ACG Clinical Guideline 2025
Dr. Francis Farraye
IBD
IBD Preventive Care
Vaccinations, cancer screening, comorbidity management, and infection prevention in IBD — ACG 2025 Update.
Vaccinations in IBD
What, when, and which vaccines
Vaccination Is a Core IBD Care Standard
Patients on immunomodulators or biologics are at risk for vaccine-preventable infections. Vaccination should be reviewed and updated before starting immunosuppression.
⚠ LIVE Vaccines — CONTRAINDICATED on Immunosuppression
MMR (Measles, Mumps, Rubella)
Varicella (Chickenpox)
MMRV (ProQuad)
Yellow Fever
Oral Typhoid (Ty21a)
Intranasal Influenza (FluMist)
Zoster live (Zostavax) — use recombinant Shingrix instead
| Vaccine | Recommendation | Notes |
|---|---|---|
| Influenza (inactivated) | Annual — ALL IBD patients | Avoid live intranasal on immunosuppression |
| COVID-19 | Primary series + boosters per CDC | mRNA preferred; immunocompromised need extra dose |
| Pneumococcal (PCV20/PPSV23) | ALL IBD patients | PCV20 preferred; or PCV15 + PPSV23 at 1 yr |
| HBV | If non-immune | Check HBsAb; 3-dose series |
| HPV | Through age 45 (if not previously vaccinated) | 9-valent preferred |
| Shingrix (recombinant zoster) | Age ≥50 OR immunosuppressed at any age | 2-dose series; safe on all IBD therapies |
| Tdap/Td | Per standard adult schedule | Booster every 10 years |
Best Practice
Check and update ALL vaccines BEFORE starting immunosuppressive therapy. Once on biologics + immunomodulators, live vaccines are contraindicated. Document vaccination status at every visit.
Farraye FA et al. ACG Clinical Guideline Update: Preventive Care in IBD. Am J Gastroenterol. 2025.