Vaccinations and IBD

The management of inflammatory bowel disease (IBD) may include drugs that suppress your immune system. Most vaccines are safe for people with IBD but some vaccines contain ‘live’ weakened viruses (“live vaccines”) to boost your immunity against certain diseases. It is important to speak with your doctor about what vaccines are safe for you.

The management of inflammatory bowel disease (IBD) may include drugs that suppress your immune system. Before commencing treatment with a drug that alters your immune system, your IBD team will check your immunity to certain diseases and may ask you to undergo vaccination.

It is also important to speak to your IBD team about your travel plans to ensure any special travel vaccinations you need are up to date.

General information regarding vaccination

In general, it’s recommended that people with IBD stay up to date with vaccinations, according to the continually updated recommendations in the Australian Immunisation Handbook (AIH).

Most vaccines are considered safe for people with IBD. However, some vaccines contain a “live” weakened virus or bacterium to boost your immunity against the disease (see Table 1). Talk to your IBD team before you get any of these live vaccines to make sure you stay safe. The live vaccines are NOT recommended if you have already started taking medicine that suppresses your immune system (“immunosuppressive therapy”). They can be safely given to people with IBD at least 3 weeks before starting these medicines. You can ask your doctor for a medical exemption letter for the vaccines you can’t safely receive.

Medications that suppress the immune system include:

• Steroids (prednisolone)
• Immunomodulators such as azathioprine, mercaptopurine, methotrexate
• Biologics such as infliximab, adalimumab, vedolizumab, ustekinumab, golimumab
• Tofacitinib, upadacitinib, ozanimod and etrasimod
• Tacrolimus and cyclosporin

All people with IBD (whether or not they are taking medication) should have and remain up to date with the following vaccinations:

• Influenza (flu) vaccine every year
• Pneumococcal (pneumonia) vaccine
• Hepatitis B vaccine
• Human papilloma virus vaccine (if aged 9-18, or at any age if on the above immunosuppressive
  medications)
• Tetanus vaccine
• COVID-19 vaccine, depending on your age and how compromised your immune system is.

Eligible people with IBD (in line with the AIH and National Immunisation Program funding criteria) should also
remain up to date with the following vaccinations:

• respiratory syncytial virus (RSV) vaccine
  • Arexvy or Abrysvo vaccine for people aged 60 years or older who are taking immunosuppressive therapy
  • only Abrysvo vaccine for pregnant women at 28–36 weeks’ gestation
• shingles (herpes zoster) vaccine
  • Shingrix vaccine for people who are taking or have taken any of the following medicines within the past 6 months: high-dose conventional immunosuppressive agents (azathioprine, mercaptopurine, tioguanine, methotrexate, tacrolimus, cyclosporin), some biologic drugs (infliximab, adalimumab) and small-molecule therapies (upadacitinib, tofacitinib, ozanimod, etrasimod).

Most people with IBD will be checked for immunity to certain diseases, like chickenpox and hepatitis B, before
starting IBD medicines. You may also be checked to see if you have been exposed to tuberculosis (TB).
Your IBD team may recommend you get vaccinated against preventable diseases by your GP or community
pharmacist.

Specific situations regarding vaccination

Live vaccines and pregnancy and newborns

Pregnant women taking immunosuppressive therapy should avoid all live vaccines, including those for measles–mumps–rubella (MMR), and should talk to their IBD team or GP about other vaccines.

Table 1: Classification of vaccines

 = not recommended whilst on immunosuppressive therapy*	✓ = safe whilst on immunosuppressive therapy
Live Vaccines Against Viruses	Inactivated Vaccines Against Viruses
 Japanese encephalitis (depends on brand)  Measles/mumps/rubella (MMR)  Measles/mumps/rubella/varicella (MMRV)  Varicella (chickenpox)  Yellow fever  Influenza- intranasal (FluMist)	✓ COVID-19 ✓ Hepatitis A ✓ Hepatitis B ✓ Human papilloma virus (HPV) ✓ Influenza (flu)- Injectable ✓ Inactivated poliomyelitis (IPV) ✓ Japanese encephalitis (depends on brand) ✓ Rabies ✓ Recombinant non-live Herpes Zoster (shingles; Shingrix) ✓Respiratory syncytial virus (Abrysvo, Arexvy)
Live Vaccines Against Bacteria	Inactivated Vaccines Against Bacteria
 Oral typhoid  Tuberculosis (BCG)  Oral cholera (depends on brand)	✓ Diphtheria-tetanus (dT) ✓ Diphtheria-tetanus-pertussis (dTpa) ✓ Haemophilus influenza type B (HiB) ✓ Injectable typhoid ✓ Meningococcal ✓ Oral cholera (depends on brand) ✓ Pneumococcal (pneumonia) ✓ Q fever

Mothers taking biologic drugs should talk to their IBD team about vaccination of their infant, as medicines
taken during pregnancy can affect the safety of live vaccines for the baby. It is now recommended that the
rotavirus vaccine can be given to babies of mothers exposed to biologic medications in pregnancy. Please
discuss this with your doctor. You can ask your doctor for a medical exemption letter for the vaccines you can’t safely receive. Not being able to receive these vaccines may increase your or your children’s risk of acquiring a disease that you or they would otherwise be protected from.

Travel vaccinations

If you are planning travel, it is important to discuss this with your IBD team and doctors in travel clinics at least 6-8 weeks prior to leaving. This allows for vaccinations to be given to you if required and/or advised by your doctors. It would be advisable to attend an expert travel clinic to ensure you are adequately prepared for the regions you plan on visiting on your trip.

• As outlined above, if you are on certain medications for your IBD that suppress the immune system, you may find you cannot take live vaccinations (table 1 above).
• Consider your travel destination carefully. If diseases that you cannot get vaccinated against are present in the country of your travel, you should consider choosing a different destination if possible.
• Carry a vaccination card with you on your travel.
• For helpful travel tips, see our separate Travel and IBD information sheet.

Some travel vaccines, like those for hepatitis A and rabies, although safe, may not be as effective when you
are taking immunosuppressive therapy for IBD.

Discuss this with your doctors

Acknowledgements:

This resource was developed in 2025 by the GESA IBD Patient Information Materials Working Group.