Latest: Coronavirus vaccine for people with Crohn’s or Colitis

19 January 2021

The COVID-19 vaccine is low risk, and is the best way to protect yourself and others against coronavirus. It's important to consider getting the vaccine when it is offered to you, especially if you are at increased risk of complications from the virus.

Any newly created medicine or vaccine can raise lots of questions - we're here to support you. Hear IBD healthcare professionals' thoughts on the vaccine by watching our live event on COVID-19 vaccines and IBD. You can also read the British Society of Gastroenterology's statement on the coronavirus vaccine for people with Crohn's and Colitis.

Visit the NHS website for general information about the vaccine and how it will be delivered. Our information is specific to Crohn's and Colitis - if you have other health conditions or feel there is another reason why the vaccine may not be right for you, speak to your healthcare professional.

Can people with Crohn's or Colitis have the COVID-19 vaccine?
I've heard that immunosuppressed people cannot have the vaccine?
Which coronavirus vaccine is best for people with Crohn's or Colitis?
Has the vaccine been tested in people with Crohn's or Colitis?
Will the COVID-19 vaccine work?
When can I have the vaccine?
My risk level is different to how the government have classified me
Will the vaccine cause my Crohn's or Colitis to flare?
Should I avoid taking the vaccine at certain times?
Do I need the vaccine if I've had coronavirus already?
Can I stop shielding once I've had the vaccine?
Are the needs of people with Crohn's and Colitis being considered?


I will take the vaccine and I will strongly encourage all my patients [with Crohn's or Colitis] to take the vaccine.

There is lots of information on the Crohn's & Colitis UK website. We will be there to fight your corner right through this for you.

Professor Shaji Sebastian
Consultant Specialist in IBD/Gastroenterology

Can people with Crohn's or Colitis have the COVID-19 vaccine?

Yes, unless you are under 16, or have certain other health conditions - ask your healthcare professional for more details. Having Crohn's or Colitis, or taking any medicine to treat your condition, will not stop you from being able to have the COVID-19 vaccine. All of the available vaccines are suitable for people on biologics, steroids and immunosuppressants. In their official statement, the British Society of Gastroenterology (BSG) have stated that "We strongly support SARS-CoV2 vaccination for patients with IBD. The risks of SARS-CoV2 vaccination in IBD patients are anticipated to be very low."

I’ve had my first dose of the coronavirus vaccine. As far as my experience so far goes, it's been okay. Nothing too exciting to write home about so far! I'm prepared to take what I view as a positive risk, for the possible chance of regaining some normality, getting back to work and, most importantly, spending quality time with my loved ones (with hugs!).

 

Heather
Living with Crohn's

 As with any medicine or vaccine, there is a small risk of side effects, which you can find out more about on the NHS website. There is no evidence to suggest that having Crohn's or Colitis, or taking any medicine to treat your condition, increases your risk of side effects. When weighing up the risk of side effects of the vaccine, it's also important to also consider the risks of complications from COVID-19 if you were to catch the virus. If you feel you have had a side effect from the COVID-19 vaccine, you can report it via the MHRA Yellow Card reporting site.

Read our Blog I've receive the coronavirus vaccine by Heather, living with Crohn's.

Being on an immunosuppressant medicine for your Crohn's or Colitis does not mean that you don't have an immune system.
Your immune system is still able to fight off infections, just not quite as well as other people. Therefore you are still able to have vaccines that are not 'live' vaccines, no matter what medicine you take for your Crohn's or Colitis. None of the COVID-19 vaccines are classed as live - including the vaccine made by Oxford, as it has been altered so that it can't replicate.

People with other medical needs may not be able to have vaccines - such as people going through transplants - as they take much higher doses of immunosuppressant medicines than the amounts taken by people with Crohn's and Colitis.

If you are taking a medicine that suppresses your immune system, your risk of coronavirus complications could be increased. It is therefore likely that you will be on the priority list for any COVID-19 vaccine - see the current prioritisation criteria

You will be able to have the coronavirus vaccine if you are immunosuppressed; you need the coronavirus vaccine if you are immunosuppressed; and you will be prioritised because you are immunosuppressed.

