Abstract
Background
Patients with IBD receive a variety of medications that modulate the immune response. However, many medications render patients more susceptible to opportunistic infections. Varicella zoster virus (VZV) infection, in particular, has been well reported in IBD patients, mostly in CD. Chickenpox results from primary VZV infection, and is predominantly seen in the pediatric population. Primary prevention via vaccination for VZV, plays an important role in preventing infections in IBD patients before they start immunomodulators, corticosteroid or biologic therapy. Given the advent of zoster vaccines, it is important to determine if IBD patients should be considered for immunization at a younger age.
Aims
1) To document the prevalence of herpes zoster virus (HZV) infection patients with IBD and to further investigate the characteristics of susceptible hosts
2) To assess the severity of herpes zoster in this patient population
Methods
A single center retrospective cohort study was conducted at the Montreal Children’s Hospital. Pediatric IBD patients (age < 18 years) who developed HZV from 2004- 2019 were identified. Data regarding HZV infection, location, severity, treatment, complications and list of all immunosuppressive medications at the time of HZV infection were retrieved as well as data regarding demographics, medical history, vaccination status including Varicella vaccine, and disease behavior.
Results
A total of 9 patients were identified from who had VZV infection or HZV. Eight out of 9 patients, had CD and one patient had UC, and 6 out of 8 CD patients had had extensive disease. The vaccine status was up to date in 6 out of 9 patients, and varicella serology was identified prior to starting steroids or biologic agents.
Eight out of nine patients were on biologics. Eight patients had local disease, skin only, and one patient had systemic disease with HZV meningitis. Four out of 9 patients had their biologic medications either stopped or the next doses were delayed, while other medications including steroids, methotrexate, thiopurines were continued. Five patients were treated with intravenous acyclovir then oral valacyclovir. The rest started on oral valacyclovir and then switched to intravenous acyclovir due to systemic disease. The overall prognosis of the illness was good, and it resulted in full resolution, including the meningitis case.
Conclusions
Our study suggests that being on biologic medication plays a significant role in increasing the chances of reactivation of HZV. Although the severity of the HZV infection in our study is limited to skin involvement, there was one systemic infection. Close attention and mandatory documentation of vaccination status is prudent especially prior to starting immunosuppressive medications. Further studies are needed to determine if these patients should be vaccinated with recombinant zoster vaccine.
Funding Agencies
None
The impact of varicella vaccination on paediatric herpes zoster epidemiology: a Canadian population-based retrospective cohort study
