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

Figure 1 Decision-tree flowchart for recombinant zoster vaccine vaccination in patients with inflammatory bowel disease. To be applied at diagnosis, annually, or at the time of therapy change. The algorithm prioritises vaccination in older adults (≥ 50 years) and in patients on or planned for immunosuppressive therapy (particularly Janus kinase inhibitors, tumour necrosis factor inhibitors, high-dose steroids, or thiopurines)[23,41]. Key features include: (1) High efficacy (65%-90% overall; > 90% in immunocompromised per Korean data)[14]; (2) Favorable safety profile (no increased risk of inflammatory bowel disease flares)[37]; (3) Special considerations for Asia/India (low vaccination uptake and rising inflammatory bowel disease burden)[55,56]; and (4) This tool shall support clinicians in identifying high-risk inflammatory bowel disease patients who would benefit most from herpes zoster prevention. IBD: Inflammatory bowel disease; RZV: Recombinant zoster vaccine; HZ: Herpes zoster; JAK: Janus kinase; TNF: Tumor necrosis factor; RR: Relative risk.