NACC advice on swine flu and IBD

Information about Swine Flu

This advice is supplied by the NACC (National Association for Colitis and Crohn's Disease)

Anyone concerned about Swine Flu can get more information from the following sources:

England and Wales: or the Swine Flu Information Line on

08001 513 513.

Scotland: or NHS 24’s dedicated flu line on 08454 24 24 24.

Northern Ireland: or the N.I. Swine Flu Helpline on

0800 0514142.

Swine Flu and immunosupression

IBD Patients on standard doses of immunosuppressant therapy (azathioprine or mercaptopurine) or anti-TNF therapy should not be exceptionally susceptible to Swine Flu and are advised to continue with their treatment, as the risk of active IBD and subsequent need for drugs such as steroids would carry a greater risk than that of contracting the infection. However, you may wish to discuss your current treatment with your Gastroenterologist or IBD Nurse Specialist to check whether your dose, drug or recent blood tests indicate that you could be at higher risk.

If you are receiving an immunosuppressant and have a household contact with flu you should consult your GP who may, in consultation with your IBD specialist, suggest that you take anti-viral medication (Tamiflu) as a precaution. (Current guidance from the Health Protection Agency on the use of prophylactic Tamiflu can be found at

What to do if you think you have Swine Flu

If you have flu-like symptoms you should stay at home and call your GP immediately for advice. Tell your doctor that you have IBD and about any medication you are taking.

Early doses (within 48 hours of symptoms) of antiviral medicines such as Tamiflu are thought to be effective in treating people with Swine Flu. There is no known interaction between Tamiflu and standard IBD drugs, and it is not thought to have any harmful effects on IBD itself.

If you are receiving anti-TNF medication (Infliximab or Humira) you should phone your IBD Nurse or contact person if you have a fever or flu-like symptoms as your treatment may need to be deferred.

Swine Flu Vaccine

The Swine Flu (H1N1) vaccination is now available. Like the seasonal influenza A and Pneumovax vaccines, the H1N1 vaccine is inactivated and considered safe to use even in people whose immune system is compromised. There is also no reason why the swine flu vaccine should adversely affect the state of your Crohn's Disease or Ulcerative Colitis".

NHS Choice states that the priority groups for vaccination include people between the ages of six months and sixty five years who are on immunosuppressive drugs: these include prednisolone (in a dose of more than 20mg/day), azathioprine, mercaptopurine, methotrexate, infliximab and adalimumab. Other members of your household may also be vaccinated if your immune system is compromised.

Furthermore, it is recommended that people on immunosuppressive drugs should receive not only the H1N1 vaccination, but also seasonal flu vaccination and Pneumovax (which is to reduce the chances of getting bacterial pneumonia).

We suggest that if you are on any immunosuppressive drug, and have not had Swine Flu, you talk to your GP soon about having these vaccinations. If in doubt about your treatment, it would also be sensible to contact your Gastroenterologist or IBD Nurse Specialist.

Specific advice regarding swine flu is likely to change over the next 6 months. NACC will therefore update the advice to patients whenever necessary.

Updated 25th November 2009.