A Decade of Varicella Screening Within a Paediatric Inflammatory Bowel Disease Population
Rachel E Harris1, Lee Curtis1, Vikas Hegde2
1Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK.
Insights
Varicella screening and immunisation in pediatric inflammatory bowel disease (IBD) patients is feasible and reduces hospital admissions. This proactive approach is crucial given increased infection risks from IBD therapies.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Infectious Disease Prevention
Background:
- Patients with inflammatory bowel disease (IBD) face increased risk of opportunistic infections, such as varicella zoster virus (chickenpox), due to immunosuppressive therapies.
- The UK's national immunization program does not routinely include varicella (chickenpox) vaccination.
- Evaluating varicella screening and immunization practices is essential for protecting pediatric IBD patients.
Purpose of the Study:
- To assess the effectiveness and feasibility of a varicella screening and immunization program for children diagnosed with IBD.
- To determine the impact of varicella screening and vaccination on infection rates and treatment needs in this vulnerable population.
Main Methods:
- Retrospective data collection of IBD diagnoses, varicella status, and vaccination/treatment interventions over a 10-year period (2009-2018).
- Analysis of screening rates, varicella immunity status (naïve vs. immune), vaccination uptake, and outcomes in 520 pediatric IBD patients.
- Comparison of screening and vaccination rates between the first and second halves of the study period.
Main Results:
- High varicella testing rates (97%) were achieved, identifying 9% of patients as varicella-naïve.
- Screening before or within 7 days of diagnosis improved over time (70% to 85%). Naïve patients were significantly younger (8.3 vs. 12.8 years).
- Vaccination was associated with significantly lower rates of post-exposure prophylaxis (0% vs. 28%) and varicella-related hospital admissions (4% vs. 22%) compared to unvaccinated patients.
Conclusions:
- Implementing varicella screening and immunization programs in pediatric IBD populations is achievable and leads to reduced hospitalizations for varicella.
- Proactive varicella immunization is increasingly important for pediatric IBD patients, especially with the advent of new therapeutic agents.
- The study highlights the success of a dedicated program in mitigating varicella risks in immunosuppressed children.
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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