Sa1997 Identifying Fistulizing Crohn's Disease in a National Pediatric Inflammatory Bowel Disease Quality Improvement Collaborative Registry

Abstract

immunized against varicella, and concerns exist regarding the safety and efficacy of this immunization in immunosuppressed patients. We aimed to evaluate the risk of varicellaand zoster-related hospitalization among children with IBD. Methods: A retrospective cohort study was performed utilizing data on varicellaand zoster-related hospitalizations from the 1997, 2000, 2003, 2006, 2009, and 2012 triennial Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID). Hospitalizations with a primary diagnosis of varicella or herpes zoster were compared between children (ages 5 to 21) with and without IBD using logistic regression. Results: There were 12,219,138 admissions in the HCUP-KID database from 1997-2012, including 4,434 with varicella and 4,488 with zoster listed as the primary diagnosis. Children with IBD accounted for 57 (1.29%) and 74 (1.64%) of the varicellaand zoster-related hospitalizations, respectively. Primary admissions for varicella or zoster accounted for 0.4% of all hospitalizations of children carrying a diagnosis of IBD. Compared to children without IBD, those with IBD were at significantly higher risk for varicella-related hospitalization (OR 4.98, 95% CI 3.84-6.47) and zoster-related hospitalization (OR 6.35, 95% CI 5.04-7.99). This risk was higher among children with Crohn's disease (varicella OR 6.22, 95% CI 4.65-8.32, zoster OR 7.39, 95% CI 5.67-9.65) compared to children with ulcerative colitis (varicella OR 2.69, 95% CI 1.50-4.81, zoster OR 4.34, 95% CI 2.75-6.85). Conclusion: Children with IBD are at increased risk for varicellaand zosterrelated hospitalization. These results highlight the importance of efforts to immunize IBD patients without a history of varicella disease or varicella immunization, ideally before the initiation of immunosuppressive therapy. Furthermore, research is needed on the safety and efficacy of varicella vaccine in children with IBD on immunomodulators including antitumor necrosis factor-alpha agents.