In adults with IBD taking chronic corticosteroids and azathioprine, does vaccination with the recombinant zoster vaccine (Shingrix) reduce the incidence or severity of herpes zoster compared to no vaccination

What is known

- The recombinant subunit zoster vaccine (glycoprotein E) reduced the risks of herpes zoster and postherpetic neuralgia among adults aged 70 or older. ¹ - Herpes zoster–related complications were reduced by approximately 90% in adults 70 years and older. ¹ - As a non-live/inactivated recombinant vaccine, it avoids the live-vaccine risks and is suggested as a vaccine to consider before starting JAK inhibitor therapy. ^1,2 - Guidelines recommend recombinant zoster vaccine in immunocompromised adults, and it is described as immunogenic and well tolerated in patients on JAK inhibitors, though the immune response may be reduced. ²

What is unknown / caveats

- Efficacy data are from largely immunocompetent adults ≥70, not IBD patients on steroids plus azathioprine - One cited efficacy source states the recombinant vaccine had not been tested in immunosuppressed individuals - The older cohort study evaluated the live vaccine (Zostavax), not the recombinant vaccine - No retrieved study directly measured herpes zoster incidence or severity after recombinant zoster vaccination specifically in IBD patients on chronic corticosteroids and azathioprine.

## References

1. Hruz P, Juillerat P, Kullak-Ublick GA, Schoepfer Alain M, Mantzaris Gerassimos J, Rogler G. Management of the Elderly Inflammatory Bowel Disease Patient. Digestion. 2020;101 Suppl 1:105-119. PMID: 31935714.

2. Parra-Izquierdo V, Ardila O, Márquez JR, Riveros J, Gómez-Venegas ÁA, Medrano-Almanza CA, Ballesteros M, Barreto-Pérez J, Frias-Ordoñez JS. REAL-WORLD EXPERIENCE WITH JANUS KINASE INHIBITORS IN EXTRAINTESTINAL MANIFESTATIONS AND INFLAMMATORY BOWEL DISEASE IN COLOMBIA: A COMPARATIVE STUDY (JAKEIM-IBD STUDY). Arq Gastroenterol. 2026. PMID: 41538670.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._