IBD Vaccine NavigatorAdult GI clinic discussion guide

Evidence, provenance, and update log

References and source map

Sources supplied in the two OpenEvidence documents are listed separately from current U.S. vaccine guidance added during review. Where recommendations differ by publication date or organization, the reconciliation section states exactly how the web tool handles the difference.

Source provenance

Two-layer evidence model

Layer 1: the IBD-specific framework and therapy effects come from the references named in the uploaded OpenEvidence documents. Layer 2: age cutoffs, vaccine products, and current-season rules are checked against current CDC/ACIP pages. This distinction prevents older schedule details from being silently presented as current.

The web tool is a transparent counseling aid rather than an autonomous clinical decision support system. It intentionally avoids calculating exact catch-up schedules when prior products or dose dates are unknown. Those pathways should be checked in the current CDC schedule, its addendum, or a validated immunization forecaster.

References supplied in the OpenEvidence documents

The first six references were listed in the uploaded document's formal reference section. The final two were cited by author and year in the second uploaded document and are included so that every named source is visible.

  1. OpenEvidence source OE-1 Caldera F, Kane S, Long M, Hashash JG. AGA Clinical Practice Update on Noncolorectal Cancer Screening and Vaccinations in Patients With Inflammatory Bowel Disease: Expert Review. Clinical Gastroenterology and Hepatology. 2025;23(5):695–706. doi:10.1016/j.cgh.2024.12.011. PMID: 39800200.
    DOI PubMed Journal full text
  2. OpenEvidence source OE-2 Benchimol EI, Tse F, Carroll MW, et al. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 1: Live Vaccines. Gastroenterology. 2021;161(2):669–680.e0. doi:10.1053/j.gastro.2020.12.079. PMID: 33617891.
    DOI PubMed
  3. OpenEvidence source OE-3 Jones JL, Tse F, Carroll MW, et al. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines. Gastroenterology. 2021;161(2):681–700. doi:10.1053/j.gastro.2021.04.034. PMID: 34334167.
    DOI PubMed
  4. OpenEvidence source OE-4 Farraye FA, Melmed GY, Lichtenstein GR, Barnes EL, Limketkai BN, Caldera F, Kane S. ACG Clinical Guideline Update: Preventive Care in Inflammatory Bowel Disease. The American Journal of Gastroenterology. 2025;120(7):1447–1473. doi:10.14309/ajg.0000000000003541. PMID: 40701559.
    DOI PubMed
  5. OpenEvidence source OE-5 Leong RW, Sakiris A, Arzivian A, et al. Consensus Statements on Assessments and Vaccinations Prior to Commencement of Advanced Therapies for the Treatment of Inflammatory Bowel Diseases. Alimentary Pharmacology & Therapeutics. 2025;61(1):132–144. doi:10.1111/apt.18318. PMID: 39387155.
    DOI PubMed
  6. OpenEvidence source OE-6 Nguyen DL, Nguyen ET, Bechtold ML. Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis. Digestive Diseases and Sciences. 2015;60(8):2446–2453. doi:10.1007/s10620-015-3631-y. PMID: 25796579.
    DOI PubMed
  7. Named in uploaded content Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease. The American Journal of Gastroenterology. 2017;112(2):241–258. doi:10.1038/ajg.2016.537. PMID: 28071656.
    DOI PubMed
  8. Named in uploaded content Lichtenstein GR, Loftus EV Jr, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn's Disease in Adults. The American Journal of Gastroenterology. 2018;113(4):481–517. doi:10.1038/ajg.2018.27. PMID: 29610508.
    DOI PubMed

Current sources added during web review

These official U.S. sources supply current age cutoffs, risk groups, seasonal recommendations, and vaccine-specific timing. Pages were reviewed September 4, 2026.

  1. Added source CDC-SCHEDULE Centers for Disease Control and Prevention. Adult Immunization Schedule and Schedule Notes, United States. Current adult schedule hub, condition table, notes, contraindications, and addendum. The website should be rechecked after every ACIP update.
    Adult schedule Schedule notes Addendum
  2. Added source CDC-AI Centers for Disease Control and Prevention. Altered Immunocompetence: General Best Practice Guidelines for Immunization. Defines high-dose corticosteroid exposure, non-live vaccine safety, and timing before/after immunosuppression.
    CDC guidance
  3. Added source CDC-PCV Centers for Disease Control and Prevention. Pneumococcal Vaccine Recommendations and Recommended Vaccines for Adults. Current routine age and risk-based pathways, including PCV15, PCV20, PCV21, and PPSV23 sequencing.
    Clinician recommendations Adult overview
  4. Added source CDC-RZV Centers for Disease Control and Prevention. Clinical Considerations for Shingrix Use in Immunocompromised Adults Aged 19 Years and Older. Two-dose recombinant zoster schedule and timing around periods of more intense immunosuppression.
    CDC guidance
  5. Added source CDC-RSV Centers for Disease Control and Prevention. RSV Vaccine Guidance for Adults. Updated February 24, 2026: one dose for all adults age 75+ and adults age 50–74 at increased risk; not currently annual.
    CDC guidance
  6. Added source CDC-COVID Centers for Disease Control and Prevention. 2025–2026 COVID-19 Vaccination Guidance and Guidance for People Who Are Immunocompromised. Individual-based decision-making, vaccination-history-dependent dosing, and modified schedules for moderate or severe immunocompromise.
    Routine guidance Immunocompromised schedule
  7. Added source CDC-FLU Centers for Disease Control and Prevention. ACIP Recommendations Summary: Influenza, 2025–2026 Season. Annual influenza vaccination and age-specific product preferences.
    CDC / ACIP summary
  8. Added source CDC-HBV Centers for Disease Control and Prevention. Hepatitis B Vaccine Administration. Updated September 18, 2025: adult vaccine eligibility, triple-panel screening, and available series.
    CDC guidance
  9. Added source CDC-HPV Centers for Disease Control and Prevention. HPV Vaccine Recommendations. Routine and catch-up vaccination through age 26, shared decision-making ages 27–45, and dose schedules.
    CDC guidance
  10. Added source CDC-MMR Centers for Disease Control and Prevention. Measles Vaccination and Clinical Questions About Measles. Evidence of immunity, adult dose indications, and live-vaccine contraindications.
    CDC vaccine guidance Clinical questions
  11. Added source CDC-VAR Centers for Disease Control and Prevention. Varicella Vaccine Recommendations. Evidence of immunity, two-dose adult series, and limitations of commercial assays for vaccine-induced immunity.
    CDC guidance

