If you or a loved one is living with Inflammatory Bowel Disease (IBD), such as Crohn’s disease or ulcerative colitis, managing your health involves looking at the whole picture. Beyond managing flares and finding the right treatment plan, maintaining an up-to-date immunization status is a vital, evidence-based strategy to protect your health.
Individuals with IBD can be at an increased risk for certain vaccine-preventable illnesses. This vulnerability can stem from the disease itself or from the immunosuppressive therapies used to control inflammation. To clear up confusion and protect patients, the Canadian Association of Gastroenterology (CAG) has established clear clinical guidelines regarding both live and inactivated vaccines for adults and children living with IBD.
Three Golden Rules for IBD Immunizations
Regardless of where you are in your health journey, the guidelines highlight three core principles that every healthcare provider and patient should follow:
- Early and regular reviews. Your complete immunization history should be reviewed by your care team right at the time of your IBD diagnosis and updated at regular intervals.
- Timing is everything. To maximize safety and effectiveness, all appropriate vaccines should ideally be administered as soon as possible prior to starting any immunosuppressive therapies.
- No delays for urgent care. If your IBD is highly active and you require urgent immunosuppressive treatment, life-altering medical therapy should never be delayed just to fit in a vaccine.
The Crucial Distinction: Live vs. Inactivated Vaccines
Vaccines generally fall into two categories: live (attenuated) vaccines, which contain a weakened version of the living virus, and inactivated vaccines, which contain no live components.
Live Vaccines: MMR and Varicella
Because live vaccines contain a weakened version of a virus, their safety depends heavily on whether your immune system is currently being altered by medications.
For individuals not on immunosuppressive therapy, the Measles-Mumps-Rubella (MMR) vaccine is strongly recommended for both children and adults who are susceptible to these diseases. Similarly, the Varicella (chickenpox) vaccine is strongly recommended for susceptible children and suggested for susceptible adults.
For individuals on immunosuppressive therapy, the guidelines explicitly advise against administering the MMR and Varicella vaccines to both adults and children in this category due to potential safety concerns from a suppressed immune system.
Inactivated and Recombinant Vaccines: Safe and Recommended
Inactivated vaccines cannot replicate in the body, meaning they do not carry the same safety risks for immunosuppressed individuals. The CAG guidelines strongly recommend or suggest staying up-to-date on the following:
- Influenza (the flu shot): strongly recommended annually for both children and adults with IBD.
- Shingles (herpes zoster): the recombinant zoster vaccine is strongly recommended for adults aged 50 and older, and suggested for adults under 50 with IBD.
- Pneumococcal disease: age-appropriate pneumococcal vaccines are recommended for all children with IBD. For adults, it is recommended for those not on immunosuppressive therapy who have other existing risk factors, and suggested for all adults currently on immunosuppressive therapy.
- Hepatitis B: recommended for all children with IBD. For adults, it is strongly recommended if you have specific risk factors for infection, and suggested if you are unimmunized without specific risk factors.
- Tetanus, diphtheria, pertussis (whooping cough): routinely recommended for both children (age-appropriate formulations) and adults with IBD.
- Human papillomavirus (HPV): strongly recommended for females aged 9 to 26 and suggested for males aged 9 to 26.
- Other childhood essentials: age-appropriate meningococcal and Haemophilus influenzae type b (Hib) vaccines remain strongly recommended for children with IBD.
Areas Where More Research Is Needed
Medicine is constantly evolving, and clinical consensus requires robust evidence. Currently, there is not enough data for the CAG to recommend either for or against giving live vaccines in the first six months of life to infants whose mothers used biologic therapies during pregnancy, administering a double-dose of the hepatitis B vaccine in unimmunized adults on immunosuppressive therapy, designing specific timing protocols for seasonal flu shots in relation to when you receive your maintenance biologic dose, or recommending HPV vaccines for patients aged 27 to 45.
Your Next Steps
Protecting yourself against preventable infections is a core pillar of comprehensive IBD care. Because treatment plans change, the safest approach is to keep an open line of communication with your gastroenterologist and your family care team.
If you are living with IBD and planning to travel, book a travel health consultation at Destinations Travel & Immunization Clinic — bring a copy of your immunization records and current treatment plan so we can help you travel safely and stay protected without disrupting your ongoing IBD care.
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The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer