Varicella Zoster Virus in Inflammatory Bowel Disease Patients: What Every Gastroenterologist Should Know

2020 ◽  
Author(s):  
Philipp Schreiner ◽  
Nicolas J Mueller ◽  
Jan Fehr ◽  
Michel H Maillard ◽  
Stephan Brand ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Varicella Zoster Virus ◽  
Bowel Disease ◽  
Disease Course ◽  
Signal Transducer ◽  
Jak Inhibitors ◽  
Varicella Zoster ◽  
Emerging Therapies ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Primary varicella zoster virus [VZV] infection results in varicella [chickenpox] and its reactivation results in herpes zoster [HZ; shingles]. Patients with inflammatory bowel disease [IBD] are susceptible to complications of primary VZV infection and have an increased risk of HZ. Concerns of VZV and HZ infection in the IBD population have been highlighted by the emergence of JAK inhibitors and their safety profile in this patient population, as with tofacitinib for the treatment of ulcerative colitis [UC]. The current pipeline of emerging therapies includes novel molecules targeting multiple pathways, including JAK/signal transducer and cytokine signalling pathways, such as JAK/STAT. Hence VZV and HZ will be increasingly relevant for gastroenterologists treating IBD patients in light of these emerging therapies. This review will focus on the epidemiology, disease course, prevention, and management of these two distinct infections in patients with IBD.

scholarly journals Immunisation status of children and adolescents with a new diagnosis of inflammatory bowel disease

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Timothy Ford ◽  
Margie Danchin ◽  
Alissa McMinn ◽  
Kirsten Perrett ◽  
George Alex ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Risk Groups ◽  
Current Evidence ◽  
Varicella Zoster ◽  
National Immunisation ◽  
Paediatric Patients ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Special Risk

Abstract Background Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines. Methods Paediatric patients (0–18 years) seen at the tertiary Royal Children’s Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available. Results Sixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC. Conclusions Children with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.

scholarly journals Varicella Zoster Virus Anterior Uveitis Complicated by Thalamic Stroke

2020 ◽  
Author(s):  
Casey Anthony ◽  
Anastasios P. Costarides ◽  
Steven Yeh ◽  
Jessica G. Shantha
Keyword(s):  
Inflammatory Bowel Disease ◽  
Weight Loss ◽  
Varicella Zoster Virus ◽  
Antiviral Therapy ◽  
Anterior Uveitis ◽  
Bowel Disease ◽  
Clinical Course ◽  
Varicella Zoster ◽  
Thalamic Stroke ◽  
Inflammatory Bowel

Abstract We report a case of varicella zoster virus (VZV)-associated anterior uveitis in a patient with weight loss, arthritis and signs of inflammatory bowel disease. Her clinical course included the development of a thalamic stroke secondary to VZV cerebral vasculopathy. Following antiviral therapy, the patient’s neurologic symptoms recovered and her ophthalmic findings improved.

scholarly journals School-related experience and performance with inflammatory bowel disease: results from a cross-sectional survey in 675 children and their parents

2018 ◽  
Vol 5 (1) ◽  
pp. e000236 ◽  
Author(s):  
Magdalena Freckmann ◽  
Alexander Seipp ◽  
Martin W Laass ◽  
Sibylle Koletzko ◽  
Martin Claßen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Health Services ◽  
Bowel Disease ◽  
Grade Retention ◽  
Chronically Ill ◽  
Influential Factors ◽  
Disease Course ◽  
Cross Sectional ◽  
Increased Risk ◽  
Inflammatory Bowel

ObjectiveWe describe school performance and experience in children with inflammatory bowel disease (IBD) across Germany and Austria. Predictors of compromised performance and satisfaction were evaluated to identify subgroups of increased risk.DesignThis cross-sectional analysis was based on a postal survey in children aged 10–15 with Crohn’s disease, ulcerative colitis or unclassified IBD and their families. Multivariate regression analysis was used to assess influential factors on parental satisfaction with school, attending advanced secondary education (ASE), having good marks and having to repeat a class. Satisfaction was assessed based on the Child Healthcare–Satisfaction, Utilisation and Needs instrument (possible range 1.00–5.00).ResultsOf 1367 families contacted, 675 participated in the study (49.4%). Sixty-eight participants (10.2%) had repeated a year, 312 (46.2%) attended ASE. The median school satisfaction score was 2.67 (IQR 2.00–3.33). High socioeconomic status (SES) and region within Germany were predictive for ASE (OR high SES 8.2, 95% CI 4.7 to 14.2). SES, female sex and region of residence predicted good marks. Grade retention was associated with an active disease course (OR 2.7, 95% CI 1.4 to 5.3) and prolonged periods off school due to IBD (OR 3.9, 95% CI 1.8 to 8.6).ConclusionsA severe disease course impacted on the risk of grade retention, but not on type of school attended and school marks. Low satisfaction of parents of chronically ill children with the school situation underlines the need for a more interdisciplinary approach in health services and health services research in young people.

