Adult Vaccination Schedule for People With IBD

Adults with inflammatory bowel disease (IBD) face higher infection risks, especially when taking immune modifying medicines. Many of these infections are preventable with vaccines. This article explains which vaccines are safe for adults with IBD in the United States, how immunosuppression changes the plan, and when vaccines are ideally given before or during treatment.

Key Takeaways

• Non‑live vaccines (flu, COVID‑19, pneumococcal, hepatitis, HPV, shingles, RSV, Tdap) are safe for people with IBD, including those on immune modifying therapy. (journals.lww.com)

• Live vaccines (MMR, chickenpox, live shingles, nasal flu, yellow fever) are usually avoided during immunosuppression and are best given beforehand when possible. (academic.oup.com)

• At or soon after IBD diagnosis, care teams should review vaccine history, check immunity to hepatitis B and chickenpox, and plan needed vaccines before biologics or other immune modifying drugs. (journals.lww.com)

• Adult IBD guidelines recommend annual flu vaccination, age and risk based COVID‑19 doses, and pneumococcal and shingles vaccines for most older or immunosuppressed adults. (journals.lww.com)

• Vaccinating close household members according to standard schedules helps protect the person with IBD through a “cocoon” effect. (academic.oup.com)

Why vaccination matters in IBD

People with IBD have a higher risk of many infections than the general population. The risk rises further with medicines that weaken the immune system, such as steroids, thiopurines, methotrexate, biologics, JAK inhibitors, and S1P modulators. (journals.lww.com)

Influenza, pneumonia, shingles, and hepatitis B are all more common or more severe in IBD, yet vaccination rates remain lower than ideal. (pubmed.ncbi.nlm.nih.gov) Large reviews show that non‑live vaccines are safe in IBD and do not increase flare risk. (journals.lww.com)

Vaccine safety basics

Non‑live vs live vaccines

• Non‑live (inactivated or recombinant) vaccines contain killed germs or pieces of them. Examples include flu shots, COVID‑19 mRNA and protein vaccines, pneumococcal, hepatitis A and B, HPV, Tdap, recombinant shingles (Shingrix), and RSV vaccines. These are considered safe for people with IBD, even during immune modifying therapy. (journals.lww.com)

• Live attenuated vaccines contain a weakened form of the germ. Examples include MMR (measles, mumps, rubella), varicella (chickenpox), live zoster (older shingles vaccine), yellow fever, and the nasal spray flu vaccine. In people on immunosuppressive therapy, these vaccines can rarely cause disease, so major guidelines advise avoiding them in that setting. (academic.oup.com)

What counts as “immunosuppressed” in IBD

For vaccine decisions, a person with IBD is usually considered immunosuppressed if taking:

• Moderate or high dose systemic steroids

• Thiopurines (azathioprine, 6‑MP)

• Methotrexate

• Biologic drugs (anti‑TNF, anti‑integrin, anti‑IL‑12/23, anti‑IL‑23)

• JAK inhibitors

• S1P receptor modulators

5‑ASA medicines and rectal steroids alone are not usually considered significant systemic immunosuppression. (journals.lww.com)

Quick safety table

*Individual situations vary and should follow current CDC and gastroenterology guidance. (cdc.gov)

Practical adult vaccine plan for people with IBD (United States)

Step 1: At diagnosis or before immune modifying therapy

When IBD is first diagnosed, or before starting a biologic or other immune modifying medicine, care teams typically:

• Review all childhood and adult vaccines.

• Order blood tests for hepatitis B and varicella (chickenpox) immunity. (journals.lww.com)

• Give any needed live vaccines (MMR, varicella) at least about 3 to 4 weeks before starting immunosuppressive therapy when possible. (academic.oup.com)

Non‑live vaccines can usually be given either before or during therapy, although responses can be slightly weaker during treatment. (journals.lww.com)

Influenza (flu) vaccine

Guidelines advise annual flu vaccination for all adults with IBD. (journals.lww.com)

• Use the inactivated flu shot, not the nasal spray, for anyone on immune modifying therapy and for their close contacts. (mdcalc.com)

• Timing: once each fall or early winter.

