American College of Gastroenterology
Advancing Gastroenterology, Improving Patient Care

Inflammatory Bowel Disease (IBD) Vaccination Schedule for Adults (Age>18)


  • Why is it important for me to get vaccines?

    If you suffer from inflammatory bowel disease (IBD), general health maintenance is an important part of staying healthy. Part of this includes getting vaccinated. We recommend you get vaccinated to avoid getting sick from infectious illnesses that are preventable.

    In general, you will follow the same vaccination schedule as the rest of the population. An important exception to this is if you have a weak immune system from drugs like steroids at high doses, immunomodulators, and certain biologics that we use to treat IBD.

    You, your gastroenterologist, and your general physician should work together to make sure you are properly vaccinated. Ideally, this should be when you are first diagnosed with the disease. It is important to note that you should not receive certain vaccines, called “live vaccines,” if your immune system is weak from medications we use to treat your IBD. Remember that there is no evidence to suggest that getting vaccinated will cause your IBD to become active.

    Below is a list of medications often used to treat IBD, which can weaken your immune system to varying degrees:

    • Steroids (i.e. prednisone) at dosages >20 mg daily for >2 weeks, or exposure to the drug within the previous 3 months at any dose
    • Immunomodulators
      • Azathioprine (Imuran®, Azasan®) at dosages >3 mg/kg daily or exposure to the drug within the previous 3 months at this dose
      • 6-mercaptopurine (6-MP, Purinethol®) >1.5 mg/kg day or exposure to the drug within the previous 3 months at this dose
      • Methotrexate (MTX, Rheumatrex®, Mexate®) >0.4 mg/kg weekly (by mouth or by injection) or exposure to the drug within the previous 3 months at this dose
    • Biologics
      • Infliximab (Remicade®), adalimumab (Humira®), certolizumab (Cimzia®), golimumab (Simponi®), natalizumab (Tysabri®)

    Vedolizumab (Entyvio®) vedolizumab is less associated with a weakened immune system but it is still advisable to receive vaccines... also need to add ustekinumab and tofa. This biologic, targeted specifically towards the immune system of the gastrointestinal tract , rather than the body as a whole, and as a result does not appear to weaken your immune system like the others listed above.

  • What are some other key things I should think about with vaccines?

    Household contacts
    Keeping yourself safe and healthy also means you need to make sure those who live with you are taken into account. If a member of your household receives live vaccines you need to be made aware. If a household member receives a live vaccine and develops a rash, you should avoid contact with the rash.

    Travel outside of the country
    You will also need to think about getting the right vaccines to keep you safe when you travel abroad. It’s always important to let your gastroenterologist know if you are planning to travel outside of the country, because you may need special vaccines if your immune system is weak. In some cases, your doctor may tell you it is unsafe to travel to an area because you are not able to safely receive certain vaccines.

    Pregnant mothers
    If you have IBD and have recently given birth, there are also steps you should take to keep your newborn healthy. If you are on drugs like infliximab (Remicade®) and adalimumab (Humira®), your baby should not receive a vaccine called rotavirus. This vaccine is usually given to infants. Talk to your pediatrician about your health and the drugs you are taking for your disease.

  • How do I take charge of my general health?

    It can be tough to keep track of the vaccines you receive over the years. Below is a chart of common, vaccine-preventable illnesses. Use the chart to write down which vaccines you have received, and when. Share this cart with your gastroenterologist and general physician.

    Recommended Vaccines for Adults with Inflammatory Bowel Disease (IBD)
    Common Vaccine-Preventable Illnesses Date(s) you received the vaccine Next due? Can I get this vaccine if my immune system is weak?1,2
    Hepatitis A virus Y
    Hepatitis B virus Y
    HPV (Human papillomavirus) [for men/women 9-26 years old] Y
    Influenza (injectable only) Yearly Y
    Meningococcal disease [for college students, military personnel, those who are asplenic, have complement deficiencies, and traveling to areas where meningococcal disease is endemic] Y
    Pneumococcal disease 3 Every 5 years Y
    Tdap (tetanus, diphtheria, & pertussis) Every 10 years Y
    Influenza (intranasal only) Yearly N
    Measles, mumps, and rubella (MMR) N
    Varicella (chicken pox)4
    Zoster (shingles)5 [for men/women ≥60 years old) N

    Vaccines for travel not routinely recommended in U.S.6,2

    1. Typhoid (oral)
    2. Yellow fever
    1. If you are on prednisone >20 mg/d for >2 weeks, high doses of immunomodulators as listed above, or any dose of the biologics listed above, or plan to take these medications within 4 weeks (at the doses listed), you should avoid live vaccines.
    2. If you are traveling to an area where the disease is very common, and it is not safe for you to get a vaccine against this disease, it is recommended you avoid travel to this region.
    3. All those >65 years old should receive the pneumococcal vaccine; if your immune system is weak, you should also get the pneumococcal vaccine. There are two different types of pneumococcal vaccines.
    4. You may consider receiving the varicella if you are taking low doses of prednisone or immunomodulators. Speak with your gastroenterologist about this. You cannot receive this vaccine if your immune system is weak. .
    5. You cannot receive this vaccine if your immune system is weak. The Center for Disease Control (CDC) recommendations, you can safely receive the Zoster vaccine if you are >60 years old and you are taking low doses of prednisone or immunomodulators. Speak with your gastroenterologist about this.
    6. When traveling abroad, talk to your gastroenterologist and a travel specialist to determine which vaccines you need, and which are safe for you before you travel.

Author(s) and Publication Date(s)

Sophie M. Balzora, MD, NYU School of Medicine and NYU Langone Medical Center, New York, NY – Published August 2016