Oct. 01, 2025
Individuals with inflammatory bowel disease (IBD) are at an increased risk of developing vaccine-preventable diseases, including herpes zoster (HZ). Although their impact on HZ risk varies, current IBD treatments, including corticosteroids, thiopurines, monoclonal antibodies and oral small molecules, are associated with an increased risk of HZ and other infections. And even when patients with IBD are not receiving immunosuppressive therapy, they have a twofold increased risk of HZ compared with the general population.
Impact of herpes zoster virus and vaccine on patients with IBD
Individuals with inflammatory bowel disease (IBD) are at an increased risk of developing vaccine-preventable diseases, including herpes zoster (HZ). Mayo Clinic gastroenterologist and researcher Francis A. Farraye, M.D., M.S., and colleagues from Mayo Clinic and the University of Wisconsin have published several articles examining the impact of HZ and the HZ vaccine in patients with IBD. Recent research findings shared by Dr. Farraye and co-investigators demonstrate that the two-dose recombinant HZ vaccine is safe and effective for adults with IBD.
Francis A. Farraye, M.D., M.S., is a gastroenterologist and director of the Inflammatory Bowel Disease Clinic at Mayo Clinic in Florida. Dr. Farraye and colleagues from Mayo Clinic and the University of Wisconsin have published several articles examining the impact of HZ and the HZ vaccine in patients with IBD. The two-dose inactive recombinant HZ vaccine is an inactive vaccine that can be administered to all patients, regardless of immunosuppressive status.
In a 2024 study publication in the Journal of Crohn's and Colitis, Dr. Farraye and co-authors reported that the HZ vaccine is associated with a 66% decrease in the risk of HZ in patients with IBD. In a 2023 publication in Alimentary Pharmacology and Therapy, the researchers demonstrated that the HZ vaccine is cost-effective in adult patients with IBD.
Building on that work, Dr. Farraye and colleagues conducted a retrospective cohort study examining whether complications of HZ are more frequent in patients with IBD than in controls without IBD. The results of this study were published in Clinical Gastroenterology and Hepatology in 2025.
Study methods
Using the Optum Research Database, the researchers identified 4,756 individuals with IBD (IBD group) and an equal number of individuals without IBD (control group). Control group members were matched by age, sex and index date, the year in which they were diagnosed with HZ. The researchers then documented any complications of HZ that occurred up to 90 days after the index date.
Results
By comparing IBD group members with control group members, the researchers evaluated the 90-day risk of HZ complications. "In this study, we demonstrate that patients with IBD are at increased risk of complications of herpes zoster compared with individuals without IBD," explains Dr. Farraye.
Key findings include the following:
- A total of 738 (15.52%) individuals in the IBD group experienced complications versus 595 (12.51%) in the control group (P < 0.0001). Complications included postherpetic neuralgia, multidermatomal involvement and hospitalization.
- Individuals in the IBD group with higher comorbidity scores were more likely to develop complications than were control group members (1.86 versus 1.18; P < 0.0001). IBD group members age 50 years and older, and individuals receiving antitumor necrosis factor therapy or corticosteroids were also at increased risk of HZ complications.
In another study, published in the Journal of Crohn's and Colitis in 2025, Dr. Farraye and co-authors demonstrated that the HZ vaccine can substantially lower the complication rate among individuals with IBD.
The 2025 update to the American College of Gastroenterology preventive care recommendations for adult patients with IBD contains additional study data related to HZ vaccination in patients with IBD. In that update, published in The American Journal of Gastroenterology, Dr. Farraye and co-authors recommend the use of the two-dose inactive recombinant HZ vaccine in adults 50 and older with IBD, and in adults 19 and older with IBD who are receiving immune-modifying therapy or planning to start therapy.
"With the availability of a safe and effective vaccine, gastroenterologists and other clinicians caring for adult patients with IBD should strongly encourage HZ vaccination, especially in at-risk patients, regardless of whether the patients were previously vaccinated for varicella," says Dr. Farraye. "Receiving a recommendation for vaccination from a trusted gastroenterologist is associated with increased vaccine acceptance among our patients."
For more information
Desai A, et al. Recombinant zoster vaccine (RZV) is effective in patients with inflammatory bowel disease: A U.S. propensity matched cohort study. Journal of Crohn's and Colitis. 2024;18:828.
Caldera F, et al. Cost‐effectiveness of an adjuvanted recombinant zoster vaccine in adults with inflammatory bowel disease. Alimentary Pharmacology and Therapeutics. 2023;57:1326.
Caldera F, et al. Patients with inflammatory bowel disease are at increased risk for complications of herpes zoster. Clinical Gastroenterology and Hepatology. 2025;23:331.
Wang Y, et al. Recombinant herpes zoster vaccine lowers shingles complication risk in patients with inflammatory bowel disease. Journal of Crohn's and Colitis. In press.
Farraye FA, et al. ACG clinical guideline update: Preventive care in inflammatory bowel disease. The American Journal of Gastroenterology. 2025;120:1447.
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