Review vaccines at diagnosis
Check the record again before a steroid, biologic, immunomodulator, JAK inhibitor, or S1P modulator is started.
For adults with Crohn's disease or ulcerative colitis
Choose the IBD treatment.
See the vaccine plan.
A plain-language, therapy-driven guide to vaccines that are generally recommended, vaccines that need special timing, and live vaccines that may be unsafe during immune-modifying treatment.
No names, dates of birth, medical record numbers, or other patient identifiers are requested. Selections stay in this browser.
Core IBD vaccine rule
Non-live vaccinesGenerally safe during IBD treatment
Live vaccinesUsually avoid during immunosuppression
Vaccinate early when possible. Do not postpone urgently needed IBD treatment solely to complete vaccines.
Evidence checked: September 4, 2026 · Local clinical approval required before deployment
Start here
Three rules that apply to almost every adult with IBD
Give non-live vaccines
Inactivated, recombinant, toxoid, and conjugate vaccines do not contain a replicating virus and are generally safe during therapy.
Plan live vaccines first
When needed, give MMR or varicella at least 4 weeks before immunosuppression. After treatment, the wait depends on the drug.
Interactive guide
Build a vaccine discussion plan
Enter only the clinical details needed for vaccine timing. This tool does not store or transmit the selections.
Recommended or due for review
Non-live vaccines are generally safe during IBD therapy.
Timing and live-vaccine cautions
These items need treatment-aware scheduling.
What the selected treatment changes
Class-specific notes for the care team.
Important: This output is an educational discussion guide, not a prescription or individualized medical advice. Verify all doses, intervals, contraindications, prior vaccine history, and product labeling before administration. Do not delay urgent IBD treatment solely to vaccinate.
At-a-glance table
Adult IBD vaccine overview
This table is intentionally simple. Prior doses, age, pregnancy, travel, and immune status can change the exact schedule.
| Vaccine | Who should review it | During immune therapy | Practical note |
|---|---|---|---|
| Influenza injection | Every adult, every season | Give | Use inactivated or recombinant vaccine; avoid the live nasal spray during immunosuppression. |
| Current-season COVID-19 | Review based on age, prior doses, and immune status | Give | Use the current CDC schedule; it changes by season. |
| Pneumococcal | All adults ≥50; ages 19–49 with qualifying risk; IBD guidance may be broader | Give | For a PCV-naive adult, PCV20 or PCV21 is the simplest one-dose pathway; prior doses require an algorithm. |
| Shingrix (RZV) | All adults ≥50 and adults ≥19 who are or will be immunosuppressed | Give | Two doses. A 1–2 month interval may be used when faster completion is clinically helpful. |
| Hepatitis B | All adults 19–59; older adults with risk or who request it; all IBD patients need HBV evaluation | Give | Use HBsAg, anti-HBs, and total anti-HBc to distinguish susceptibility, immunity, and prior infection. |
| RSV | All adults ≥75; ages 50–74 at increased risk | Give if eligible | One dose; not currently annual. Moderate or severe immune compromise is a qualifying risk factor. |
| HPV | Routine through 26; shared decision ages 27–45 | Give | Use a 3-dose schedule when vaccination is indicated in an immunocompromised patient. |
| Tdap / Td | Every adult; Tdap each pregnancy | Give | One Tdap if never received, then Td or Tdap every 10 years and for wound indications. |
| MMR / varicella | Only when immunity is absent or incomplete | Usually do not give | Live vaccines: complete at least 4 weeks before immunosuppression whenever possible. |
| Travel vaccines | Based on destination and itinerary | Specialist review | Yellow fever and oral typhoid are live; use non-live alternatives when available. |
PCV = pneumococcal conjugate vaccine; RZV = recombinant zoster vaccine. This overview is for U.S. adult practice and should be reconciled with current CDC/ACIP schedules.
Before a biologic, JAK inhibitor, S1P modulator, or substantial steroid course
Pre-treatment vaccine and infection checklist
The best visit is not only a vaccine visit. It is also a chance to document immunity, screen for infections that can reactivate, and create a plan for future live vaccines.
Time-sensitive principle
Complete needed vaccines before treatment when feasible, but do not postpone urgently needed therapy. Non-live vaccines can still be given after treatment begins.
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1
Retrieve the vaccine record
State registry, primary care, pharmacy, prior health system, and patient-held records.
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2
Screen hepatitis B with the triple panel
HBsAg, anti-HBs, and total anti-HBc. Vaccination does not treat current or prior HBV infection.
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3
Document MMR and varicella immunity
A complete documented vaccine series is presumptive evidence. If susceptible, give live vaccine at least 4 weeks before immunosuppression.
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4
Catch up non-live vaccines
Influenza, COVID-19, pneumococcal, Shingrix, hepatitis B, HPV, and Tdap/Td as indicated.
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5
Complete therapy-specific infection screening
Common elements include TB testing, hepatitis C, and selected HIV or other testing according to drug label and local protocol.
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6
Act on positive HBV markers
Coordinate reactivation-risk assessment and antiviral prophylaxis or monitoring before immunosuppression when indicated.
Common questions
IBD vaccine FAQ
Can vaccines trigger an IBD flare?
Inactivated and recombinant vaccines are not associated with exacerbation of IBD activity in the supplied AGA guidance. A brief fever, fatigue, or sore arm can occur after vaccination and is not the same as an IBD flare.
Should a biologic be held or timed halfway between doses?
Routine non-live vaccines generally should not be delayed just to match a biologic dosing cycle. Vaccine response can be lower with some therapies, especially anti-TNF combination therapy, but protection is still valuable. Do not hold an IBD drug unless the treating team specifically directs it.
What counts as “high-dose” systemic steroid use for live-vaccine safety?
The CDC threshold is prednisone-equivalent 20 mg/day or more (or 2 mg/kg/day) for at least 14 consecutive days. Live vaccines are generally deferred during that exposure and for at least 1 month after it ends. Other immune therapies may require a longer, drug-specific wait.
Why is Shingrix emphasized for JAK inhibitors?
JAK inhibitors increase the clinical importance of preventing herpes zoster. Shingrix is recombinant—not live—and can be administered during immune-modifying treatment when indicated.
What if hepatitis B antibody is below 10 after a prior vaccine series?
The AGA IBD update recommends one hepatitis B challenge dose, followed by anti-HBs testing 4–8 weeks later. A level of at least 10 mIU/mL shows an amnestic response. If it remains below 10, complete a second full 2- or 3-dose series.
Why does this page not give an exact COVID-19 dose count?
COVID-19 schedules are seasonal and depend on age, immune status, prior products, and prior doses. The planner therefore points the care team to the current CDC schedule instead of embedding a schedule that can become stale.
Does this replace primary care or pharmacy vaccine review?
No. IBD vaccination works best when gastroenterology, primary care, pharmacy, and infectious diseases coordinate. The complete vaccine record and exact drug regimen are required for final decisions.
Keep the clinical logic auditable
Every recommendation links to a source.
The reference page presents one numbered, deduplicated list of every publication and official guidance source used by the tool.