Biochemical Markers, Genotype, and Inflammation in Pediatric Inflammatory Bowel Disease: A Danish Population-Based Study

2018 ◽  
Vol 37 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Farah Ziade ◽  
Christine Rungoe ◽  
Thomas Kallemose ◽  
Anders Paerregaard ◽  
Anne Vibeke Wewer ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Biochemical Markers ◽  
Pregnane X Receptor ◽  
Population Based ◽  
Disease Course ◽  
Extensive Disease ◽  
Markers Of Inflammation ◽  
Increased Risk ◽  
Inflammatory Bowel

Background: Our aim was to characterize the biochemical markers at diagnosis in patients with inflammatory bowel disease (IBD), to assess the utility of these to predict disease course and investigate if genotype influences biochemical markers of inflammation. Summary: Patients were included from a population-based pediatric IBD cohort from Eastern Denmark. Data on biochemical markers and medical as well as surgical treatment were registered at diagnosis, 30 days, 6 and 12 months after diagnosis. Fifty-two single nucleotide polymorphisms (SNPs) known to be associated with IBD were selected for genotyping based on previous genetic studies. Key messages: A total of 190 IBD patients (97 ulcerative colitis [UC], 87 Crohn’s disease [CD], and 6 IBD unclassified) were included. UC patients with extensive disease had higher C-reactive protein, erythrocyte sedimentation rate, and platelet count at diagnosis compared to UC patients with less extensive disease. No similar differences between disease extent groups were found in CD. Low albumin at diagnosis was associated with an increased risk of surgery in both UC (OR 1.35; 95% CI: 1.05–1.75) and CD patients (OR 1.23; 95% CI: 1.01–1.48) and increased use of azathioprine and anti-tumor necrosis factor alpha use in the total IBD cohort (OR 1.15; 95% CI: 1.04–1.27 and OR 1.19 [1.08–1.34]). One SNP (rs4986791 in the TLR-4 locus) and 2 SNPs (rs6785049 in the Pregnane-x-receptor gene and rs10500264 in the SLCA10 gene) were associated with a change in albumin and hemoglobin over time respectively in our IBD cohort. Our study confirms albumin to be a marker of severe disease course. Furthermore, the patient’s genotype possibly affects the inflammatory response. Future studies in larger pediatric cohorts are needed to confirm our findings.

A Decade of Varicella Screening Within a Paediatric Inflammatory Bowel Disease Population

2019 ◽  
Vol 14 (5) ◽  
pp. 608-616 ◽  
Author(s):  
Rachel E Harris ◽  
Lee Curtis ◽  
Vikas Hegde ◽  
Vikki Garrick ◽  
Lisa Gervais ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Hospital Admissions ◽  
Immunisation Programme ◽  
Post Exposure Prophylaxis ◽  
Varicella Zoster ◽  
Post Exposure ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Exposure Prophylaxis

Abstract Introduction Increased risk of opportunistic infection—e.g., varicella zoster infection—secondary to therapies is a cause of morbidity in inflammatory bowel disease [IBD] patients. The UK vaccination schedule does not include varicella immunisation. We aimed to evaluate the varicella screening and immunisation programme in a paediatric IBD population. Methods Data regarding IBD diagnosis, varicella status, and consequent immunisations/treatment interventions were collected retrospectively from the records of patients diagnosed with IBD over a 10-year period [2009–2018]. Results In all, 520 IBD patients were diagnosed; 505/520 [97%] had varicella testing; 46/505 [9%] were naïve. Of 501 patients, 391[78%] were tested before or within 7 days of diagnosis; this increased in the second 5-year period compared with the first (229/268 [85%] versus 162/233 [70%]; p <0.00001). Median diagnosis age of naïve patients was lower [8.3 years versus 12.8 years; p <0.00001]. Where vaccination was feasible, 21/31 [68%] had two and 7/31 [23%] one immunisation. Prednisolone induction led to lower rates of vaccination (5/13 [39%] versus 23/33 [70%] for other induction therapies; p =0.02). Of 28 vaccinated patients, 5 [18%] had suspected breakthrough varicella; and 6/18 [33%] unimmunised patients required post-exposure prophylaxis or treatment for varicella. Immunisation was associated with a decrease in patients requiring post-exposure prophylaxis (0/28 [0%] versus 5/18 [28%]; p =0.0006) and varicella-related hospital admission (1/28 [4%] versus 4/18 [22%]; p =0.01). Conclusions High rates of varicella screening and immunisation within a PIBD population are possible, resulting in a reduction in hospital admissions for varicella treatment. Varicella immunisation may be of increasing importance within the PIBD population with the emergence of novel therapeutic strategies.

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