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology

I've heard that immunosuppressed people cannot have the vaccine?

People with Crohn's and Colitis who take medicines that weaken their immune systems should not have vaccines that are 'live' vaccines. None of the COVID-19 vaccines ordered by the UK government are classed as live vaccines. This means that you can have whichever vaccine you are offered.

The Oxford vaccine is originally based off of a live vaccine, but is not considered 'live' as it has been made safe enough for people on immunosuppressants to take. The vaccine is made by taking a common cold virus that normally infects chimpanzees, and altering it so that it looks a lot more like coronavirus. The virus has been changed so that it cannot multiply inside humans. This means that you can't get COVID-19 from taking it. So even though the Oxford vaccine is originally based on a live virus, it has been altered to make it safe enough for people on immunosuppressant medicines to take.

You may have seen conflicting messages elsewhere about whether you can have the Oxford vaccine. We recommend that you refer your healthcare professional to the following resources which state that you are able to have the vaccine:

  • Page 14 of the Green Book on the official gov.uk website states that "Although [Oxford] AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating and is considered safe in immunosuppressed people." The Green Book has the latest information on vaccines and vaccination procedures for vaccine preventable infectious diseases in the UK.
  • Public Health England's guidance for healthcare professionals does not list immunosuppression as a reason not to have any of the vaccines.
  • The British Society for Immunology state that "All three of the COVID-19 vaccines (Pfizer/BioNTech; AstraZeneca/Oxford; Moderna) that have currently been approved for use in the UK are safe to use for people who are immunocompromised or immunosuppressed."

People with other medical needs may not be able to have any of the COVID-19 vaccines - such as people going through transplants - as they take very high dose of immunosuppressant medicines. This does not apply to people with Crohn's and Colitis, as the doses given to do not severely weaken the immune system. You are not considered 'severely' immunocompromised by taking medicines to treat your Crohn's or Colitis.

I would recommend everyone with Crohn's or Colitis to have the coronavirus vaccine as I recently had mine. I feel it is important especially for those who are immunosuppressed – we are all here to fight it together with the support and guidance from Crohn's & Colitis UK, who can provide you with more advice and information.

Daljit Chohan
IBD Specialist Nurse

Which coronavirus vaccine is best for people with Crohn's or Colitis?

All of the coronavirus vaccines that are licensed or in the final stages of testing are considered suitable for people with Crohn's or Colitis, as they are not live vaccines. Therefore having Crohn's or Colitis, or taking medicine to treat your condition, will not affect which coronavirus vaccine is best for you. You should have whichever vaccine you are offered.

The vaccines approved by the UK so far are the ones made by Pfizer/BioNTech, Moderna, and Oxford/AstraZeneca. Current evidence suggests that all of the Pfizer, Moderna and Oxford vaccines are considered suitable for people with Crohn's or Colitis to take, including people who take immunosuppressant medicines. They will be made available across the UK to priority groups first.

The Pfizer and Moderna vaccines are completely synthetic - meaning made in a lab. They are not live vaccines. The Oxford vaccine is different, as it is made by taking a common cold virus that normally infects chimpanzees, and altering it so that it looks a lot more like coronavirus. However, the virus has been changed so that it cannot multiply inside humans. This means that you can't get COVID-19 from taking it. So even though the Oxford vaccine is originally based on a live virus, it has been altered to make it safe enough for people on immunosuppressant medicines to take.

In their official statement, the British Society of Gastroenterology (BSG) have stated that "We recommend that IBD patients accept whichever approved SARS-CoV2 vaccination is offered to them, in accordance with UK Department of Health and Social Care and the Medicines and Healthcare products Regulatory Agency (MHRA)."

We understand that you may have seen conflicting messages elsewhere about whether you can have the Oxford vaccine. We recommend that you refer your healthcare professional to Page 14 of the Green Book on the official gov.uk website, which states that "Although [Oxford] AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating and is considered safe in immunosuppressed people." The Green Book has the latest information on vaccines and vaccination procedures for vaccine preventable infectious diseases in the UK.


