Ryan A. Smith, MD: RSV Risk in Patients with IBD


Data presented at ACG 2023 shows a significantly increased risk of infection and hospitalization due to RSV in patients with IBD. An investigator discusses implications during an era of increased vaccine options.

Adults with inflammatory bowel disease (IBD) are at a more than 2-fold greater risk of respiratory syncytial virus (RSV) infection than the general population, according to new research presented at the American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting in Vancouver, BC this weekend.

Research from a team of US investigators suggested that every adult age group—from ≥18 years old through ≥65 years old—with IBD was at a significantly greater risk of developing an RSV infection than a control cohort. The team additionally observed that patients with IBD and comorbid diabetes mellitus, chronic lung disease, cardiovascular disease and chronic kidney disease (CKD) were all additionally at significantly increased risk of RSV infections.

What’s more, adults with IBD were at a greater risk of severe disease from an RSV infection that may result in hospitalization.

At a time when new RSV vaccines have reached the US market for older adults—and more candidates are in development—the investigators concluded that adult patients with IBD should heavily consider vaccination options against the seasonal virus.

In an interview with HCPLive during ACG 2023, study investigator Ryan A. Smith, MD, of the University of Wisconsin Hospitals and Clinics, discussed the known risk of infections associated with IBD, and how his peers should navigate this current RSV season with new vaccine options available.

Smith explained this trend of increased infection risk is known across numerous viral and bacterial pathogens, including influenza and pneumococcal pneumonia.

“We know that patients with (IBD) just at their baseline…with some of the underlying immune dysregulation, that these patients are highly susceptible,” Smith said. “And then in the setting of much of our modern therapies affecting patient’s immune systems, all of the studies have shown that this still increased the risk for respiratory infections.”

A secondary analysis in Smith and colleagues’ research considered the medications that patients with IBD were taking, and the said associative risk of RSV infection. Smith explained it’s important to interpret infection susceptibility across the “wide spectrum” of agents available to treat IBD.

Regarding takeaways, Smith believes the findings should help inform specialists’ conversations with patients regarding vaccination options, as well as further research into who is more susceptible to viral infections and how.

“There's going to need to be a little bit more evidence on, how did these patients respond to vaccines, and is there any other kind of unforeseen side effects that can come from this?” Smith said. “So far, these populations have been kind of excluded from any of the RSV work that's been done here thus far.”

Smith also noted the “disconnect” often present between primary care physicians and specialists like his peers in gastroenterology; there is an unchecked assumption that frontline physicians are the ones prioritizing and initiating preventive measures like vaccination based on a patients’ risk.

“The research would suggest that there'sthis other side of the spectrum too, where primary care assumes that the gastroenterologist is handling everything to do with the inflammatory bowel disease,” Smith said. “And so, as the experts in the field, we really should be owning these discussions and looking at options of providing these preventative measures for our patients if available to us.”


Smith RA, Desai A, Hayney M, Kochhar GS, et al. Increased Risk of Respiratory Syncytial Virus Among Patients With Inflammatory Bowel Disease. Paper presented at: ACG 2023 Annual Scientific Meeting. Vancouver, BC, Canada. October 20 – 25, 2023.

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