COVID‑19 vaccines

As of 2025, U.S. policy uses “shared clinical decision making” for COVID‑19 vaccination, but chronic disease and immunosuppression remain important risk factors for severe illness. (washingtonpost.com)

Many professional groups recommend that adults with IBD, especially those on immune modifying drugs or with other risk factors, stay up to date with the current COVID‑19 schedule for their age and risk level. (journals.lww.com)

Pneumococcal (pneumonia) vaccines

Pneumococcal vaccines protect against serious lung and bloodstream infections.

• The 2025 U.S. adult schedule recommends a pneumococcal conjugate vaccine that covers 20 or 21 strains (PCV20 or PCV21) for all adults aged 50 and older, and for adults 19 to 49 with immunocompromising conditions, including those on IBD immune modifying therapy. (cdc.gov)

• Some people may also receive the older polysaccharide vaccine (PPSV23) depending on previous doses; this follows CDC rules.

Shingles (herpes zoster) vaccine

People with IBD have a higher risk of shingles, especially when using steroids, thiopurines, or biologics. (journals.lww.com)

• The recombinant zoster vaccine (RZV, Shingrix) is non‑live and given as 2 doses, usually 2 to 6 months apart.

• Updated IBD guidelines suggest this vaccine for all adults with IBD aged 50 and older, and for adults 19 and older on immune modifying therapy or about to start it. (journals.lww.com)

Hepatitis B (and often hepatitis A)

Hepatitis B can reactivate and become severe when immune modifying drugs are used. (journals.lww.com)

• All adults with IBD should be tested for hepatitis B infection and immunity.

• Those without immunity usually receive a full hepatitis B vaccine series, ideally before starting biologics or other strong immunosuppressants. Some may need higher‑dose or extra doses to respond. (journals.lww.com)

Hepatitis A vaccination is advised for people with chronic liver disease, certain exposures, or relevant travel, and should be considered in non‑immune IBD patients according to U.S. risk based guidance. (academic.oup.com)

HPV vaccine

Human papillomavirus (HPV) vaccines help prevent cervical, anal, and other cancers.

• Routine series is recommended for adolescents and young adults, with catch‑up through age 26.

• For ages 27 to 45, vaccination is based on shared decision making, especially for those with new or multiple partners. (cdc.gov)

Immunosuppression may increase HPV related cancer risk, so completing the series is particularly important in IBD. (journals.lww.com)

Tdap and Td vaccines

Adults need protection against tetanus, diphtheria, and pertussis (whooping cough).

• One Tdap dose in adulthood, then a Td or Tdap booster every 10 years, regardless of IBD status. (cdc.gov)

RSV vaccine

Respiratory syncytial virus (RSV) can cause severe lung infections in older and immunosuppressed adults.

• The 2025 schedule recommends RSV vaccination for all adults aged 75 and older, and risk based vaccination for adults 60 to 74 with conditions that increase RSV risk, including immunosuppression. (cdc.gov)

• The updated IBD guideline suggests RSV vaccination for all adults with IBD aged 75 and older and for those 50 to 74 with additional risk factors, such as significant IBD on immune modifying therapy or chronic lung or heart disease. (journals.lww.com)

Other and travel vaccines

Some adults with IBD also need other vaccines based on their situation:

• Meningococcal and Hib vaccines for those with an absent or poorly working spleen, or certain rare immune problems. (academic.oup.com)

• Mpox vaccine for people with higher sexual or occupational exposure risk. (cdc.gov)

• Travel vaccines, such as yellow fever or typhoid, which may be live or non‑live. Yellow fever and some other live travel vaccines are usually avoided during immunosuppression and require early planning with a travel or infectious diseases clinic. (academic.oup.com)

FAQs

Do vaccines trigger IBD flares?

Current evidence shows that non‑live vaccines do not increase flare risk in IBD. Most side effects are mild, such as a sore arm or short‑lived fatigue, and rates are similar to those in people without IBD. (journals.lww.com)

What if immune modifying therapy is starting very soon?

Ideally, live vaccines are given at least about 3 to 4 weeks before starting immunosuppressive therapy. If treatment cannot wait, care teams usually proceed with therapy and focus on non‑live vaccines, which can be given during treatment, accepting that responses may be slightly weaker. (academic.oup.com)

Should family members change their vaccines because someone at home has IBD?

Household members should stay fully vaccinated according to standard schedules. Live vaccines such as MMR, varicella, and live zoster can be safely given to close contacts in almost all cases and help protect the person with IBD. The main exception is rare situations of extreme immunosuppression, where clinicians may give special instructions. (academic.oup.com)