Before Starting Biologics for UC: TB/Hep B Screening + Vaccine Checklist
Last Updated Jan 15, 2026
Starting a biologic for ulcerative colitis (UC) can be a big step, especially when treatment is escalating. Because biologics calm parts of the immune system, they can raise the chance of certain infections. A short pre-start plan, including screening tests and vaccines, can help the care team lower preventable risks and avoid delays later.
TB (tuberculosis) and hepatitis B screening, what to ask and why it matters
Many gastroenterology teams use a biologic safety checklist before the first dose. Two common “must-check” infections are tuberculosis (TB) and hepatitis B, because these infections can be silent for years and may flare when immunity is lowered.
TB test before biologics: Screening often includes a risk review (past exposure, travel, work settings), a TB blood test called an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST), and a chest X-ray when needed. If latent TB infection (infection is present but inactive) is found before biologic therapy, treatment is typically planned before or alongside the biologic start, depending on urgency and specialist input. [1]
Hepatitis B screening biologics: Hepatitis B virus testing is commonly done as a “triple panel” blood test: hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), and total antibody to hepatitis B core antigen (total anti-HBc). This combination helps sort out whether someone is currently infected, immune from vaccination, immune from past infection, or still at risk and may need vaccination. [2]
Key questions to bring to the visit (or send in a message):
- Which TB screening method is being used (IGRA blood test, skin test, chest X-ray), and when are results expected?
- What exactly were the hepatitis B results (HBsAg, anti-HBs, total anti-HBc), and what do they mean in plain language?
- Is hepatitis B vaccination recommended before starting, and will immunity be rechecked later?
- If screening is positive, will an infectious disease or liver specialist be involved before the first dose?
This kind of clarity can reduce stress and prevent last-minute surprises right before the infusion or injection start.
Vaccine checklist and timing before immunosuppression (and what to do if time is short)
When people search “vaccines before biologics ulcerative colitis,” the main goal is usually timing. Vaccines work best when the immune system can respond fully, so many clinicians try to review immunizations early, ideally before immunosuppression begins.
A practical vaccine checklist often includes:
- Flu (influenza) shot every year (avoid the live nasal spray option when immunosuppressed)
- COVID-19 according to current public health recommendations
- Pneumococcal (pneumonia) vaccination (type and schedule depend on age and prior vaccines)
- Hepatitis B vaccination when not immune
- Human papillomavirus (HPV) vaccine when eligible
- Shingles protection using the recombinant (non-live) vaccine when eligible
- Review of live vaccines status (for example measles, mumps, rubella [MMR] and varicella/chickenpox), since live vaccines are generally not used during systemic immunosuppression and may need to be completed ahead of time [3]
Timing basics: When immunosuppressive therapy is being started, the Centers for Disease Control and Prevention (CDC) notes that clinicians generally wait about 4 weeks after a live vaccine and about 2 weeks after a non-live vaccine before beginning immunosuppressive medications, when feasible. [4]
If UC symptoms require a faster start, the care team may prioritize what can be done immediately (for example, many non-live vaccines) and document what should be revisited later. The main “quick win” is making sure the vaccine plan, TB test before biologics, and hepatitis B screening biologics are all discussed together, so timing decisions are coordinated instead of rushed.