Herpes zoster vaccination in inflammatory bowel disease: Evidence, guidelines, and reality

Patients with inflammatory bowel disease (IBD) have a 1.3-2.0 times higher risk of developing herpes zoster (HZ) compared to the general population, mainly due to immunosuppressive treatments. The risk is greatest with Janus kinase inhibitors, combination therapies, and high-dose corticosteroids, especially in younger patients with Crohn's disease. The recombinant zoster vaccine (RZV, Shingrix) provides high efficacy, with 65%-90% protection against HZ and a significant decrease in postherpetic neuralgia, along with a safety profile that does not increase IBD flares, even during immunosuppression. Guidelines from the American College of Gastroenterology, the European Crohn's and Colitis Organisation, and the Advisory Committee on Immunisation Practices strongly advise RZV for all IBD patients aged 50 and above, as well as those aged 19 and over undergoing immunomodulatory therapy. Real-world evidence supports consistent benefits across different age groups, treatments, and ethnic backgrounds. Nonetheless, there are notable implementation gaps, particularly in resource-poor Asian regions such as India, due to cost, awareness, and access constraints. Adopting a risk-gradient approach that targets high-risk individuals helps optimise resource allocation. RZV is a safe, effective, and cost-efficient method to decrease HZ-associated morbidity in IBD patients. Integrating vaccination proactively into routine IBD management is crucial to close the gap between current evidence and clinical practice.