As the school year begins, we at the MassGeneral Hospital for Children Inflammatory Bowel Disease Center know that many families have concerns about the return to in-person school this fall. Although we’ve learned a great deal about the virus over the past year and a half, there are still many unknowns especially as new variants emerge. Guidelines change and adapt as we learn new information. We know that school is a very personal decision for families. At this time, there is no indication from current data that children with IBD are at higher risk of COVID-19 infection or its complications compared to other children. We do know that those who take medicines that suppress their immune system may need a third dose to ensure full protection.
While we do not recommend keeping a child with IBD out of school, we do encourage you to review your school district’s COVID-19 plan. These plans should include a mask policy, cleaning practices, and information on social distancing. These are important details to assure that you and your child are making an informed decision about in-person schooling.
We also strongly encourage all our patients that are 12 and up to get vaccinated. This is a very important step in protecting your child. We have received questions about the CDC’s recommendation regarding a third dose of the COVID-19 vaccine. The FDA has authorized a third dose for patients that take certain medications that cause some suppression of the immune system. We encourage you to speak to your child’s GI physician or PCP for any specific questions regarding the booster. Based on this recommendation, many of our IBD patients qualify based on the following medications used for treatment.
- High dose corticosteroids (≥20mg prednisone or equivalent per day for ≥14 days)
- Antimetabolites (ex: methotrexate, azathioprine, 6-MP)
- TNF alpha inhibitors (ex: adalimumab, infliximab, certolizumab, golimumab)
- Other biologic agents that are immunosuppressive or immunomodulatory (e.g., vedolizumab, ustekinumab,natalizumab)
Patients who have already received 2 doses of a mRNA COVID-19 vaccine (e.g., Pfizer or Moderna) with the 2nd dose at least 28 days ago AND are on one or more of the above types of medicines.
Which Vaccine to Get?
Pfizer is approved for ages 12 years and older and Moderna for 18 years and older. We recommend that you get the same brand of vaccine (Pfizer or Moderna) that you had for your first 2 doses.
- Wait for least 28 days after your 2nd shot before you get the 3rd shot.
- If possible, get your shot at least 2 weeks before you start any immunosuppressive therapy; you can discuss this with your doctor.
Patients who have received a single dose of the Johnson & Johnson vaccine are not recommended to receive additional doses of vaccine at this time.
Please note, Mesalamine (Lialda, Apriso, Asacol, Delzicol,Pentasa, Colazal, Canasa, Rowasa) and sulfasalazine (Azulfidine) medicines are NOT immune suppressing medicines and do not increase your risk of infection.
General Booster Shot
Because it appears that protective immunities may decrease over time, the FDA has recently recommended a booster shot for all vaccinated individuals who have received the mRNA vaccines (Pfizer and Moderna). This is recommended for all our patients who fit in this category regardless of the medications you are taking; however, (i) boosters will not be immediately available; (ii) booster shots will be made available in the fall of 2021 beginning 8 MONTHS AFTER you have received your last dose of either the Pfizer or Moderna mRNA vaccine; (iii) typically the first group to receive the booster will be those at highest risk including residents of long term care facilities, older adults, and healthcare workers. For more information, see the CDC's website for more information. https://www.cdc.gov/coronavirus/2019- ncov/vaccines/booster-shot.html
Finally, we strongly recommend that you continue your current IBD treatment and general healthcare. This means taking all medicines and continuing with routine appointments and vaccinations. The MGHfC has mental health support for any families or individuals who feel they would benefit from counselling. You can access these resources by contacting your primary gastroenterologist.
We also recommend that you review CDC policies for school reopening to make the best decision for you and your family.