Ulcerative Colitis and Vaccines

Vaccines are part of routine preventive care for all Americans, but for people living with ulcerative colitis (UC), they play an even more important role in protecting against infections.

Staying up-to-date on vaccines is one of the simplest ways to protect your health. But for people with UC, it’s not always as straightforward as following the standard schedule. You’ll also need to consider your treatment plan and disease risk.

Recommended Vaccines for the UC Community

Vaccine recommendations for people with UC are similar to those for people who don't have the condition, says Alan Moss, MD, the chief scientific officer at the Crohn’s and Colitis Foundation and a professor of gastroenterology at Boston University.

“In general, adults with UC should follow the standard adult vaccination schedule — influenza, COVID-19, pneumonia, shingles, hepatitis A and B, Tdap — with some additional attention to age of vaccination and specific vaccines when specific immunosuppressive therapies are used,” Dr. Moss says.

• Influenza (flu) vaccine: Annually, using the injectable (non-live) version only
• COVID-19 vaccine and boosters
• Pneumococcal vaccines: Recommended at age 50, may be sooner if you take immunosuppressants
• Shingles (recombinant zoster) vaccine: Recommended at age 50, may be sooner if you take immunosuppressants
• Hepatitis A and B vaccines: In patients who don’t have immunity (determined by a blood test), especially before starting an immunosuppressive treatment
• Tdap (tetanus, diphtheria, pertussis): Booster every 10 years
• HPV vaccine

“Staying up-to-date is critical because it reduces preventable infections and their complications across your lifespan, and this remains important even if you are not currently on biologic therapy, since your treatment needs and infection risks can change over time,” Moss says.

Immunosuppression and Vaccines

Vaccines take on added importance in UC because both the disease and its treatment, medications that suppress your immune system, make you more likely to get an infection. And Moss says illness is more concerning for UC patients than the general public. “Any infection that occurs in patients with UC can trigger flares, hospitalizations, and complications at a time when your body’s defenses are not operating at full strength,” he says.

Another layer of risk comes from infections that can stay in your body for years without causing symptoms, but may surface when your immune system is compromised, says Anish Sheth, MD, a gastroenterologist and the codirector of the Center for Digestive Health at Penn Medicine Princeton Health in Plainsboro, New Jersey.

“Many of these what we call latent infections, infections that you can harbor without manifesting signs or symptoms, can reactivate when the immune system is suppressed,” Dr. Sheth says, noting that patients are often screened for infections like hepatitis B before starting biologic therapy for this reason.

Disease activity, such as when you’re in a flare, also plays a role. “When you're malnourished and you've lost weight and you're on a medicine that's going to suppress parts of your immune system, then the concern is that you're going to have a more complicated, severe course of that infection if you do get sick,” Sheth says.

But that doesn’t mean vaccination isn’t worthwhile. “By taking the vaccine, you hope to prevent getting the infection to begin with, but then even if you do contract it, the hope is that the infection will be less severe than it otherwise would have been,” Sheth says.

Live vs. Inactivated Vaccines

• Live-attenuated vaccines are made from a weakened form of a virus to trigger an immune response.
• Inactivated (non-live) vaccines use killed viruses or virus fragments, making them safer for people with weakened immune systems.

• Measles, mumps, and rubella (MMR)
• Varicella (chicken pox)
• Yellow fever and typhoid
• Nasal spray flu vaccine

Most routine vaccines for adults are non-live and safe to receive during treatment. “The flu shot that most of us get, which is the injection, is inactivated. There's no issue with that,” Sheth says. “And there are no issues with inactivated viruses in general.”

When to Get Vaccinated

You should discuss vaccinations with your doctor as soon as you get diagnosed with UC — ideally before you start treatment, says Victor Chedid, MD, a gastroenterologist specializing in IBD at the Mayo Clinic in Rochester, Minnesota, and spokesperson for the American Gastroenterological Association.

“We review the vaccine schedule with each patient during their IBD clinic visit and always collaborate with their primary care physicians or our IBD practice to make sure their vaccines are up to date,” Dr. Chedid says.

Getting caught up on vaccines before starting biologics, thiopurines, JAK inhibitors, or high-dose steroids maximizes your immune response, Moss says. “If possible, we prefer to give needed vaccines at least about four weeks before starting a new biologic or other strong immunosuppressive therapy, particularly for any live vaccines.”

Expect it to be part of the conversation in your ongoing care, Sheth says. You and your doctor should check in about your vaccination history before flu season or upcoming travel, for example, and before you start a new medication.