy controls. Our study consisted of three IBD groups: adults with IBD stratified based on maintenance medication regimen for at least three months 1) azathioprine/6-mercaptopurine (AZA/6MP); 2) biologic (TNF alpha inhibitor); and 3) combination therapy (biologic and immunomodulator (AZA/6MP or methotrexate). The healthy control group consisted of patient without chronic health conditions. All subjects received the two doses of MMR vaccine. Measles,mumps, and rubella antibody concentrations were measured using ELISA methods (Alpha Diagnostic International; San Antonio, TX) and the results adjusted to WHO standards. The primary objective of this study is to compare MMR antibody concentrations in three IBD treatment groups: azathioprine/6-mercaptopurine, anti-TNF agents, and combination therapy. Results: Sixty-six individuals with documented MMR immunization (n=46 IBD patients; n=20 healthy) were used. The patients with IBD and the healthy controls were comparable in age, sex distribution, and time since MMR administration. (Table 1). The antibody concentrations in subjects with IBD were not significantly different from that of the healthy subjects (Table 2). Among the three treatment groups, statistically significant difference was found in the mumps antibody concentration between the azathioprine and the combination treatment groups. MMR antibody concentrations were not significantly different among all other comparison groups.Table. DemographicsTable: Table. Measels, Mumps and Rubella Antibody ConcentrationsConclusion: This is the first study evaluating sustained antibody concentrations in immunosuppressed IBD patients with confirmed history of MMR vaccine series. No significant difference in MMR antibody concentrations were found between IBD and healthy patients, as well as among three common IBD treatment groups. IBD patients immunized with the MMR series have sustained protection comparable to healthy controls regardless of immunosuppressive regimen. Immunization history is a reliable surrogate for determining seroprotection to measles and rubella.