Evidence reconciliation decisions

These are the main places where the uploaded content, IBD specialty guidance, and current CDC pages do not use the same wording or cutoff.

RSV age and risk group

The uploaded documents reflect 2025 IBD guidance, including either age 75+ plus age 60–74 with risk or an AGA recommendation for all adults with IBD age 60+. CDC's February 2026 guidance recommends one dose for all adults age 75+ and adults age 50–74 at increased risk, including moderate or severe immune compromise.

Tool decision: use current CDC eligibility in the primary result, while displaying the broader AGA 2025 recommendation as a clinician discussion note for ages 60–74.

Pneumococcal eligibility in younger adults

AGA 2025 recommends initial pneumococcal vaccination for all adults with IBD ages 19–64. Current CDC routine guidance recommends vaccination for all adults age 50+ and adults age 19–49 with a qualifying risk condition, including iatrogenic immunosuppression.

Tool decision: mark vaccination as recommended for age 50+ or qualifying immunosuppression; for younger non-immunosuppressed adults with IBD, show a transparent “discuss” card rather than hiding the specialty recommendation.

How long to wait after corticosteroids before a live vaccine

The uploaded IBD content uses a broad 3-month post-immunosuppression interval. CDC specifically states at least 1 month after stopping high-dose systemic corticosteroids given for at least 14 days.

Tool decision: use the CDC 1-month interval when high-dose corticosteroid is the only relevant exposure. For biologics, JAK/S1P agents, immunomodulators, or combinations, show an agent-specific warning and the commonly used IBD interval of at least 3 months rather than applying the steroid rule to every drug.

COVID-19 recommendation language

The uploaded content says to follow ACIP. The current 2025–2026 CDC schedule uses individual-based decision-making and a modified schedule for moderate or severe immunocompromise.

Tool decision: avoid hard-coding a dose count. Link to the current schedule and clearly state that vaccination should not be delayed solely because immunosuppressive therapy is underway.

Recombinant zoster interval

AGA's IBD table describes a 4–8 week interval during immune-modifying therapy. CDC describes the standard 2–6 month interval and permits shortening to 1–2 months when faster completion would help avoid more intense immunosuppression.

Tool decision: present the CDC wording in the patient-facing card and retain the IBD rationale in the source note.

Recommendation source map

Every major rule in the interactive plan maps to at least one IBD-specific source and/or current vaccine authority.

RecommendationPrimary source(s)How used
Review vaccination at diagnosis and before therapyOE-1, OE-2, OE-4, OE-5Golden rules and pre-treatment checklist
Non-live vaccines are safe in IBDOE-1, OE-3, CDC-AIGlobal safety banner and therapy cards
Live vaccines and immunosuppressionOE-2, CDC-AI, vaccine-specific CDC pagesLive-vaccine status engine
Prednisone thresholdOE-2, CDC-AIAt least 20 mg/day (or 2 mg/kg/day) for at least 14 days
Anti-TNF response attenuationOE-1, OE-3, OE-6Therapy note and pre-treatment emphasis
Vedolizumab / ustekinumab responseOE-1, OE-4Therapy-specific counseling with uncertainty note
Hepatitis B triple panel and challenge doseOE-1, OE-5, CDC-HBVVaccine card and clinic checklist
InfluenzaOE-1, CDC-FLUAnnual non-live vaccine and product preference
PneumococcalOE-1, OE-4, CDC-PCVCurrent age/risk pathway with specialty-guidance note
Recombinant zosterOE-1, OE-4, CDC-RZVAge 50+ or immunocompromised age 19+; two-dose timing
RSVOE-1, CDC-RSVCurrent CDC eligibility with AGA 2025 difference displayed
COVID-19CDC-COVIDCurrent-season shared decision and modified schedule link
HPV, MMR, varicella, Tdap/Td, HepACDC-SCHEDULE, CDC-HPV, CDC-MMR, CDC-VARUniversal vaccine table and age/risk logic

Maintenance and clinical governance

Review before clinical deployment

A designated GI clinician, pharmacist, infection-prevention specialist, and clinic governance owner should approve the local wording, verify medication classes and product labels, define who may place vaccine orders, and establish an update process. Recheck the site after every ACIP meeting, every annual influenza/COVID formulation change, and any IBD guideline or drug-label update.

Current content review date: September 4, 2026. Jurisdiction: United States, adults age 19+. Data handling: static client-side page; no form submission, analytics, cookies, local storage, or server-side patient data.