Herpes zoster vaccination in inflammatory bowel disease: Evidence, guidelines, and reality

Table 7 Indications for use of different types of herpes zoster vaccines in various guidelines

Guideline	Indications for LZV (live attenuated)	Indications for RZV (recombinant)	Ref.
ACG 2025 (United States)	Not recommended for IBD patients; contraindicated in those on immune-modifying therapy or aged < 50 if immunosuppressed	All IBD patients ≥ 50 years; ≥ 19 years on or planning immune-modifying therapy (e.g., JAKi, TNFi, high-dose steroids); regardless of prior HZ or varicella status	[41]
ECCO 2021 and 2025 (Europe)	Contraindicated in immunosuppressed IBD; limited to immunocompetent adults ≥ 50-60 years without IBD risks	Strong recommendation for all adult IBD on immunosuppression (≥ 18-19 years); treatment-tailored, prioritize JAKi users due to dose-dependent HZ risk; all ≥ 50 years	[23,52]
Indian Consensus Guidelines 2024 (general)	Not preferred	≥ 50 years universally; recommended in patients with immune compromising conditions including HIV	[53]
Asian (e.g., Korean, AOCD 2023-2025)	Contraindicated in immunosuppressed; optional for immunocompetent ≥ 50 in low-access settings	≥ 50 years in all; ≥ 19 years on JAKi or other IS; emphasize in high-HZ-burden populations (e.g., 10-12/1000 PY in IBD)	[14,15,54]
ACIP 2022 (United States, general with IBD overlap)	Contraindicated in immunocompromised; for immunocompetent ≥ 50-60 years	≥ 19 years if immunocompromised (including IBD on IS); ≥ 50 years universally	[35]

ACG: American College of Gastroenterology; ECCO: European Crohn’s and Colitis Organization; AOCD: Asian Organization for Crohn’s and Colitis; ACIP: Advisory Committee on Immunization Practices; LZV: Live attenuated zoster vaccine; IBD: Inflammatory bowel disease; RZV: Recombinant zoster vaccine; JAKi: Janus kinase inhabits; TNFi: Tumor necrosis factor inhabits; HZ: Herpes zoster; HIV: Human immunodeficiency virus; IS: Immunosuppressed; PY: Patient-years.