How to use it
Fill in the patient, disease and medicines. The clinician checklist groups screening, vaccines, cancer prevention, bone, mood, smoking and (if relevant) pregnancy, each with its source. The patient plan says the same things in plain language (aim: grade 8) and prints on its own page. Copy the chart note into the record; it has a checkbox per item.
“Immunosuppressed” here means any thiopurine, methotrexate, systemic steroid, biologic, JAK inhibitor or S1P modulator. Mesalamine, sulfasalazine and budesonide are not counted.
Vaccines at a glance (Canada, October 2026)
| Vaccine | Immunosuppressed adult | Not immunosuppressed |
|---|---|---|
| Influenza (inactivated) | Every year | Every year |
| COVID-19 | Two doses a year, at least 3 months apart (moderately–severely immunocompromised) | NACI age-based advice |
| Pneumococcal | One dose of Pneu-C-20 or Pneu-C-21; no repeats | At 65; earlier only with another risk condition |
| Shingles (RZV, Shingrix) | 2 doses from age 18 | 50+; can be considered under 50 (CAG) |
| RSV | 75+; 65–74 with increased risk; consider 18–64 (ECCO 2026: suggested at 60+) | 75+; 65–74 with increased risk |
| HPV | 9–26, 3 doses; 27–45 can be considered | 9–26; 27–45 can be considered |
| Hepatitis B | If not immune; check anti-HBs after | If not immune |
| MMR, varicella (live) | Contraindicated; give in a planned gap | If not immune |
Live vaccines: at least 4 weeks before starting immunosuppression, or at least 3 months after stopping it (4 weeks after high-dose steroids: prednisone 20 mg/day or more for 14 days or more). Do not delay urgent IBD treatment to vaccinate (CAG 2021). ECCO 2026 shortens the wait after stopping to at least 1 month; this tool keeps the Canadian Immunization Guide’s 3 months, which BSG 2025 also uses.
Guillain-Barré syndrome: since late 2025 the Canadian monographs for Shingrix, Arexvy and Abrysvo warn of an increased risk of GBS in the 42 days after vaccination, seen in observational studies of people 65 and older. NACI’s April 2026 RSV statement judged the benefit to outweigh this very rare risk. It is not a reason to skip these vaccines; tell patients which symptoms to report.
Screening
- Hepatitis B (HBsAg, anti-HBs, total anti-HBc) before any immunosuppressive therapy, including thiopurines and methotrexate, ideally at diagnosis (ECCO 2026; AGA 2025; BSG 2025). Hepatitis C, HIV and EBV serology at baseline too (ECCO 2026).
- Latent TB ideally at diagnosis and before any immunosuppression; required before biologics, JAK inhibitors and S1P modulators by the Canadian monographs. ECCO 2026 asks for it before vedolizumab, ustekinumab, IL-23 inhibitors and S1P modulators only when there are extra risk factors; this tool follows the monographs.
- Cervical screening in Ontario has used HPV testing since March 2025. People on immunosuppressive medicines for 3 years or more count as immunocompromised and are screened every 3 years. ECCO 2026 now also advises age-appropriate screening in line with the national programme (its 2021 guideline suggested yearly screening).
- Colon: see the dysplasia surveillance tool.
Pitfalls
- Pregnancy. “Most IBD medicines are safe” is not true for methotrexate, JAK inhibitors or S1P modulators. The plan prints the drug-specific statement; use the pregnancy assistant for a full plan.
- Ustekinumab. The Canadian monograph gives 90 mg every 8 weeks, or every 12 weeks for some patients. Every 4 weeks is outside the monograph and is flagged.
- Upadacitinib maintenance at 65 or older: 15 mg only.
- Skin checks are linked to thiopurines (non-melanoma skin cancer) and anti-TNF (melanoma in some cohorts), not to vedolizumab or IL-23 inhibitors. BSG 2025 also links methotrexate to skin cancer and advises skin-cancer counselling for everyone with IBD; the tool adds sun-protection advice for methotrexate.
- Vedolizumab is gut-selective; this tool still treats it as a biologic for live-vaccine decisions, the cautious reading of the guidance.