Along with Crohn’s disease, ulcerative colitis (UC) is one of the two main conditions classified as inflammatory bowel disease (IBD).

UC occurs when inflammation causes tiny sores along the lining of your large intestines. About 9 to 20 per 100,000 people in the United States receive a diagnosis of UC each year.

The Crohn’s & Colitis Foundation recommends that people with IBD get vaccinated for COVID-19. Vaccines approved for use in the United States are considered safe for people with IBD, and most people with IBD can create an expected immune response.

Receiving a vaccine can help you prevent infection with SARS-CoV-2, the virus that causes COVID-19, or severe illness. Research suggests some immunosuppressants used to treat UC are associated with poorer COVID-19 outcomes.

Research has also found evidence that COVID-19 can cause UC flare-ups, likely because of increased psychological and physical stress.

Keep reading to learn more about the vaccine recommendations for people with UC.

The Centers for Disease Control and Prevention (CDC) recommends vaccination for everybody ages 5 and up. This includes children with UC.

It’s a good idea to speak with your child’s doctor or healthcare professional before having them vaccinated if they’re currently taking corticosteroids or tumor necrosis factor (TNF) inhibitors to understand how their medications may impact their immune response.

Rates of adverse effects among people with IBD after receiving a COVID-19 vaccine are similar to those of the general population.

In a study of 228 people with IBD, researchers found the most common side effects after the first dose were:

After the second dose, the most common side effects were:

  • general feeling of being unwell — 26.4 percent
  • fever — 20.7 percent
  • headache — 19.7 percent

It’s possible that physiological stress induced by the vaccine may increase the risk of experiencing UC flare-ups. Psychological stress from vaccine anxiety could also contribute.

Weakened vaccine response

Some immunosuppressant medications used to treat UC may interfere with your response to the vaccine. Some medications may impact vaccine response more than others. A doctor or healthcare professional can help advise you about whether any adjustment to your medication is needed before or after your vaccine or whether you may need a booster dose.

Current evidence suggests that the vast majority of people taking medications to treat IBD still mount an effective immune response to COVID-19 vaccines.

In a 2022 study, researchers found that people taking the medications infliximab or tofacitinib had a lower vaccine response than the general population. Vaccine response in people treated with infliximab was lowered by 10 times.

A total of 10 percent of people on infliximab and 13 percent on infliximab or tofacitinib didn’t have an effective response to the vaccine.

People treated with thiopurines, ustekinumab, or vedolizumab had no significant reduction in vaccine response compared with the general population.

In another 2022 study, researchers found evidence that the use of TNF inhibitors or corticosteroids didn’t influence the effectiveness of the COVID-19 vaccine in people with IBD compared with the general population.

Not getting vaccinated against COVID-19 puts you at a higher risk of developing COVID-19 or developing severe illness.

A 2021 review of studies found evidence that the risk of developing COVID-19 is similar between people with IBD and the general population and that the risk is similar between people with UC and people with Crohn’s disease.

The researchers also found that outcomes were poorer in people with IBD taking steroids or 5‐aminosalicylates than in the general population, but biological agents seem to protect against severe disease.

One case study presented a 50-year-old male whose UC was believed to be triggered by SARS-CoV-2 infection.

Immunosuppressive therapy may put people with IBD at an increased risk of many other types of infectious conditions, such as:

Receiving vaccines for each of these conditions can help lower your chances of developing them.

Most people with UC aren’t considered immunosuppressed and don’t need an additional vaccine.

The Advisory Committee on Immunization Practices announced in 2021 that it recommends an additional dose of an mRNA vaccine (Moderna or Pfizer-BioNTech) for people taking:

  • high doses of corticosteroids
  • anti-TNF biologics
  • immunomodulators

This recommendation was meant for people who’ve had a solid organ transplant or had a similar level of immunosuppression that would be beyond the level of most people with UC.

The CDC recommends that people over the age of 12 who are moderately or severely immunosuppressed receive five doses of an mRNA COVID-19 vaccine.

However, most people with UC taking medication aren’t considered immunosuppressed, and all vaccines approved in the United States are considered safe. A doctor or healthcare professional can best advise you if they think you’d benefit from receiving a certain vaccine.

The Crohn’s & Colitis Foundation recommends that people receiving a booster dose should receive the same shot that they received for their first two doses. For example, if you had Pfizer for your first two doses, you should get Pfizer for your third dose.

People with UC or Crohn’s disease who aren’t taking immunosuppressive therapy can safely and effectively receive the same vaccines as people without IBD.

If you’re taking immunosuppressive therapy with UC, it’s a good idea to speak with a doctor or healthcare professional to understand how your medications may affect your vaccine response. A doctor or healthcare professional may recommend adjusting your doses in the time immediately before or after your vaccine.

Most people with UC can safely receive any of the COVID-19 vaccines approved in the United States. Research suggests that most people taking immunosuppressants for IBD are still able to mount an immune response to the vaccine.

It’s a good idea to speak with a doctor or healthcare professional before receiving your vaccine if you’re taking immunosuppressants to understand how your medications may affect your response to the vaccine.