At a glance
- Ask your IBD team to check your vaccines when you are diagnosed, and before you start any new IBD medicine.
- Get the flu shot every fall and stay up to date with COVID-19 vaccines. Choose the shot, not the nasal spray.
- On immune-weakening medicines, you need one dose of a newer pneumonia vaccine (Prevnar 20 or Capvaxive) and two doses of the shingles vaccine Shingrix.
- Non-live vaccines are safe on all IBD medicines. They may work a little less well, but they still protect you.
- Do not get live vaccines (MMR, chickenpox, yellow fever, oral typhoid, nasal flu) while on immune-weakening medicines.
- If you may need a live vaccine, get it at least 4 weeks before starting an immune-weakening medicine.
- Make sure you are immune to measles before you start. If you are near someone with measles, call your doctor the same day.
- Planning a trip? See a travel clinic well before you go and tell them about your IBD medicines.
- If you took a biologic in pregnancy, tell your baby's doctor before any vaccines.
Why vaccines matter in IBD
Many people with IBD take medicines that calm the immune system. These medicines control your IBD, but they can make some infections more likely, or more serious. Vaccines are one of the best ways to protect yourself.
The best time to catch up on vaccines is before you start an immune-weakening medicine. So ask your IBD team to check your vaccines when you are first diagnosed. Ask again before any new medicine. But if you need treatment urgently, it should not wait for vaccines.
Which medicines weaken the immune system?
For vaccines, these count as immune-weakening:
- Prednisone at 20 mg a day or more, for 2 weeks or longer
- Azathioprine, mercaptopurine and methotrexate
- Biologics, such as infliximab, adalimumab, vedolizumab, ustekinumab and risankizumab
- JAK pills, such as tofacitinib and upadacitinib
- S1P pills, such as ozanimod and etrasimod
If you are not sure about your own medicine, ask your IBD team.
Live and non-live vaccines
There are two kinds of vaccines.
- Non-live vaccines contain no living germ. They cannot give you the infection. They are safe on every IBD medicine. On some medicines your body may make a little less protection, but it is still worth it.
- Live vaccines contain a weakened germ. In a person with a weak immune system, that germ can rarely cause real illness. So live vaccines are not given while you take immune-weakening medicines.
Non-live: safe on every IBD medicine
- Flu shot (not the nasal spray)
- COVID-19
- Pneumonia (Prevnar 20, Capvaxive)
- Shingles (Shingrix)
- RSV
- Hepatitis A and hepatitis B
- HPV
- Tetanus and diphtheria (Td, Tdap)
- Typhoid shot for travel
Live: not on immune-weakening medicine
- MMR (measles, mumps, rubella)
- Chickenpox
- Nasal flu spray
- Yellow fever for travel
- Oral typhoid for travel
- Chikungunya (Ixchiq) for travel
Your vaccine checklist
All the vaccines in this table are non-live. They are safe on every IBD medicine.
| Vaccine | Who | When |
|---|---|---|
| Flu shot (not the nasal spray) | Everyone with IBD | Every fall |
| COVID-19 | Strongly advised on immune-weakening medicine. Others can choose it | Once a year. Twice a year if your immune system is quite weak |
| Pneumonia (Prevnar 20 or Capvaxive) | Adults on immune-weakening medicine, and all adults 65+ | Usually one dose |
| Shingles (Shingrix) | Adults 18+ on or starting immune-weakening medicine, and all adults 50+ | 2 doses, 2 to 6 months apart |
| RSV | Adults 75+, and adults 65 to 74 at higher risk. Younger adults at higher risk can ask | One dose |
| Hepatitis B | Anyone not already immune (a blood test can tell) | 3 or 4 doses |
| HPV | Usual ages (ask your doctor) | 3 doses on immune-weakening medicine |
| Tetanus and diphtheria (Td, Tdap) | Every adult | Every 10 years. Tdap once as an adult and in every pregnancy |
What is new
- Pneumonia vaccine. In the past, people often needed two different pneumonia vaccines. Now, most adults on immune-weakening medicine need just one dose of a newer vaccine, Prevnar 20 or Capvaxive. If you had pneumonia vaccines before, your doctor will check if you need another.
