Correspondence (letter to the editor): Clarifications.

The German Standing Vaccination Committee (Standige Impfkommission, STIKO) at the Robert Koch Institute welcome the fact that the authors draw attention to gaps in vaccination and to vaccination requirements in patients with chronic inflammatory bowel disease (IBD), especially if they receive treatment with immunosuppressants. These patients quite often do not get protective vaccines although they are of particular importance for them. However, cursory reading may prompt readers to misunderstand the recommendations made by the STIKO. The STIKO therefore wish to clarify the following facts: Table 1 of the article might create the impression that the STIKO have issued general vaccination recommendations explicitly for patients with IBD. However, this is not the case. Regarding vaccination against hepatitis A and hepatitis B, the authors correctly point out that the vaccination recommendation in this context relates to patients with disorders of the liver or those that involve the liver, which may—or may not—be the case in IBD. According to the cited STIKO recommendations (Epidemiologisches Bulletin of the Robert Koch-Institute 30/2010) immunizations against influenza and pneumococci are indicated in case of congenital or acquired immunodeficiencies (for example, pharmacological immunosuppression) or in case of an increased health risk due to an underlying disease. IBD is not mentioned on the incomplete list of exemplary underlying diseases. It therefore requires individual medical assessment to establish whether an increased health risk is present. The statements concerning the meningococcal and Haemophilus influenzae type B (Hib) vaccinations exceed the STIKO recommendations. In the cited remarks these vaccinations are termed as “indicated” for patients with immunodeficiency in analogy to the (conjugated) pneumococcal -vaccine. However, the STIKO explicitly mentioned the unsatisfactory data situation and existing licensing restrictions. The paper of Teich et al. might lead to the incorrect impression that these remarks are formal STIKO recommendations.