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Freddy Caldera, Francis A Farraye, Joel R Rosh, Mary S Hayney, Prudence Using Serology to Determine Vaccine-Induced Immunity to Measles and Varicella in Patients With Inflammatory Bowel Disease, Inflammatory Bowel Diseases, Volume 25, Issue 9, September 2019, Page e113, https://doi.org/10.1093/ibd/izz106
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To the Editor:
We read with great interest the article by Debruyn et al., in which the authors evaluated serologic protection to vaccine-preventable childhood infections.1 Determining if patients with inflammatory bowel disease (IBD) are immune to vaccine-preventable infections is of the utmost importance due to recent outbreaks of measles and the growing phenomenon of vaccine refusal and hesitancy in the United States. The authors found low seroprotection rates in a cohort with high vaccine coverage. These results should, however, be interpreted with caution because the lack of seroprotection associated with commercially performed assays may not be indicative of a lack of immunity to these infections.
The authors used a commercial assay to determine seroprotection to varicella. Sixty of their patients received the varicella vaccine, but only 5 completed the 2-dose series, which has been the recommendation of the Advisory Committee on Immunization Practice (ACIP) since 2006. The ACIP advises against using serology to determine immunity to varicella in individuals who have received the vaccines series.2 The varicella vaccine induces antibody concentrations that are 10-fold lower than natural infection.2 Researchers from the Centers for Disease Control and Prevention (CDC) found that currently available varicella antibody commercial assays had a 34% false negative rate compared with the more sensitive CDC assay.3 The ACIP states that documentation of receiving 2 doses of varicella vaccine is acceptable evidence of immunity in the general population.