- Shingles vaccine. Shingrix is a non-live vaccine. It is advised for all adults 18 and older who are on, or about to start, immune-weakening medicine. The second dose can be given as soon as 4 weeks after the first. The old live shingles vaccine is no longer sold in Canada.
- COVID-19. If your immune system is moderately or severely weakened, you may be advised to get a second dose each year, at least 3 months after the first.
What is free in Ontario?
Free (publicly funded) vaccines change often. As of fall 2026:
- Prevnar 20 is free for adults 18 to 64 on immune-weakening medicine. Capvaxive is free for adults 65 and older.
- Shingrix is free only for people aged 65 to 70. Others can buy it. Some drug plans cover it, so check yours.
- RSV vaccine is free for adults 75 and older. It is also free for some adults 60 to 74 at high risk, such as people who live in long-term care. Others can buy it.
Ask your pharmacist or family doctor what is free for you.
Live vaccines and timing
If you need a live vaccine, such as MMR (measles, mumps, rubella) or chickenpox, timing matters:
Before treatment
At least 4 weeks before
Get any live vaccine at least 4 weeks before you start an immune-weakening medicine. Non-live vaccines work best if you get them at least 2 weeks before you start.While on treatment
No live vaccines
Non-live vaccines are safe and useful at any time.After stopping
Wait at least 3 months
Wait at least 3 months after stopping an immune-weakening medicine before a live vaccine. After a long course of high-dose prednisone, the wait is about 4 weeks.
A blood test can show whether you are already immune to measles, chickenpox or hepatitis B.
Measles
Measles has spread in parts of Canada since late 2024. In November 2025, Canada lost its “measles-free” status. So make sure you are immune to measles before you start an immune-weakening medicine.
If you are on one of these medicines and you are near someone with measles, call your doctor the same day. A shot of antibodies, given within 6 days, can help protect you.
If you take only mesalamine (also called 5-ASA), you are usually not counted as immune-weakened. Check with your IBD team before a live vaccine.
Travel
See a travel clinic well before your trip. Bring a list of your medicines.
- Yellow fever and oral typhoid vaccines are live. You should not get them on immune-weakening medicine. There is a typhoid shot that is not live. For yellow fever, ask the travel clinic about the risk where you are going. They may give you a letter to explain why you cannot have the vaccine.
- Chikungunya is a virus spread by mosquitoes. One vaccine for it (Ixchiq) is live, so you should not get it on immune-weakening medicine. Another (Vimkunya) is not made from live virus. Ask the travel clinic.
- Hepatitis A and most other travel vaccines are non-live and safe.
Babies born to parents on biologics
If you took a biologic while pregnant, your baby may still have some of it in their blood for months. This matters for live vaccines given in the first months of life. Your baby should not get the BCG vaccine in the first 6 months. The rotavirus vaccine may be given on time, as a 2025 expert consensus advises. Canada’s national vaccine guide is more cautious, but its advice on this is older. Most other baby vaccines are given on time. See Pregnancy and IBD for details.
Sources for this guide
Sources
- Public Health Agency of Canada. Canadian Immunization Guide, Part 3: Immunization of immunocompromised persons (last partial update September 2026; accessed October 2026). Yearly influenza; one dose of Pneu-C-20 or Pneu-C-21 for immunocompromised adults ≥18 (schedule depends on age and history); RZV 2 doses for ≥18; HPV 3-dose schedule regardless of age; hepatitis B double dose, 3–4 doses, check antibodies; RSV for ≥65 especially with immunocompromise, may be considered 18–64 at increased risk; live vaccines ≥4 weeks before immunosuppression; generally ≥3 months after stopping therapy; 4 weeks after long-term high-dose steroids (≥20 mg/day prednisone for ≥14 days); non-live vaccines ideally ≥14 days before starting therapy.
- Benchimol EI, Tse F, Carroll MW, et al. Canadian Association of Gastroenterology clinical practice guideline for immunizations in patients with IBD — Part 1: Live vaccines. Gastroenterology 2021;161(2):669–80. PMID 33617891 Review vaccines at diagnosis and regularly; vaccinate as soon as possible; do not delay urgently needed therapy. MMR and varicella recommended for those not on immunosuppression, not for those on it. Live vaccines ≥4 weeks before and not for ≥3 months after immunosuppressive therapy. Immunosuppressive therapy is listed as corticosteroids, thiopurines, biologics and small molecules such as JAK inhibitors (S1P modulators are also small molecules; the ozanimod and etrasimod monographs advise against live vaccines during treatment).