Has the vaccine been tested in people with Crohn's or Colitis?

It's understandable to have questions about the fact that there has been no specific vaccine trial for people with Crohn's or Colitis on immunosuppressants. However, this is true of most medicines and vaccines. The coronavirus vaccine has been extensively tested, and trials have involved people with varied chronic underlying conditions and broad age ranges, including many older people. Older people have weaker immune systems than younger people, and the vaccine was still found to be suitable for them. The data on how people with Crohn's and Colitis have coped with coronavirus, even those taking medicines that affect their immune system, is reassuring, and shows no signficant differences from the general population.

It is not recommended that you delay having the COVID-19 vaccine until data for Crohn's and Colitis patients is available. This is because all the data we have from other vaccines shows us that people with Crohn's and Colitis are not at any increased risk of side effects. Delaying your vaccine could lead to you having worse complications if you catch coronavirus. 

Every medicine that IBD patients take outside of their usual IBD medicines - for example paracetamol for your headache, or insulin for diabetes, blood pressure medicines - none of those medicines have been tested specifically in clinical trials of IBD patients. But this doesn't mean that these medicines are risky for IBD patients. It's the same for all other vaccines that we use in routine practice, they were never tested in IBD patients prior to their approval for the general population. Accordingly, we should consider these new vaccines low risk in IBD patients.

We will of course continue to monitor how these vaccines perform as they are rolled out. Balancing risk is an important consideration for all medicines. The one thing we know for certain is that coronavirus infection itself is definitely high risk, and can cause serious problems and even death in some patients. 

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology

Will the COVID-19 vaccine work?

Yes - having Crohn's or Colitis does not make the vaccine any less effective for you. If you are on a 5-ASA medication, or no medication at all, you can expect the vaccine to work just as well as it does for the general population.

If you take an immunosuppressant medicine, the vaccine may be slightly less effective. This is because some immunosuppressants may make your body less able to defend itself against viruses and other harmful germs - this is called the immune response. (Visit our Treatments page to see if the medicine you take is an immunosuppressant - most medicines for Crohn's and Colitis are, except 5-ASAs like Mesalazine and Pentasa). We still don't know which medicines, if any, will reduce the effectiveness of the coronavirus vaccine. It is thought that there may be a chance of this happening from what we have seen from flu vaccine studies.

This does not mean you should stop your treatment. Stopping treatment can lead to a flare of your Crohn's or Colitis, which puts you at greater risk from serious complications of COVID-19. Even if the COVID-19 vaccine works slightly less well for you, it will still offer greater protection than not having the vaccine.

As is the case with other vaccines, no coronavirus vaccine will be 100% effective for everyone, and there is no guarantee that it will give complete protection. To compare, flu jabs are around 50% effective on average for the general population, yet are still effective in reducing the amount of hospitalisations and serious complications from flu. If you do catch COVID-19 after being vaccinated, it is likely that the virus will be less severe and you will recover faster than if you had not had the vaccine. Having the vaccine will reduce your risk of being hospitalised with coronavirus. Being vaccinated may also stop you spreading the virus to other people, although there is no evidence of this as yet. 

As there's a chance vaccine may work slightly less well for you, you should continue to follow government guidance on reducing the risk of infection, even after you have received the vaccine. It is likely that the general population will also be asked to continue to take some precautions after vaccination too, as we don't yet know how long the vaccine will protect you for, and how well it stops you from passing on the virus to others.

There are a number of research studies that will help scientists decide the best way to vaccinate people with Crohn's and Colitis (including those taking medicines which weaken their immune system). For example, it may be found that people on immunosuppressants could benefit from an extra dose of the vaccine to make it as effective as possible. Find out more about coronavirus research in people with Crohn's and Colitis.

Some of the commonly used vaccines are a bit less effective in people taking immunosuppressants. If you look at the flu vaccine, we see some reduction in antibody formation in patients on anti-TNF medication. However, this doesn't mean that it won't provide some protection.

