Preventive Care in Inflammatory Bowel Disease

Publication Date: February 1, 2017
Last Updated: March 14, 2022

Preventive health maintenance recommendations

Statement 1a: All adult patients with IBD should undergo annual vaccination against influenza. (Conditional (weak)  “We suggest”, Very low)

Statement 1b: Those on immunosuppressive therapies and their household contacts should receive the non-live trivalent inactivated influenza vaccine, but not the live inhaled influenza vaccine. (, )

Statement 2: Adult patients with IBD receiving immunosuppressive therapy should receive pneumococcal vaccination with both the PCV13 and PPSV23, in accordance with national guidelines. (Conditional (weak)  “We suggest”, Very low)

Statement 3: Adults with IBD over the age of 50 should consider vaccination against herpes zoster, including certain subgroups of immunosuppressed patients. (Strong  “We recommend”, Low)

Statement 4: Adults with IBD should be assessed for prior exposure to varicella and vaccinated if naive before initiation of immunosuppressive therapy when possible. (Conditional (weak)  “We suggest”, Very low)

Statement 5: Patients with IBD who are immunosuppressed and traveling to endemic areas for yellow fever should consult with a travel medicine or infectious disease specialist prior to travel. (Conditional (weak)  “We suggest”, Very low)

Statement 6: Adolescents with IBD should receive meningococcal vaccination in accordance with routine vaccination recommendations. (Conditional (weak)  “We suggest”, Very low)

Statement 7: Household members of immunosuppressed patients can receive live vaccines with certain precautions. (Conditional (weak)  “We suggest”, Very low)

Statement 8: Adults with IBD should receive age-appropriate vaccinations before initiation of immune suppression when possible. (Conditional (weak)  “We suggest”, Very low)

Statement 9: Vaccination against Tdap, HAV, HBV, and HPV should be administered as per Advisory Committee on Immunization Practice guidelines. (Conditional (weak)  “We suggest”, Very low)

Statement 10: Women with IBD on immunosuppressive therapy should undergo annual cervical cancer screening. (Conditional (weak)  “We suggest”, Very low)

Statement 11: Screening for depression and anxiety is recommended in patients with IBD. (Conditional (weak)  “We suggest”, Low)

Statement 12a: Patients with IBD (both ulcerative colitis and CD) should undergo screening for melanoma independent of the use of biologic therapy. (Strong  “We recommend”, Low)

Statement 12b: IBD patients on immunomodulators (6-mercaptopurine or azathioprine) should undergo screening for NMSC while using these agents, particularly over the age of 50. (Strong  “We recommend”, Low)

Statement 13: Patients with conventional risk factors for abnormal bone mineral density with ulcerative colitis and CD should undergo screening for osteoporosis with bone mineral density testing at the time of diagnosis and periodically after diagnosis. (Conditional (weak)  “We suggest”, Very low)

Statement 14: Patients with CD who smoke should be counseled to quit. (Strong  “We recommend”, Low)

Recommendation Grading



Preventive Care in Inflammatory Bowel Disease

Authoring Organization

Publication Month/Year

February 1, 2017

Last Updated Month/Year

January 17, 2024

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

The purpose of this article is to review preventive care for the inflammatory bowel disease (IBD) patient.

Target Patient Population

Patients with Inflammatory bowel disease

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Prevention

Diseases/Conditions (MeSH)

D015212 - Inflammatory Bowel Diseases, D011315 - Preventive Medicine, D014611 - Vaccination


vaccination, inflammatory bowel disease, chronic inflammatory disease (CID), preventive care

Source Citation

Farraye, Francis A MD, MSc, FACG; Melmed, Gil Y MD, MS, FACG; Lichtenstein, Gary R MD, FACG; Kane, Sunanda V MD, MSPH, FACG4 ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease, American Journal of Gastroenterology: February 2017 - Volume 112 - Issue 2 - p 241-258 doi: 10.1038/ajg.2016.537