Hospitalization for Varicella and Zoster in Children with Inflammatory Bowel Disease
Daniel J Adams1, Cade M Nylund1
1Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
Insights
Children with inflammatory bowel disease (IBD) face increased risks of hospitalization for varicella and herpes zoster. Vaccination is crucial for IBD patients lacking immunity, ideally before immunosuppressive therapy.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Inflammatory bowel disease (IBD) involves chronic inflammation of the digestive tract.
- Children with IBD often require immunosuppressive therapies, potentially increasing infection risks.
- Varicella (chickenpox) and herpes zoster (shingles) are viral infections that can cause severe illness in immunocompromised individuals.
Purpose of the Study:
- To investigate the association between pediatric inflammatory bowel disease (IBD) and hospitalizations due to varicella and herpes zoster.
- To quantify the risk of these viral infections in children diagnosed with IBD.
Main Methods:
- A cross-sectional study analyzed inpatient data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (1997-2012).
- Billing codes identified pediatric patients (ages 5-20) with IBD (Crohn's disease, ulcerative colitis) and primary diagnoses of varicella or herpes zoster.
- Logistic regression models were used to calculate odds ratios for viral hospitalizations.
Main Results:
- The study included over 8.8 million pediatric admissions.
- Children with IBD, particularly Crohn's disease, showed significantly higher odds of hospitalization for varicella and herpes zoster compared to those without IBD.
- The association was stronger for Crohn's disease (varicella OR 12.75; zoster OR 7.91) than for ulcerative colitis (varicella OR 4.25; zoster OR 3.90).
Conclusions:
- Pediatric inflammatory bowel disease is linked to increased hospitalizations for varicella and herpes zoster.
- Vaccination against varicella is recommended for IBD patients without immunity, prior to immunosuppressive treatment.
- Further research is needed on varicella vaccine safety and efficacy in IBD children receiving immunomodulators or biologics.
Objective:
To evaluate the association between inflammatory bowel disease (IBD) and varicella- and herpes zoster-related pediatric hospitalizations.
Study Design:
We performed a cross-sectional inpatient study using the triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for years 1997-2012 to evaluate the association between a secondary diagnosis of IBD and a primary diagnosis of varicella or herpes zoster for hospitalized children ages 5-20 years. Billing codes were used to identify varicella, herpes zoster, ulcerative colitis, Crohn's disease, and other immunocompromising conditions. A logistic regression model was fitted to quantify the odds of varicella or zoster between these categories.
Results:
There were 8 828 712 weighted admissions meeting the study criteria, 4434 with varicella and 4488 with herpes zoster. There was an association of IBD and immunocompromising conditions with hospitalization for varicella and herpes zoster. This association was stronger among children with Crohn's disease (varicella OR, 12.75; 95% CI, 8.30-19.59; zoster OR, 7.91; 95% CI, 5.60-11.18) compared with children with ulcerative colitis (varicella OR 4.25; 95% CI 1.98-9.12, zoster OR 3.90; 95% CI 1.98-7.67).
Conclusions:
IBD in children is associated with hospitalizations for varicella and herpes zoster. These results highlight the importance of efforts to vaccinate patients with IBD without varicella immunity, ideally before the initiation of immunosuppressive therapy. Furthermore, research is needed on the safety and efficacy of the varicella vaccine in children with IBD on immunomodulators or biologic therapy.
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