As yet there is no proof that this would happen with the coronavirus vaccine. For these vaccines, the protection is around 95%, so these are probably much better vaccines than the flu vaccine, where protection is more like 50-60%. So, the starting level at which you're protected from coronavirus is much higher to start with, even if your medicine may make the vaccine slightly less effective. As we start vaccinating IBD patients, we'll find out the answers to these questions. It is worth remembering that without vaccination, IBD patients will have no protection whatsoever from this dangerous virus.

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology

When can I have the vaccine?

The people most vulnerable to coronavirus will have access to the vaccine first. Reassuringly, current data on COVID-19 shows good outcomes for people with Crohn's and Colitis, including those in the high risk group.

The Joint Committee on Vaccination and Immunisation (JCVI) have published a list of who will be given priority for the vaccination first. The government have said they aim to have all priority groups vaccinated by Easter, in the following order. The groups in bold are currently being offered vaccination:

  1. Residents in a care home for older adults and their carers 
  2. All those 80 years of age and over AND: 
    Frontline health and social care workers
  3. All those 75 years of age and over
  4. All those 70 years of age and over AND:
    Clinically extremely vulnerable (high risk) individuals over 16 years old
  5. All those 65 years of age and over 
  6. All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality*
  7. All those 60 years of age and over 
  8. All those 55 years of age and over 
  9. All those 50 years of age and over

You can find out what risk group you are in by checking our decision tree

* If you are not in the high risk group but take a medicine that affects your immune system, then you are likely to be given vaccine priority at level 6. Visit our Treatments page to see if the medicine you take is an immunosuppressant - most medicines for Crohn's and Colitis are, except 5-ASAs like Mesalazine and Pentasa.

If you do not take an immunosuppressant medicine, you are unlikely to be eligible for a priority vaccine due to your Crohn's or Colitis (you may be prioritised for other reasons, such as your age, job, or other health conditions). You will be able to access a COVID-19 vaccine when it is rolled out to the general population.

If you are aged between 16-18, there is a chance you may not be called for a vaccine in the priority groups. This is because the risk of complications from coronavirus is very low in people under 18. However if you are offered the COVID-19 vaccine, we recommend that you still take it. 

This advice on vaccination does not include pregnant people and those under the age of 16 years. There are currently no plans to prioritise vaccinating people who live with someone who is in a higher risk group. 

You do not need to contact your healthcare professional to receive the vaccine; the NHS will contact you and let you know the next steps.


My risk level is different to how the government have classified me

Experts in Crohn's and Colitis have lots of specific knowledge about the conditions, and have classified risk levels slightly differently to the government. You can find out more about this on our risk page.

The priority risk groups outlined above relate to how the government have assessed your risk level. Therefore if you received a shielding letter saying you are at high risk, but specialist advice for your specific condition advises that you are actually moderate risk, you still may be contacted for the vaccine at the same time as people at high risk. We advise you to get the vaccine as soon as it is offered to you, even if you have been put in the incorrect risk group. This is because we don't know if you will be able to opt in to the vaccine later.

If you are in the high risk group, it's important that the government are aware of this, so that you will be contacted to receive a vaccine at the right time. If you have not already been receiving letters from the government explaining that you are at high risk, ask your GP if they can add you to the Shielded Patients List. You can show them your results from the COVID-19 IBD UK risk tool to help you explain your risk level. You can also ask your IBD Team to make a note in your clinic letter (which is sent to your GP) that you need to be added to the Shielded Patients List.


Will the vaccine cause my Crohn's or Colitis to flare?

There is no evidence to suggest that the COVID-19 vaccine would cause a flare-up of your condition. There is also no evidence that the vaccine would stop your medicine from working properly. If you do have a flare-up after receiving the vaccine, this is likely to be a coincidence, as Crohn's and Colitis flares can happen unexpectedly. It's common for periods of stress to trigger a flare-up, so this might also be responsible. If you feel you have had a side effect from the COVID-19 vaccine, you can report it via the MHRA Yellow Card reporting site.

If you look at the history of vaccinations in people with immune problems like Crohn's and Colitis, there has been no evidence that commonly used vaccinations trigger a flare in your disease.

