Infection Prevention & Vaccinations

Keeping infections at bay is a core part of IBD care, especially when immune‑modifying medicines are used. This guide explains what to screen for before treatment, which vaccines are recommended, and how to time them. Most vaccines are safe during therapy. Live vaccines are different and usually need to be given before treatment starts. A short, proactive plan lowers risk and avoids delays later.

Key takeaways

• Screen before immune‑modifying therapy: tuberculosis (TB), hepatitis B triple panel, consider hepatitis C and HIV, and check varicella immunity if uncertain. (cdc.gov)

• Give vaccines before therapy when possible, ideally 2 weeks for non‑live and 4 weeks for live vaccines. Household contacts should be fully vaccinated. (cdc.gov)

• Pneumococcal: one dose of PCV20 or PCV21 completes the series for most adults who are vaccine‑naïve. If PCV15 is used, add PPSV23, with shorter intervals allowed in immunocompromised adults. (cdc.gov)

• Shingles: recombinant zoster vaccine (Shingrix) is recommended as a 2‑dose series for immunocompromised adults starting at age 19. (cdc.gov)

• Respiratory viruses: annual inactivated influenza and up‑to‑date COVID‑19 vaccination, with extra 2024–25 doses for immunocompromised people; a single RSV vaccine dose for adults 75+, and for ages 60–74 at increased risk (immunosuppression included). (cdc.gov)

Who counts as “immunosuppressed” in IBD

Medicines that can blunt vaccine responses or increase live‑vaccine risks include systemic corticosteroids at high dose, thiopurines, methotrexate, anti‑TNF agents, IL‑12/23 or IL‑23 inhibitors, JAK inhibitors, and S1P modulators. Non‑live vaccines are safe to give, though responses may be lower. Live vaccines are generally avoided during therapy. (cdc.gov)

Pre‑treatment infection screening checklist

• Tuberculosis: IGRA or TST with chest imaging based on risk, and treat latent TB before high‑risk drugs, especially anti‑TNF and JAK inhibitors. Short rifamycin‑based regimens are preferred. (cdc.gov)

• Hepatitis B: one‑time triple panel for all adults (HBsAg, anti‑HBs, anti‑HBc). Vaccinate if non‑immune; plan antiviral prophylaxis or monitoring if HBsAg positive or anti‑HBc positive when starting immunosuppression. (cdc.gov)

• Consider testing for hepatitis C and HIV, and document varicella history or IgG if uncertain. Use a standardized opportunistic infection checklist at diagnosis. (academic.oup.com)

Vaccination plan and timing

When time allows, give non‑live vaccines at least 2 weeks and live vaccines 4 weeks before starting immune‑modifying therapy. If urgent treatment is needed, start therapy and continue with indicated non‑live vaccines; avoid live vaccines until off high‑level immunosuppression. Encourage all household contacts to stay current on vaccines to reduce exposure risk. (cdc.gov)

Core adult vaccines for people with IBD

These recommendations reflect current CDC and ACIP guidance for adults, with IBD‑specific emphasis from ACG’s 2025 preventive care update. (cdc.gov)

Preventing specific infections during therapy

• Tuberculosis: Treat latent TB before starting anti‑TNF or other high‑risk agents when possible. Short‑course options include 3 months of once‑weekly isoniazid plus rifapentine, or 4 months of daily rifampin. (cdc.gov)

• Hepatitis B: Universal one‑time triple‑panel screening is now recommended for all adults. Non‑immune adults should be vaccinated, and those at risk of reactivation should receive antiviral prophylaxis or close monitoring when immunosuppression is used. (cdc.gov)

• Pneumocystis jirovecii pneumonia (PJP): Routine prophylaxis is not needed for most, but consider trimethoprim‑sulfamethoxazole in higher‑risk situations such as triple immunosuppression, use of calcineurin inhibitors, high‑dose steroids, older age, or lymphopenia. (academic.oup.com)

Travel and household protection

Live travel vaccines, such as yellow fever, are usually contraindicated during immunosuppression. Plan early with a travel clinic to review destinations and alternatives. Household contacts should receive all routine vaccines, including MMR and varicella. If a contact develops a post‑varicella‑vaccine rash, close contact with the immunosuppressed person should be avoided until it resolves; hand hygiene is advised after diaper changes for infants who received rotavirus vaccine. (cdc.gov)

FAQs

Can vaccines trigger an IBD flare

Non‑live vaccines are safe in IBD, and studies show good safety even during immune‑modifying therapy. Timing before therapy can improve antibody responses, but treatment should not be delayed when care is urgent. (cdc.gov)

What if pneumococcal or COVID‑19 doses were given in past years

Follow the current CDC job aids to complete or update pneumococcal series based on prior doses. For COVID‑19, people who are moderately or severely immunocompromised may receive additional 2024–25 doses at least 2 months apart under clinical guidance. (cdc.gov)

Should family members avoid vaccines

No. Vaccinating close contacts lowers risk for the person with IBD. Only a few precautions are needed after varicella and infant rotavirus vaccination as noted above. (cdc.gov)

Editor note: source required for local payer coverage details or clinic implementation tools.