Immunologic studies in children and adults with IBD found IIV to generally induce appropriate immune response to influenza.33 34 However, when patients are receiving immunosuppressive therapies with combined thiopurines and anti-TNF-alpha agents, serologic response to vaccines is lower compared with monotherapy or non-immune suppressing treatment.28 34 35 Nonetheless, even a blunted vaccination response is thought to be benefi36cial, and immunological correlates of protection against influenza remain poorly understood.32 This evidence concerns the gene TNF and inflammatory bowel disease.