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

Table 8 Vaccination strategy for herpes zoster prevention in inflammatory bowel disease patients

Aspect	Recommendation	Ref.
Who	(1) All IBD patients ≥ 50 years; and (2) IBD patients ≥ 19 years on JAK inhibitors, TNF inhibitors, or high-dose corticosteroids (> 20 mg/day prednisone equivalent for ≥ 14 days)	[14,15,23,35,41,52,54]
When	(1) At diagnosis or during remission; (2) Before starting immunosuppression if possible; (3) During stable immunosuppression for RZV; and (4) Avoid LZV if immunosuppressed
How	(1) RZV: Two doses/ 0.5 mL each, 2-6 months apart, intramuscular; (2) LZV: Single dose (contraindicated in immunosuppressed); and (3) No routine boosters; revaccinate if incomplete series
Monitoring	(1) Assess for flares post-vaccination (low risk); and (2) Serologic testing not required pre-vaccination

IBD: Inflammatory bowel disease; JAK: Janus kinase; TNF: Tumor necrosis factor; RZV: Recombinant zoster vaccine; LZV: Live attenuated zoster vaccine.