saudigastro.com/patients/ibd-vaccines-infections
Category
Chronic
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Inflammatory bowel disease (IBD), meaning Crohn's disease and ulcerative colitis, is treated with medicines that calm the immune system. These medicines (steroids, immunomodulators, and many biologic and small-molecule drugs) can make it harder for the body to fight infections. Vaccination before or during treatment reduces the risk of serious infections such as influenza, pneumonia, hepatitis B and shingles.
How common is it?
Infections are among the more common problems for people with IBD on immune-suppressing treatment, and many vaccine-preventable infections are avoidable. Despite this, vaccination is often missed, so asking about your vaccines at the start of treatment is worthwhile.
Why does it happen?
Immune-lowering medicines reduce the body's defence, so infections can be more frequent or more severe, and some dormant infections (such as tuberculosis or hepatitis B) can wake up. Live vaccines, which contain a weakened living germ, may cause infection in people with a weakened immune system and are generally avoided while on strong immune-lowering treatment. Vaccines made from inactivated (killed) germs or parts of germs are safe, though the response may be weaker on some medicines.
Symptoms
- Fever, chills or night sweats
- Cough, sore throat or breathlessness
- Painful blistering rash on one side of the body (shingles)
- Burning urine, skin infections or mouth sores
- Diarrhea that is different from your usual flare pattern (could be infection)
- Persistent tiredness, weight loss or cough (tuberculosis or other chronic infections)
Red flags — seek urgent medical care
Fever of 38 degrees Celsius or higher while on immune-lowering medicines
Infection can progress quickly. Contact your doctor the same day, or go to emergency if unwell.
Breathlessness, chest pain or a worsening cough
May be pneumonia or another serious chest infection. Seek urgent care.
Blistering rash with pain, especially near the eye
Shingles can be more serious on immune-lowering treatment; see a doctor urgently.
Severe diarrhea with fever or blood
Could be an infection or a flare. Get tested promptly.
Confusion, severe headache or neck stiffness
May be meningitis or another serious infection. Emergency care now.
How is it diagnosed?
Before starting treatment, your team usually checks your vaccination history and tests for infections that could reactivate: hepatitis B (and often hepatitis C), tuberculosis (skin or blood test, chest X-ray when needed), and sometimes chickenpox immunity (varicella antibody) and HIV. When you are unwell, they test for infection with blood, stool, urine or chest tests.
What the latest science says
Guidelines from major IBD and gastroenterology societies recommend reviewing vaccines at diagnosis and giving inactivated vaccines (influenza, pneumococcal, COVID-19, hepatitis B, HPV and recombinant shingles vaccine as appropriate) as needed, ideally before starting strong immune-lowering therapy. Some people on certain medicines may need extra doses or antibody checks. Recommendations are updated regularly, so your doctor will confirm what applies to you.
Outlook — what to expect
With vaccination and sensible precautions, most people with IBD can safely stay on the treatment that keeps their disease controlled. Preventing infection helps prevent hospital stays and interruptions to treatment.
Treatment
Habits & Lifestyle
Simple daily habits reduce infection risk.
- Wash hands often and avoid close contact with people who are clearly sick.
- Keep a record of your vaccines and bring it to appointments.
- Check with your IBD team before any travel vaccine, especially live vaccines.
- Stop smoking, take care of your skin and mouth, and have regular dental checks.
- Check household members' vaccines are up to date; some can protect you indirectly.
Diet
Food safety matters more when your immunity is lowered.
- Cook meat, poultry, eggs and fish thoroughly.
- Avoid unpasteurised milk and soft cheeses made from it.
- Wash fruit and vegetables and keep raw and cooked foods separate.
- Use safe drinking water, particularly when travelling.
Medications
Vaccines and protective medicines are part of IBD care.
- Inactivated vaccines (for example influenza each year, pneumococcal, hepatitis B, COVID-19, HPV, recombinant shingles) are considered safe on IBD treatment.
- Live vaccines (for example MMR, varicella, yellow fever) are usually avoided while on strong immune-lowering treatment; where needed, they are given in advance or after a planned break, only on your doctor's advice.
- If hepatitis B or latent tuberculosis is found, protective treatment may be started before or alongside your IBD medicine.
- Do not start antibiotics or stop IBD medicines on your own when you have a fever; call your team.
Procedures & Surgery
There is no procedure for this topic. Testing is the main step.
- Screening blood tests and a TB test before starting biologic or similar treatment.
- Chest X-ray when tuberculosis screening is positive or unclear.
- Check antibody levels after some vaccines (for example hepatitis B) to confirm protection.
In the Saudi context
Before Umrah or Hajj, or other travel, speak with your IBD team early about required and recommended vaccines, as some travel vaccines are live and may not be suitable for you.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Which vaccines do I need, and which should I avoid on my medicine?
- Should I be vaccinated before I start a new treatment?
- Have I been tested for hepatitis B and tuberculosis?
- What should I do if I get a fever while on treatment?
- Are my family's vaccines safe for me to be around?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide