COVID-19 risk for people with Crohn's or Colitis

Mixed Group, Outdoor Walk

As coronavirus restrictions are being relaxed across the four nations of the UK and each of the nations announces its plan for living with COVID-19, we have been reviewing our information about COVID-19 and what it means for people living with Crohn’s or Colitis. In partnership with the British Society of Gastroenterology (BSG), we have looked at whether people with Crohn’s and Colitis are at increased risk if they get COVID-19 infection and what factors to consider when assessing your own risk.

How have we previously defined risk?

What has changed?

Antiviral treatment

What are the recommendations for people considered to be at higher risk?

How do I assess my risk now?

What about children?

Mixed Group, Outdoor Walk
Last reviewed May 2022

How have we previously defined risk?

Early in the pandemic, the BSG produced a risk grid to identify which people with Crohn’s and Colitis were at highest risk of severe illness from COVID-19. The risk grid was based on the best available evidence at the time. It categorised people as having high risk (clinically extremely vulnerable), moderate risk (clinically vulnerable) or lower risk (similar to the general population). This categorisation was based on several factors that were thought to increase a person’s risk of severe illness if they got COVID-19. These included:

  • Current or recent Crohn’s or Colitis medication.
  • Crohn’s or Colitis disease activity (whether the person is in a flare-up).
  • Other conditions the person may have (such as lung disease, heart disease or diabetes).
  • Age over 70 years.

We used this risk grid to develop a decision tree to help people with Crohn’s or Colitis to assess their own risk. 

Over the past 2 years we have learned a lot more about coronavirus and there is now much more evidence about the effects of the virus in people with Crohn’s and Colitis. The risk grid is no longer relevant as a tool for assessing your risk of severe complications from COVID-19. Read the latest statement from the BSG about the withdrawal of the risk grid.

We have been working with the BSG to make sure that our information about risk reflects up-to-date evidence that we now have available.

 

What has changed?

Risk

There is now reassuring evidence that most people with Crohn’s or Colitis are not at higher risk of getting COVID-19 or having more severe COVID-19 because of their disease or treatment. However, your risk may be higher if you are in a flare-up or you are taking oral steroids. So it is important to keep taking your Crohn’s and Colitis medicine to help keep your disease under control as much as possible.

Vaccination

The vaccination programme has now been widely rolled out across the UK, including a third primary dose for those people who were immunosuppressed at the time of their first and second doses, and booster doses. Further booster doses are planned.

Having Crohn's or Colitis in itself does not make the vaccine any less effective for you. If you are on a 5-ASA medicine, or no medicine at all, you can expect the vaccine to work just as well as it would for someone who doesn't have Crohn's or Colitis. However, being on certain immunosuppressant medicines may make the vaccine less effective. Evidence from studies such as CLARITY and VIP shows that people who were taking an anti-TNF medicine, such as infliximab, an anti-TNF medicine plus a thiopurine or methotrexate, or tofacitinib around the time of their first vaccination may have a reduced response to vaccines. After two doses of vaccine, most people had a good response. However, this response reduced faster over time in some people.

Because of this, people who were immunosuppressed (had a weakened immune system) at the time of their first and second vaccines should receive a third dose of COVID-19 vaccine followed by a booster (fourth dose). If you are in this group, the third dose will increase your chances of making a good immune response. This will help protect you from serious COVID-19 infection.

Read more about coronavirus vaccines in people with Crohn’s and Colitis and the vaccination programme.

 

Antiviral treatment

As explained above, there are some people with Crohn’s or Colitis who may still be considered at higher risk of serious complications if they get COVID-19. People in this group may be eligible for early treatment with antiviral medicines if they become infected with COVID-19. The aim of early treatment with these medicines is to prevent you from becoming seriously ill with COVID-19 or having to go to hospital.

Read more about who is eligible for these treatments and how to get them.

 

What are the recommendations for people considered to be at higher risk?

There is separate guidance for people whose immune system means they are higher risk. You may wish to follow this guidance if you:

or

This guidance includes additional recommendations on keeping safe. These recommendations differ slightly across the devolved nations and are currently under review. We will update our information when further details are available.

 

How do I assess my risk now?

Because of these changes in what we know, the availability of coronavirus vaccines and new medicines to treat COVID-19, the risk grid is no longer relevant as a tool for assessing your risk of severe complications from COVID-19.

Everyone’s risk will be different. An acceptable level of risk will vary from person to person and situation to situation. Here are some things that you might want to consider when thinking about your own risk and whether you want to take extra precautions.

  • Have you been vaccinated? Getting vaccinated is the best thing you can do to reduce your risk of getting COVID-19 or becoming seriously ill if you do get it.
  • What treatment are you on? Some medicines, such as oral steroids, may increase your risk. And some medicines may reduce how well the vaccine works. If you are worried about how the medicine you are taking affects your risk, please discuss with your IBD specialist. It is most important to keep taking your medicines to keep your Crohn’s or Colitis under control.
  • Disease activity – are you in a flare-up? Being in a flare-up may increase your risk of becoming seriously ill if you get COVID-19.
  • Other conditions that you may have such as lung disease, heart disease and diabetes may also increase your risk of becoming seriously ill if you get COVID-19.
  • How old you are. Increasing age increases your risk. People over 75 are at increased risk of becoming seriously ill if they get COVID-19.

What about children?

Most children will only experience mild symptoms if they get COVID-19 infection. This is also true for children with Crohn’s or Colitis who are immunosuppressed because of their medication. Vaccines are now available for children aged 5 years and older. Antiviral treatments are available from 12 years for those considered to be at highest risk.

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