Table 2.

Vaccines Recommended in Elderly Patients With IBD

Disease	Type of Immunogen	General Recommendation(s) for Vaccination in Patients With IBD	Concerns With IBD Patients on Immunosuppressive Therapy
HBV	Recombinant protein	An accelerated double-dose regimen is recommended in all HBV anti-HBc–seronegative patients with IBD.	None
Influenza	Inactivated virus	1 dose annually	None
Pneumococcus	Polysaccharides, conjugated or not to a protein carrier	Patients should receive 1 dose of PCV13 followed by PPSV23 after 8 weeks if immunocompromised or after 1 year if immunocompetent, followed by PPSV23 dose every 5 years.	None
Tetanus	Inactivated toxoid	If a patient was previously vaccinated, administer 1 dose every 10 years. If a patient was not previously vaccinated or if his or her vaccination status is unknown, administer 3 doses. The first 2 doses should be administered 4 weeks apart, with the third dose administered 6-12 months following the second dose.	None
Varicella zoster virus	Live attenuated virus	Check titers and vaccinate if not immune 3 months prior to biologic/immunosuppression initiation. If a patient is nonimmunized, administer 2 doses (0 and 1-2 months).	Risks and benefits should be evaluated on an individual basis.
Herpes zoster virus	Live attenuated virus	ECCO guidelines: patients >60 years should follow the standard schedule. ACG guidelines: patients >50 years, including those on low levels of immunosuppression (methotrexate, <0.4 mg/kg/week; azathioprine, <3.0 mg/kg/day; 6-mercaptopurine, <1.5 mg/kg/ day), should follow the standard schedule.	Risks and benefits should be evaluated on an individual basis.
ACG, American College of Gastroenterology; anti-HBc, hepatitis B core antibody; ECCO, European Crohn’s and Colitis Organisation; HBV, hepatitis B virus; IBD, inflammatory bowel disease; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine.
Adapted from Mir FA and Kane SV.91