Infection prevention & vaccination
Adult Vaccination Schedule for People With IBD
Last Updated Nov 11, 2025
Vaccines lower the risk of serious infections in inflammatory bowel disease (IBD). This guide explains which vaccines are recommended, which are safe with immune‑modifying IBD medicines, and when to get them. It follows current U.S. Centers for Disease Control and Prevention (CDC) guidance and gastroenterology society recommendations as of November 2025. Always review timing before starting or changing immunosuppressive therapy. (cdc.gov)
Key takeaways
Non‑live vaccines are safe to give during immunosuppression. Live vaccines are not. (cdc.gov)
Get flu and COVID‑19 vaccines regularly, and pneumococcal vaccination once with a modern conjugate option. (cdc.gov)
Shingrix is recommended starting at age 50, and from age 19 if immunosuppressed. (cdc.gov)
RSV vaccine is a one‑time dose for all adults 75+, and for adults 60–74 at higher risk. (cdc.gov)
Try to give any needed live vaccines at least 4 weeks before starting immunosuppressive therapy. (cdc.gov)
What “immunosuppressed” means in IBD
Many IBD medicines lower the body’s ability to fight infections. These include systemic corticosteroids at high doses, thiopurines, methotrexate, anti‑TNF biologics, anti‑integrin therapy, IL‑12/23 or IL‑23 inhibitors, JAK inhibitors, and S1P receptor modulators. With these medicines, use non‑live vaccines only. Live vaccines may be given first if time allows. High‑dose steroids are usually defined as 20 mg or more of prednisone daily (or 2 mg/kg/day) for 14 days or longer. (cdc.gov)
Timing principles
Before starting immunosuppression: give needed inactivated and, if indicated, live vaccines. Try to give live vaccines at least 4 weeks before therapy. (cdc.gov)
Already on immunosuppression: give all needed non‑live vaccines. Response can be lower, but protection still helps. Avoid live vaccines until at least 3 months after stopping most immunosuppressive drugs, and longer after B‑cell depleting agents. (cdc.gov)
Household contacts should be fully vaccinated. They may receive the nasal spray flu vaccine unless they care for someone who is severely immunosuppressed in a protected environment. (cdc.gov)
Core adult vaccines for people with IBD
Vaccine | Safe on immunosuppression | When to get it | Notes |
|---|---|---|---|
Influenza (inactivated or recombinant) | Yes | Every fall | Avoid the live nasal spray while immunosuppressed. (cdc.gov) |
COVID‑19 | Yes | Follow the current CDC schedule. Immunocompromised adults should receive at least two 2024–25 doses 6 months apart, with the option for more based on risk. | Formulas change each season. Do not delay vaccination when starting IBD therapy. (cdc.gov) |
Pneumococcal | Yes | One dose of PCV20 or PCV21 for adults who have not received a conjugate dose. If PCV15 is used, give PPSV23 at least 1 year later. | Adults 50+ and immunocompromised adults 19–49 are covered by current recommendations. No PPSV23 is needed after PCV20 or PCV21. (cdc.gov) |
Tdap/Td | Yes | One Tdap once, then Td or Tdap every 10 years | Also give Tdap during each pregnancy. (cdc.gov) |
Hepatitis B | Yes | Universal adult vaccination up to age 59, and at any age with risk factors | Consider checking anti‑HBs 1–2 months after series in immunocompromised adults, with revaccination if non‑immune. Heplisav‑B allows a 2‑dose series. (cdc.gov) |
Hepatitis A | Yes | For anyone who wants protection or has risk factors, including chronic liver disease or travel | Two‑dose series or Twinrix options. (cdc.gov) |
HPV | Yes | Through age 26 routinely, ages 27–45 by shared decision | Use a 3‑dose series if immunocompromised. (cdc.gov) |
Shingles (RZV, Shingrix) | Yes | Age 50+ routinely. Also age 19+ if immunosuppressed | Two doses 2–6 months apart. This is not a live vaccine. (cdc.gov) |
RSV | Yes | Single lifetime dose for all adults 75+. For ages 60–74, give one dose if at increased risk of severe RSV | Not an annual vaccine at this time. Best given late summer to early fall. (cdc.gov) |
Live vaccines: who can get them and when
Measles, mumps, rubella (MMR) and varicella (chickenpox) are live vaccines. They are contraindicated during moderate to severe immunosuppression. If there is no evidence of immunity and immunosuppression is not yet started, give two doses 4–8 weeks apart, then wait 4 weeks before starting therapy. (cdc.gov)
The live nasal spray flu vaccine and live travel vaccines such as oral typhoid and yellow fever are contraindicated during immunosuppression. Consider alternate inactivated options or adjust travel plans. (cdc.gov)
Travel and special situations
Travel vaccines: inactivated typhoid (shot), hepatitis A and B, Japanese encephalitis, and polio boosters are safe if indicated. Live yellow fever vaccine is contraindicated with significant immunosuppression. If travel cannot be deferred, discuss a medical waiver and strict mosquito bite prevention. (cdc.gov)
Asplenia: ensure Hib once in adulthood if not given, plus pneumococcal and meningococcal vaccinations per CDC schedules. (cdc.gov)
Practical vaccine plan at diagnosis or before therapy
Review records and give any due inactivated vaccines right away. Prioritize influenza, COVID‑19, pneumococcal, Tdap, and hepatitis B. (cdc.gov)
If non‑immune to MMR or varicella and time allows, complete live vaccines and wait 4 weeks before starting immunosuppression. (cdc.gov)
For hepatitis B, consider post‑vaccination anti‑HBs testing in immunocompromised adults to confirm protection and plan boosters if needed. Test 1–2 months after the final dose. (cdc.gov)
Once on therapy, continue all needed non‑live vaccines on schedule. Avoid live vaccines until immune function has recovered. (cdc.gov)
What recent IBD‑specific guidelines say
Gastroenterology guidelines emphasize early vaccination, use of non‑live vaccines during therapy, and prompt pneumococcal, influenza, COVID‑19, and zoster vaccination, with schedules aligned to CDC. The American College of Gastroenterology issued an updated preventive care guideline in 2025 that reinforces these priorities for adults with IBD. (journals.lww.com)
FAQs
Are vaccines less effective during IBD treatment
They can be. Some medicines blunt responses. Even with lower responses, vaccines still lower the risk of severe infection, so vaccination is advised. Timing doses before therapy can help when possible. (cdc.gov)
Which vaccines should close contacts get
Contacts should get all routine vaccines. They should avoid the nasal spray flu vaccine if they care for someone who is severely immunosuppressed in a protected environment. (cdc.gov)
Is RSV vaccine annual
No. For adults, it is a one‑time dose at this time. Adults 75+ should get it, and adults 60–74 at higher risk should get it. (cdc.gov)
What about shingles if someone had chickenpox before
Prior infection does not change the need for Shingrix. It is recommended at age 50+, and at 19+ for those who are or will be immunosuppressed. (cdc.gov)
Editor note: This article summarizes CDC and specialty‑society guidance and is educational. Individual plans should be set with the clinical team.