Should You Get Vaccinated If You Are Taking a Biologic for IBD?
Medically reviewed by Robert Burakoff, MD, MPH
Being vaccinated against infections is a vital part of an overall healthcare plan for people who have inflammatory bowel disease (IBD). Staying up-to-date on immunizations is important for many reasons, but especially when biologic medications might be used in the future.
In general, the most beneficial time to give vaccinations is before a biologic is started, but some might also be given when they are needed after that.
People with IBD should check with their physicians about their vaccination status. Adults, in particular, may need a plan to get in all the recommended vaccinations they need. Being proactive about immunizations will be the best defense against preventable infections in the future.
In general, vaccinations are recommended before a patient starts on a biologic therapy. Immunization against common infections is necessary because biologic therapy suppresses the immune system. This means a person receiving a biologic drug may be more likely to get an infection.
Infections can cause a lot of harm and even mean the biologic has to be stopped for a time while the infection is resolved. That's not an outcome that would be beneficial for treating the underlying IBD, and that's why vaccinations are often given before starting a biologic drug, or even sometimes after.
Should Biologic Therapy Be Postponed for Vaccines?
A physician will be the best resource to answer this question, but in most cases, probably not. Many vaccinations could still be given after starting biologic therapy.
The type that is generally to be avoided is the live attenuated vaccines, or LAIVs, which are vaccines that contain a live virus.
As soon as biologics are discussed as a treatment option, vaccines should be part of the conversation.
Vaccines Recommended for Those Receiving Biologic Therapy
Every patient's vaccination plan will be different, based on the vaccinations they've already received and their risk of developing certain infections.
The physician administering the vaccines should work with the IBD patient to develop the plan that ensures full vaccination coverage. Some vaccinations are considered safe for those already undergoing treatment with biologics:
Hib vaccine: The Haemophilus influenzae type b (Hib) virus can cause meningitis, pneumonia, and other infections. This vaccine is routinely given in children and recommended in adults who never received it, including anyone receiving a biologic.
HPV vaccine: The human papillomavirus (HPV) vaccine is a series of three shots that are given to prevent infection with HPV. HPV has been linked to the development of several different forms of cancer of the reproductive system, as well as throat and anal cancer. The HPV vaccine is recommended up until the age of 26 for people who are immunocompromised (which includes IBD patients who receive biologic therapy).
Pneumococcal vaccine: This is an immunization against Streptococcus pneumoniae bacteria, which can cause many different types of illness. It is important that every patient receive this vaccination, with every effort made to give it before starting biologic therapy. This vaccination is more complicated because it is different for those who have received it before and for those who have never received it. Those who have received the vaccine in the past may need two immunizations, which are generally (but not always) given about a year apart. For IBD patients who have never received the pneumococcal vaccine, there may be three immunizations needed. A booster every five years is also recommended.
Seasonal flu shot: The seasonal flu shot is recommended for people with IBD, even those that are receiving a biologic therapy or are taking other drugs that suppress the immune system. The flu shot does not contain a live flu virus. The nasal spray mist is not recommended because it is a LAIV.
Tetanus: For people with IBD, the tetanus shot is recommended the same as it is in the general population. Tetanus shots should be given at least every 10 years, and more frequently if an accident happens, such as stepping on a rusty nail. The tetanus vaccine is also combined with other vaccines in the diphtheria/tetanus/pertussis (DTaP) vaccine. Adults who never received a pertussis vaccine may need the DTaP, which might be given in a series of three vaccines.
Vaccines Recommended In Certain Circumstances
Certain other vaccines may be given to adults with IBD who take biologics:
Hepatitis A vaccine: The hepatitis A virus may cause liver disease. This vaccine is recommended for all people at high risk of contracting the virus, including those on a biologic medication.
Hepatitis B vaccine: The hepatitis B virus can cause infection in the liver, which has the potential to become chronic. This vaccine is also recommended for those at high risk of contracting the hepatitis B virus.
Herpes zoster vaccine: The herpes zoster virus causes chickenpox and another condition called shingles. People who have had chickenpox may develop shingles, usually if they are over age of 60. The herpes zoster vaccine (Shingrix) is more than 90% effective at preventing shingles and complications caused by the herpes zoster virus. The American Gastroenterological Association recommends all adults over 50 and anyone ages 18 to 49 years with IBD who are treated with immunosuppression.
Meningococcal vaccine: The meningococcal vaccine protects against infection with a type of bacteria called Neisseria meningitidis. This vaccine might be needed for people who are at high risk of meningococcal disease, which includes infants, children, and young adults (especially those attending college).
Polio vaccine: The polio vaccine is no longer given routinely in the United States. It is usually recommended only for people who are at risk of contracting the virus that causes polio because of travel to an area of the world where it is still common.
Live Vaccines Not Recommended While Receiving Biologic Therapy
IBD patients receiving biologic medications should not receive vaccinations that contain live viruses. Ideally, if these vaccines are needed, they should be given before starting therapy with a biologic:
Chickenpox vaccine: The chickenpox vaccine helps prevent infection with the varicella-zoster virus. This vaccine is typically given to children in two doses. This is a LAIV, so in most cases, it would not be recommended for anyone who is currently taking a biologic. Newer research suggests this vaccine may not be so unsafe in patients receiving biologic therapy, but for now, the recommendations are to continue to avoid it.
Measles-mumps-rubella vaccine: The measles, mumps, and rubella (German measles) vaccine is routinely given to children. It's not recommended for people who are receiving a biologic because it is a LAIV.
A Word From Verywell
Immunology is a complex science and it becomes even more so in people who have a chronic illness like IBD. While there are guidelines as to what vaccines are recommended in people with IBD who are receiving a biologic, there are also exceptions. It's important for anyone with IBD to be up-to-date with vaccines, ideally before starting biologic therapy, because these drugs suppress the immune system.
However, many vaccines can still be given to a patient who is taking a biologic. The key to all of this is to have an open dialogue about vaccination with your healthcare professional before drugs that suppress the immune system are needed. Decisions about when to vaccinate and if to hold off on treatment until after vaccinating is an individual decision that should be made along with a gastroenterologist and/or an internist or family physician.
Correction - August 24, 2023: This article was updated to correct the recommendation for the herpes zoster vaccine, which is no longer a live vaccine.
