Manrai M, Pachisia AV, Jha AA, Shukla R, Hande V, Thareja S. Herpes zoster vaccination in inflammatory bowel disease: Evidence, guidelines, and reality. World J Virol 2026; 15(3): 121081 [DOI: 10.5501/wjv.121081]
Corresponding Author of This Article
Manish Manrai, AGAF, FRCPE, Professor, Department of Gastroenterology, Command Hospital, Cariappa Road, Lucknow Cantt, Lucknow 226002, Uttar Pradesh, India. manishmanrai75@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Virol. Sep 25, 2026; 15(3): 121081 Published online Sep 25, 2026. doi: 10.5501/wjv.121081
Herpes zoster vaccination in inflammatory bowel disease: Evidence, guidelines, and reality
Manish Manrai, Aditya V Pachisia, Atul A Jha, Rajat Shukla, Vivek Hande, Sandeep Thareja
Manish Manrai, Atul A Jha, Department of Gastroenterology, Command Hospital, Lucknow 226002, Uttar Pradesh, India
Aditya V Pachisia, Department of Gastroenterology, Command Hospital, Bangalore 560007, Karnātaka, India
Rajat Shukla, Vivek Hande, Sandeep Thareja, Department of Gastroenterology, Army Hospital Research and Referral, Delhi 110001, India
Author contributions: Manrai M conceptualized, supervised the review study, and was involved with validation; Manrai M, Pachisia AV, Shukla R, Hande V, and Thareja S were involved in editing; Manrai M, Pachisia AV, and Jha AA were involved with resources and writing; Shukla R, Hande V, and Thareja S were involved with resources. All authors have read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Manish Manrai, AGAF, FRCPE, Professor, Department of Gastroenterology, Command Hospital, Cariappa Road, Lucknow Cantt, Lucknow 226002, Uttar Pradesh, India. manishmanrai75@gmail.com
Received: March 16, 2026 Revised: June 1, 2026 Accepted: June 29, 2026 Published online: September 25, 2026 Processing time: 187 Days and 11.8 Hours
Abstract
Patients with inflammatory bowel disease (IBD) have a 1.3-2.0 times higher risk of developing herpes zoster (HZ) compared to the general population, mainly due to immunosuppressive treatments. The risk is greatest with Janus kinase inhibitors, combination therapies, and high-dose corticosteroids, especially in younger patients with Crohn’s disease. The recombinant zoster vaccine (RZV, Shingrix) provides high efficacy, with 65%-90% protection against HZ and a significant decrease in postherpetic neuralgia, along with a safety profile that does not increase IBD flares, even during immunosuppression. Guidelines from the American College of Gastroenterology, the European Crohn’s and Colitis Organisation, and the Advisory Committee on Immunisation Practices strongly advise RZV for all IBD patients aged 50 and above, as well as those aged 19 and over undergoing immunomodulatory therapy. Real-world evidence supports consistent benefits across different age groups, treatments, and ethnic backgrounds. Nonetheless, there are notable implementation gaps, particularly in resource-poor Asian regions such as India, due to cost, awareness, and access constraints. Adopting a risk-gradient approach that targets high-risk individuals helps optimise resource allocation. RZV is a safe, effective, and cost-efficient method to decrease HZ-associated morbidity in IBD patients. Integrating vaccination proactively into routine IBD management is crucial to close the gap between current evidence and clinical practice.
Core Tip: Patients with inflammatory bowel disease (IBD) have an elevated risk of herpes zoster due to disease-related immune dysregulation and the widespread use of immunosuppressive therapies, including corticosteroids, thiopurines, biologics, and Janus kinase inhibitors. Major international guidelines now recommend the recombinant zoster vaccine for adults aged ≥ 50 years and for younger adults who are or will be immunosuppressed. The recombinant zoster vaccine, a non-live adjuvanted vaccine, is highly effective and safe in immunocompromised populations, including those with IBD. The vaccination uptake among IBD patients remains low, largely due to gaps in awareness, uncertainty regarding timing around therapy, and cost barriers. In the setting of constrained healthcare resources, a risk-stratified approach is more feasible than blanket vaccination.
