What immunizations are recommended for a 23-year-old female with ulcerative colitis on Remicade (Infliximab)?

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Recommended Immunizations for a 23-Year-Old Female with Ulcerative Colitis on Remicade

For a 23-year-old female with ulcerative colitis on Remicade (infliximab), all three vaccines mentioned (Prevnar, Tdap, and Gardasil) are strongly recommended based on current guidelines. 1

Core Recommended Vaccines

Pneumococcal Vaccine (Prevnar)

  • Strongly recommended for patients with IBD on immunosuppressive therapy like Remicade 1
  • The Canadian Association of Gastroenterology recommends pneumococcal vaccines for adult IBD patients on immunosuppressive therapy (conditional recommendation, low certainty of evidence) 1
  • Patients on biologics like Remicade are considered immunosuppressed and at higher risk for pneumococcal infections

Tetanus, Diphtheria, and Pertussis (Tdap)

  • Strongly recommended for all adult patients with IBD (strong recommendation, moderate certainty of evidence) 1
  • Should be administered regardless of immunosuppression status
  • Particularly important for patients on biologics to maintain protection against these infections

Human Papillomavirus (Gardasil)

  • Strongly recommended for female patients with IBD aged 9-26 years (strong recommendation, moderate certainty of evidence) 1
  • This patient at 23 years falls within the recommended age range
  • Particularly important as immunosuppressed patients may have higher risk of HPV-related complications

Additional Recommended Vaccines

Influenza Vaccine

  • Annual influenza vaccination is strongly recommended for all adult IBD patients (strong recommendation, moderate certainty of evidence) 1
  • Should be administered regardless of timing relative to Remicade infusions (no consensus on optimal timing) 1

Hepatitis B Vaccine

  • Recommended for all unimmunized adult IBD patients, even without specific risk factors (conditional recommendation, low certainty of evidence) 1
  • Should check serology first to determine vaccination status

Recombinant Zoster Vaccine

  • Consider for adults with IBD younger than 50 years (conditional recommendation, low certainty of evidence) 1
  • Non-live zoster vaccine is safe in immunosuppressed patients

Implementation Considerations

  • All these vaccines are inactivated and safe to administer to patients on Remicade
  • Ideally, vaccination status should be assessed at diagnosis of IBD, before starting immunosuppressive therapy
  • Vaccine response may be suboptimal while on Remicade, but benefits outweigh risks
  • No need to time vaccinations with Remicade infusion schedule (no consensus on optimal timing) 1

Common Pitfalls to Avoid

  • Delaying vaccination due to concerns about IBD flares (inactivated vaccines do not trigger disease flares)
  • Assuming primary care providers have addressed vaccination needs
  • Waiting for disease remission before vaccinating (may miss opportunity to protect patient)
  • Forgetting to check vaccination status before initiating immunosuppressive therapy

The evidence strongly supports administering all three vaccines mentioned (Prevnar, Tdap, and Gardasil) to this 23-year-old female with ulcerative colitis on Remicade, as they are all inactivated vaccines that are safe and recommended for patients on immunosuppressive therapy.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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