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COVID-19 and IBD

Crohn’s and Colitis Canada COVID-19 and IBD task force guidance statements

(Updated March 14, 2023)

Note from the COVID-19 and IBD Task Force:

The Crohn’s and Colitis Canada COVID-19 and IBD Task Force was formed in March 2020 when the SARS-CoV-2 (COVID-19) pandemic was declared. The purpose of the Task Force was to:

• Assess the impact of COVID-19 on people living with inflammatory bowel disease (IBD),
• Interpret the rapidly evolving evidence of risk, vaccination and treatment of COVID-19 in people with IBD, and 
• Provide the IBD community with educational resources and guidance. 

Read the 2021 Impact of COVID-19 & IBD in Canada report.

Task force recommendations

Vaccinations

1. We strongly recommend that all patients with IBD receive the primary series of 3 doses of mRNA-based COVID-19 vaccinations (available in Canada under the names Comirnaty^® from Pfizer-BioNTech and Spikevax^® from Moderna). Bivalent or polyvalent vaccines should be used as the primary series to provide the most updated coverage for circulating strains of virus. These vaccines have been proven safe and effective at reducing the risk of COVID-19 infection and severe COVID-19 in IBD patients. Protein subunit vaccines (Nuvaxovid^® from Novavax) or plant-based virus-like particle vaccines (Covifenz^® from Medicago) are also likely safe and effective, but have not been studied in patients with IBD.
2. Following the initial series, we strongly recommend additional booster vaccine doses every 4-6 months. We suggest that booster vaccine doses be given 4-6 months after a previous dose, or 3-4 months after a known and confirmed natural infection with COVID-19.
3. We recommend that booster doses using bivalent or polyvalent versions of the vaccine be given to provide the best coverage for the currently circulating strains of SARS-CoV-2. We strongly recommend a bivalent or polyvalent dose be given immediately to any person with IBD who has previously received only the monovalent forms of the vaccine.

Other (Non-COVID) Vaccines in People with IBD

In general, patients with IBD should receive all standard non-live vaccines available in Canada. People who are taking immunosuppressive medications should not receive live vaccines. People who are not on immunosuppressive medications are able to receive both live and non-live vaccines.

Immunosuppressive medications include:

• Systemic steroids (prednisone, methylprednisolone, prednisolone)
• Azathioprine
• Methotrexate
• Biologics (infliximab, adalimumab, golimumab, ustekinumab, vedolizumab, risankizumab).
• Small molecules (tofacitinib, upadacitinib).

For more information on vaccinations in people with IBD, please see the clinical practice guidelines from the Canadian Association of Gastroenterology:

Part 1 – Live Vaccines
Part 2 – Inactivated Vaccines

Masking

There are many risk factors for transmission of COVID-19, an airborne viral illness. These include indoor (vs. outdoor) settings, particularly those with poor ventilation, and the prevalence of COVID-19 in the local population. The below recommendations are intended as general guidance, but individual people should consider the risk of transmission in their area and the risk factors for severe COVID-19 (advanced age, other chronic illnesses, etc.).

1. We recommend that patients with IBD consider wearing a well-fitted N95 or KN95 mask in certain settings:
   • Crowded indoor settings, including public transit.
   • Poorly ventilated locations.
   • Highly dense and crowded outdoor settings.

There is some evidence that patients who contract COVID-19 (or other viruses) may be at risk for flares of their IBD (active inflammation resulting from infection). Therefore, this recommendation should apply to all IBD patients, whether taking immunosuppressive medications or not.

2. We recommend that IBD patients be mindful of ventilation in indoor areas, and use masks in poorly ventilated locations. We suggest the use of HEPA filters, Corsi-Rosenthal boxes, and open windows in indoor settings with people at risk for severe COVID-19. We suggest that at-risk IBD patients could consider the use of portable CO¬2¬ detectors to monitor air quality and avoid poorly ventilated locations with large crowds. 

Further information on:
Ventilation and COVID-19 transmission

3. We strongly recommend masking indoors for:
   • IBD patients with severe underlying cardiac or respiratory conditions, or other end-organ disease.
   • IBD patients who are taking systemic steroids at a dose equivalent to prednisone >20 mg/day (or >0.5 mg/kg/day in children).
   • IBD patients who are unvaccinated or undervaccinated (>6 months since last vaccine, or monovalent vaccine only).

4. Crohn’s and Colitis Canada strongly advocates for the de-stigmatization of mask-wearing in public areas. Many people at-risk for severe COVID-19 or other viral infections, as well as those simply wishing to protect themselves should have the freedom to choose to wear a mask. These people should not be bullied, discriminated against, or excluded because of this choice.

Use of anti-viral medications:

1. We recommend the use of Paxlovid® in IBD patients after confirmed COVID-19 infection, unless there are significant drug interactions or other contraindications (please consult with your physician, nurse practitioner, or pharmacist). There is new evidence that Paxlovid^® may reduce the risk of post-acute sequelae of COVID-19 (long COVID) (see news article in JAMA here). Criteria for qualification for Paxlovid^® vary by province. However, adults who are immunosuppressed qualify for a prescription of Paxlovid^® in most provinces, and off-label prescriptions may be provided to some children by pediatric specialist physicians. Please consult your physician, nurse practitioner or pharmacist to see if you qualify in your region.