Evidence
All publications and official guidance used by the planner appear below in one numbered, deduplicated list. A source is listed only once, even when it was identified in both the supplied materials and the additional evidence review.
The two supplied OpenEvidence documents were the starting clinical synthesis and identified the IBD-focused publications. Current official CDC/ACIP and society guidance was added where recommendations change over time. The references are not separated by origin: every distinct source appears once in the single numbered list below.
References are numbered once and used consistently throughout the planner and the recommendation-to-source map.
Clinical Gastroenterology and Hepatology. 2025;23(5):695–706. doi:10.1016/j.cgh.2024.12.011.
Gastroenterology. 2021;161(2):669–680.e0. doi:10.1053/j.gastro.2020.12.079.
Gastroenterology. 2021;161(2):681–700. doi:10.1053/j.gastro.2021.04.034.
The American Journal of Gastroenterology. 2025;120(7):1447–1473. doi:10.14309/ajg.0000000000003541.
Alimentary Pharmacology & Therapeutics. 2025;61(1):132–144. doi:10.1111/apt.18318.
Digestive Diseases and Sciences. 2015;60(8):2446–2453. doi:10.1007/s10620-015-3631-y.
The American Journal of Gastroenterology. 2017;112(2):241–258. doi:10.1038/ajg.2016.537. The 2025 update in reference 4 is used preferentially where it supersedes this earlier guideline.
The American Journal of Gastroenterology. 2018;113(4):481–517. doi:10.1038/ajg.2018.27.
Current official source for routine adult recommendations, age cutoffs, special situations, and catch-up rules.
Current official source for non-live vaccine safety, the high-dose systemic corticosteroid threshold, timing before immunosuppression, and post-steroid deferral of live vaccines.
Current official source for PCV20/PCV21, PCV15 followed by PPSV23, current routine age threshold, risk-based indications, and prior-dose pathways.
Current official source for eligibility, two-dose timing, the shortened 1–2 month interval when clinically useful, and the 4-week minimum interval.
Current official source for the one-dose recommendation for all adults age 75 or older and adults age 50–74 at increased risk, including moderate or severe immune compromise.
Current official source for the hepatitis B triple panel—HBsAg, anti-HBs, and total anti-HBc—and current adult vaccination indications.
Current official sources for the seasonal schedule. The planner does not hard-code a dose count because recommendations vary by season, age, immune status, product, and prior doses.
Current official source for annual influenza vaccination, avoidance of live attenuated nasal vaccine in immunocompromised people, and age-based product preferences.
Current society guidance used to frame drug-specific HBV reactivation risk assessment, antiviral prophylaxis, or monitoring when HBsAg or anti-HBc is positive.
The supplied content remains the clinical starting point. Recommendations that change over time were checked against the current official sources in the same list above.
The supplied draft used the earlier “all adults 75 or older, and ages 60–74 with risk factors” framework. Current CDC guidance recommends one dose for all adults 75 or older and adults ages 50–74 at increased risk. The planner uses the current age 50–74 risk-based rule.
The 2025 IBD society guidance is broader than the current general CDC age/risk framework. The planner gives a clear CDC indication at age 50 or older and at ages 19–49 with a qualifying immunocompromising condition, while labeling younger patients with IBD on no immune-modifier or 5-ASA alone as an IBD-specific discussion.
The supplied draft summarized an accelerated 4–8 week interval. Current CDC wording is two doses usually 2–6 months apart, with a 1–2 month interval when a shorter schedule would help an immunosuppressed patient; the minimum valid interval is 4 weeks.
The supplied draft stated a general 1–3 month or 3-month post-treatment delay. Current CDC best-practice guidance specifies at least 1 month after stopping high-dose systemic corticosteroids. For biologics, JAK inhibitors, S1P modulators, and other immune therapies, the planner directs the clinician to the drug-specific recovery period and product labeling.
Because the COVID-19 schedule is seasonal and changes by age, immune status, product, and prior doses, the planner links to current CDC guidance instead of embedding a fixed number of doses.
The planner now presents three visibly separate, independent medication groups: “Planning to start,” “Taking now,” and “Recently stopped.” A patient can have different therapies in all three groups, and systemic steroid dose and duration are recorded separately for each applicable status.
The numbered references below match the single list above. Individual result cards link directly to the same reference numbers.
| Planner rule | Primary references | How used |
|---|---|---|
| Review vaccines at diagnosis and before immune therapy | [1], [4], [5] | Core workflow and pre-treatment checklist. |
| Non-live vaccines are generally safe during treatment | [1], [3], [10] | Safe-to-give rule and treatment-timing cards. |
| High-dose steroid threshold | [2], [10] | Prednisone-equivalent ≥20 mg/day or ≥2 mg/kg/day for ≥14 days for live-vaccine safety. |
| Live vaccines before immune therapy | [1], [2], [10] | At least 4 weeks before immunosuppression when possible; no compression of the interval. |
| Vaccine response by IBD therapy | [1], [4], [5], [6] | Therapy interpretation and caution that anti-TNF combination therapy and some small molecules can blunt responses. |
| Influenza | [1], [16] | Annual non-live vaccine; current age-based product preference; avoid nasal live vaccine during immunosuppression. |
| Pneumococcal | [1], [4], [11] | Current CDC age/risk eligibility and product/interval pathways, with the broader IBD guidance disclosed. |
| Recombinant zoster vaccine | [1], [4], [12] | Age 50 routine or age 19+ when immunosuppressed; current two-dose interval. |
| Hepatitis B vaccination and reactivation | [1], [8], [14], [17] | Triple-panel screening, vaccine/challenge-dose logic, and separate reactivation pathway for positive markers. |
| RSV | [13]; [1] for IBD context | Current age 75+ routine and age 50–74 risk-based recommendation. |
| HPV, Tdap/Td, and risk-based vaccines | [1], [9] | Current adult schedule and special-indication review. |
| Current-season COVID-19 | [1], [15] | Links to the live current schedule rather than hard-coding a dose count. |
Assign a named clinical owner and a review date before publishing. At minimum, recheck the CDC adult schedule, COVID-19, influenza, RSV, pneumococcal, and product-label links each season or whenever ACIP changes a recommendation.