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N003. Practicalities of varicella screening and vaccination in the paediatric inflammatory bowel disease (IBD) patients

L. Curtis, V. Garrick, P. McGrogan, A. Barclay, K. Fraser, R. Russell, Glasgow Royal Hospital for Sick Children, Gastroenterology department, Glasgow, United Kingdom

Background

Varicella Zoster Virus (VZV) has been suggested to cause significant morbidity and mortality to the immunosuppressed child with IBD [1]. Pre-emptive strategies should be considered for a child with IBD to reduce the impact of the varicella infection in line with published guidelines [2]. We aim to describe the impact of our VZV screening and immunisation programme.

Methods

Universal varicella serology screening was introduced at the time of IBD diagnosis in our tertiary unit from 2009. Children identified as VZV negative, were then considered for vaccination. A two stage varicella vaccination programme was implemented, using either the Varivax® or the Varilrix® vaccine, with an interval time of 4wks. For children with negative serology unsuitable for vaccination, varicella specific education was delivered to the family by the IBD Nurse. Median values were compared using a Mann–Whitney test (Minitab v.15).

Results

Between 2009–2011, 136 children were diagnosed with IBD, 91 (67%) Crohn's Disease (CD), 30 (22%) Ulcerative Colitis (UC) and 15 (11%) IBD Unclassified. 6/136 (4.4%) were not tested for varicella serology. Of the remaining 130 patients, 117 (86%) were positive and 13 (9.6%) negative. Of the negative patients 10 had CD and 3 UC. Median age of varicella negative patients was significantly younger than positive patients (8.77 years vs. 12.16 years, p = 0.01). 8/13 (62%) varicella negative patients were successfully vaccinated. In the children with negative serology, 5 received Exclusive Enteral Nutrition therapy, of which 80% were successfully vaccinated. Of the patients not vaccinated, 4 (80%) were treated with a course of steroids. There was only one opportunity to vaccinate one of these patients post completion of their steroid therapy. 6/8 of patients vaccinated demonstrated sero-conversion post vaccination. Of the remaining 5 (38%) children who were not immunised, 2 required post exposure prophylaxis. None required Varicella, however 7 children with IBD who were immunosuppressed and diagnosed with IBD prior to 2009, required treatment for Varicella (5 with IV aciclovir and 2 oral aciclovir) in the 3yr period.

Conclusion

At diagnosis 10% of newly diagnosed paediatric patients were found to be VZV negative. Serology negative patients can be successfully vaccinated. The ability to vaccinate is dependent on early treatment choices. The IBD Nurse is identified as having a pivotal role in coordinating management strategies that may reduce the need for treatment of varicella infection.

1. Roderick M, et al, (2007), Should the UK introduce varicella vaccine?, Archive disease child, 1051–1052

2. Rashier J F et al, (2011), The European (ECCO) Consensus on infection in IBD: what does it change for the clinician? ECCO, Gut, 1313–5.