- Mahadevan U, Seow CH, Barnes EL, et al. Global Consensus Statement on the Management of Pregnancy in Inflammatory Bowel Disease. Inflamm Bowel Dis 2025;31(10):2615–64. PMID 40874613 Infants exposed to biologics in the womb: live rotavirus vaccine may be provided (GRADE 33, conditional, very low certainty); avoid BCG for 6 months after anti-TNF exposure (GRADE 34). The Canadian Immunization Guide's more cautious rotavirus advice dates from its November 2016 update.
- Farraye FA, Melmed GY, Lichtenstein GR, et al. ACG Clinical Guideline Update: Preventive Care in Inflammatory Bowel Disease. Am J Gastroenterol 2025;120(7):1447–73. PMID 40701559 Vaccination safety and timing in IBD; more than 70% of people with IBD will at some time take immune-modifying therapy.
- National Advisory Committee on Immunization. Guidance on the use of COVID-19 vaccines starting fall 2026 (summary, June 2026). One dose per year for most; second yearly dose (≥3 months apart) for people 6 months and older who are moderately to severely immunocompromised.
- National Advisory Committee on Immunization. Updated guidance on RSV vaccines for older adults at high risk of severe RSV disease (summary, April 10, 2026). Strongly recommended for all adults ≥75 and adults 65–74 at increased risk; may be considered by other adults at increased risk; single dose.
- Public Health Agency of Canada. Canadian Immunization Guide, Part 4: Herpes zoster (shingles) vaccine (accessed October 2026). RZV 2 doses 2–6 months apart for adults ≥50, and for adults ≥18 who are or will be immunocompromised; second dose can be as soon as 4 weeks; finish ≥14 days before starting immunosuppression. The live zoster vaccine (Zostavax) was discontinued in Canada in 2023; RZV is the only zoster vaccine authorized.
- Public Health Agency of Canada. Canadian Immunization Guide, Part 4: Tetanus toxoid and Pertussis vaccine chapters (accessed October 2026). Td booster every 10 years; one adult dose of Tdap; Tdap in every pregnancy, ideally at 27–32 weeks (pertussis chapter).
- Ontario Ministry of Health. Health care provider fact sheet: pneumococcal conjugate vaccines for adults aged 18 years and older (August 2026). Publicly funded Prevnar 20 (Pneu-C-20) for ages 18–64 at high risk, including immunocompromising therapy such as long-term steroids and other immunosuppressive therapy; Capvaxive (Pneu-C-21) for 65 and older.
- City of Toronto. Shingles (herpes zoster) vaccine (accessed October 2026). In Ontario, Shingrix is publicly funded only for ages 65 to 70 who have not had a shingles vaccine; others can buy it.
- Public Health Agency of Canada. Canadian Immunization Guide, Part 4: Measles vaccine (accessed October 2026). Post-exposure prophylaxis with immune globulin for immunocompromised contacts, as soon as possible and within 6 days of exposure (serology first for less severely immunocompromised groups); MMR for susceptible adults.
- Public Health Agency of Canada. Statement on Canada's measles elimination status (November 10, 2025). PAHO confirmed Canada no longer holds measles elimination status after more than 12 months of transmission from an outbreak that began in October 2024.
- Ontario Ministry of Health. Respiratory syncytial virus (RSV) prevention programs (updated September 29, 2026). Adult RSV Prevention Program (year-round, one dose for those not previously given a publicly funded RSV vaccine): all adults 75 and older; adults 60 to 74 in long-term care, Elder Care Lodges, retirement homes or alternate level of care, and certain other high-risk groups (dialysis, transplant, glomerulonephritis with immunocompromise, home oxygen, homelessness, First Nations, Inuit or Metis). No general immunosuppressive-therapy category.
- Public Health Agency of Canada. Canadian Immunization Guide, Part 4: Chikungunya vaccine (new chapter February 2026; page updated July 2026). Two vaccines authorized in Canada: IXCHIQ (live attenuated, contraindicated in immunocompromised people) and VIMKUNYA (recombinant virus-like particle; not yet reviewed by CATMAT).
This guide is for general education. It can't replace advice from your own care team, who know your health history.