After nearly 25 years of managing Crohn’s disease and multiple biologic switches, I’ve learned that vaccine timing isn’t a once-and-done conversation with my gastroenterologist. It’s ongoing coordination between my GI team, primary care doctor, and sometimes specialists, especially as new vaccines become available and my treatment changes.

The basic principle I follow is simple: live vaccines are off the table while I’m on immunosuppressive therapy. Inactivated vaccines are essential. The challenge is that “inactivated” versus “live” isn’t always obvious from the vaccine name, and timing matters more than I initially realized.

The vaccines I get regularly

Since starting Remicade in 2004, I’ve maintained a routine that includes annual flu shots and COVID boosters as recommended. I get these at my primary care office, usually in early fall for flu season. The timing works well because it’s far enough from my infusion schedule that I can separate any minor side effects.

I also stay current on the pneumococcal vaccines. When I turned 50, my primary care doctor recommended the updated pneumococcal conjugate vaccine (PCV20), which replaced the older two-shot sequence I’d received years earlier. Being on a biologic puts me at higher risk for pneumococcal infections, so this wasn’t optional.

The hepatitis B series was something I completed before starting biologics, back in 2003 when my GI team was doing baseline screening. I’m glad we handled it then — starting a three-shot vaccine series while immunosuppressed would have been more complicated.

The vaccines I avoid

Live vaccines are the clear no-go list while I’m on Rinvoq or any other immunosuppressive therapy. This includes the nasal flu vaccine (FluMist), the shingles vaccine (Zostavax, though this has been largely replaced), and travel vaccines like yellow fever or oral typhoid.

The shingles situation is particularly frustrating. The newer Shingrix vaccine is inactivated and safe for people on biologics, but it wasn’t available when I was younger and might have benefited most from shingles prevention. I received Shingrix in 2024 at age 54, which felt late but was the right timing given my treatment history.

Timing around treatment changes

The most complex vaccine timing I’ve navigated was around my 2026 switch from Remicade to Rinvoq. My GI team recommended updating any needed vaccines during the washout period between stopping Remicade and starting the JAK inhibitor. This gave me a window where my immune system was less suppressed but I wasn’t yet on the new therapy.

I used that time to get a COVID booster and confirm my pneumococcal vaccination was current. The window was only about six weeks, so we had to be strategic about what could be completed. My primary care doctor coordinated with my GI team to make sure the timing worked with my treatment schedule.

For routine vaccines like annual flu shots, I don’t worry about precise timing relative to my Rinvoq schedule. The drug is daily rather than infused, so there’s no obvious “best” day to get vaccinated. I just make sure to mention it at my next appointment so my team knows what I’ve received.

The coordination challenge

What I’ve learned over the years is that vaccine management on biologics requires more coordination than I expected. My gastroenterologist knows my IBD treatment inside and out. My primary care doctor manages most of my routine vaccines and knows the broader recommendations for adults.

I keep a vaccine record that both doctors can access, and I update it myself when I receive anything. This has been essential during treatment transitions, when one team might not immediately know what the other has recommended.

Travel vaccines are where the coordination becomes most critical. Before a 2019 trip to Southeast Asia, I needed hepatitis A vaccination and typhoid protection. The travel clinic wanted to give oral typhoid (live vaccine, not safe), but my GI team helped me get the injectable typhoid vaccine instead. Without that coordination, I might have received the wrong vaccine or skipped protection entirely.

What I track and when I ask questions

I maintain a simple list of what vaccines I’ve received and when, especially for anything that needs boosters. My primary care office has records, but having my own copy has been useful when seeing new doctors or during treatment changes.

I ask about vaccine updates at my annual physical and whenever there’s news about new recommendations. The COVID vaccine rollout taught me that recommendations can change quickly, and being on immunosuppressive therapy often means I’m eligible for boosters sooner than the general population.

When I’m unsure about a specific vaccine — whether it’s live or inactivated, whether the timing works with my treatment — I ask both my primary care doctor and my GI team. They don’t always have the same immediate answer, but between them, they can usually figure it out or find the right specialist to consult.

The bigger picture

After more than 20 years on various immunosuppressive therapies, I’ve come to see vaccine management as part of the broader work of living with IBD. It’s about preventing infections and maintaining the kind of baseline health that lets me travel, work, and live without constantly worrying about preventable illnesses.

The conversations have gotten easier over time, partly because my care team knows my history and partly because I’ve learned which questions to ask. But each treatment change brings new considerations, and new vaccines become available regularly enough that this isn’t a set-it-and-forget-it part of my care.

What works for me is staying proactive about routine vaccines, asking questions when I’m unsure, and making sure my care team stays coordinated. It’s one more thing to manage, but it’s manageable — and it’s helped me avoid infections that could have complicated my IBD treatment or forced treatment interruptions I’d rather avoid.