The COVID-19 vaccine particles are unlikely to live in your body forever. Your body will probably eliminate the particles in about ten days [from what we have seen from mice studies] and then it's gone forever. You generate an immune response against them. Your immune system is smart and has an excellent memory. It will remember the viral components present in the vaccine, and if it ever sees the coronavirus itself in the future, it will recall the encounter and rapidly generate antibodies that neutralize the virus, or protective immune cells called T-cells.

Your immune system is also highly specific. The immune cells triggered to generate a response to the coronavirus vaccine, are completely different to the immune cells likely to be involved in damaging the gut IBD. Therefore, it is unlikely that immune activation stimulated by the vaccine would be misdirected and make your IBD worse. We certainly haven't seen this happen with any other the other commonly used vaccines.

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology

When weighing up the risk of side effects of the vaccine, it's also important to also consider the risks of complications from COVID-19 if you were to catch the virus. Complications from the virus can be life-threatening, especially if you are at increased risk, and some people have reported that testing positive for coronavirus has led them to develop a flare-up. It is safer to receive protection from coronavirus rather than risk infection.

My experience with coronavirus felt no different to when I have a bad flare up. It started with abdominal pain, nausea, aching followed by a fever and high output from my stoma. I was also very fatigued throughout this and it continued for seven days. On day 6, I was admitted for to hospital and placed on IV antibiotics and fluids.

Emma
Living with Colitis

Should I avoid taking the vaccine at certain times?

The coronavirus vaccine is suitable to take in most circumstances, including when you are in a Crohn's or Colitis flare-up. It is fine to have the vaccine on the same day that you take your regular biologic medicine - although you may wish to do this on a different day if you are likely to experience pain at the injection site. 

If you feel very unwell on the day of your appointment (for example if you have a high fever), your vaccine may be postponed until you have fully recovered.

You should ideally wait 7 days between the coronavirus vaccine and any other vaccination, such as the flu jab. This is because in the very rare circumstance that you have an allergic reaction, it will be important to tell which vaccine has caused it. This does not apply to biologic injections, as they are not vaccines - but seek advice from your IBD team if you are starting a new treatment in the same week as your COVID-19 vaccine.

If you have Crohn's or Colitis it's better to be protected from flu as soon as possible, so if you are eligible for a flu jab and haven’t yet had it this winter, contact your GP or community pharmacy.


Do I need the vaccine if I've had coronavirus already?

Yes. It is not known how long immunity from coronavirus lasts, and it may be possible get COVID-19 more than once. Therefore it is important to get the vaccine, even if you have had the virus already.

If you've recently tested positive for coronavirus – even if you have no symptoms – contact your healthcare professional for advice. They may recommend that you wait for a certain period of time before getting the vaccine.


Can I stop shielding once I've had the vaccine?

Currently, people who have had the COVID-19 vaccine still have to follow the same legal restrictions as people who have not had the vaccine.

Shielding guidance for clinically extremely vulnerable (high risk) people is optional, and not enforced by law. Therefore as long as you continue to follow the general government restrictions, it is your decision if you no longer wish to shield after having your COVID-19 vaccine. However, it is strongly recommended that you continue to take all possible precautions to keep yourself and others safe. This is because we don't yet know how long the vaccine will protect you for, and how well it stops you from passing on the virus to others. If you take a medicine that affects your immune system, there's also a chance that the vaccine might work slightly less well for you, meaning there may still be a small risk of catching coronavirus.

It is important to have the vaccine, even though you still need to take precautions. If you do catch COVID-19 after being vaccinated, it is likely that the virus will be less severe and you will recover faster than if you had not had the vaccine. Having the vaccine will reduce your risk of being hospitalised with coronavirus.


Are the needs of people with Crohn's and Colitis being considered?

Many people with Crohn's and Colitis are at increased risk of complications from coronavirus - we're fighting to make sure that those most at risk are protected.

We've written to the JCVI, who advise UK health departments on immunisation, asking them to ensure that people with Crohn's or Colitis in both the moderate and high risk groups would be eligible for priority COVID-19 vaccination. We have also written to the relevant Ministers in all four UK nations and the Chief Medical Officers with the same ask.

More coronavirus support and information