P067 Immunosuppressive therapy in inflammatory bowel disease patients is associated with reactivation of Herpes Zoster: A tertiary center experience

Abstract

BACKGROUND: Herpes Zoster (HZ), also known as shingles, is the reactivation of the varicella zoster virus (VZV). The incidence of HZ is 4 per 1,000 person-years. Though HZ can occur at any age and in any population, the incidence increases with age and is up to ten times higher in immunocompromised patients. Vaccine guidelines for inflammatory bowel disease (IBD) patients on immunosuppressive therapy recommend obtaining age appropriate non-live attenuated vaccinations while strongly considering risks and benefits when administering the live-attenuated vaccines. Currently, CDC guidelines recommend the new non-live HZ vaccine, Shingrix, in patients over the age of 50. As this is a non-live vaccine it is safe to administer in patients on immunosuppressive therapy. The purpose of our study was to identify risk factors associated with the development of HZ among IBD patients. METHODS: Using our institution’s electronic research data warehouse, we performed a case-control study including IBD patients enrolled in the prospectively maintained IBD patient database at the University of Chicago IBD Center between January 1, 2005 and January 1, 2017. Controls included individuals presenting to the general gastroenterology and hepatology clinics. The diagnosis of HZ was identified using ICD codes (053.9, 053.19, B029, B028) and documentation of a characteristic rash at the corresponding clinic visit. Demographic variables, disease-related and therapy-related factors including HZ vaccination were recorded. Data were analyzed using Wilcoxon rank-sum test for continuous variables and Fischer’s exact test for dichotomous variables. RESULTS: We identified 88 unique patients encounters (57 IBD, 34 non-IBD) with a diagnosis of HZ. The non-IBD controls primarily included individuals with a history of liver disease (n = 21). The IBD patients were predominantly Caucasian (80%) and of younger age when compared to the control population (P < 0.001). Among the 57 IBD patients, 20 (35%) had active disease and 51 (89%) were on active immunosuppression. There were no other statistically significant demographic features between the groups with regards to active smoking or prior HZ vaccination. Only 6 (19%) IBD patients who were over the age of 50 were vaccinated. IBD patients were more likely to be on active immunosuppression or have a history of immunosuppression (P < 0.001) compared to controls. Despite a high level of active disease and immunosuppression, IBD patients had higher albumin and hemoglobin levels compared to the controls. Following the onset of HZ, there was no significant difference in the onset of post-herpetic neuralgia. CONCLUSION(S): Active immunosuppression in IBD patients is a risk for HZ, but no other variables were identified. The disease course with respect to development of post-herpetic neuralgia is not different compared to controls. Only a small number of eligible patients received vaccination for HZ and none of these developed HZ. Further studies should identify independent risk factors for vaccination or expand the eligibility of vaccination to larger cohorts of patients in order to prevent the onset of HZ.