P523 Identifying ‘at-risk’ inflammatory bowel disease patients who may be targeted with a new adjuvant herpes zoster subunit vaccine
W. Bye*1, M. Sparrow2, S. J. Connor3, J. M. Andrews4, K. Ellard5, W. Ng3, G. Hume6, S. Antoniades1, A. J. Walsh1
1St Vincent’s Hospital, Department of Gastroenterology, Sydney, Australia, 2The Alfred Hospital, Department of Gastroenterology, Melbourne, Australia, 3South Western Sydney Local Health District, Liverpool Hospital, Department of Gastroenterology, Sydney, Australia, 4Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, Adelaide, Australia, 5Private practice, Sydney, Australia, 6Mater Hospital, Brisbane, Australia
Inflammatory bowel disease (IBD) patients on immunosuppressive therapy are at an increased risk of herpes zoster (HZ) infection. These patients are unable to be vaccinated with the available live-attenuated HZ vaccine. This study aimed to identify at-risk IBD patients who may be targeted with a new adjuvant HZ subunit vaccine.
This was an Australian, multicentre study involving tertiary referral IBD centres, public hospitals and private practices. Gastroenterologists identified cases of HZV infection amongst their IBD patients. Treating gastroenterologist completed a proforma for each individual patient: patient demographics (age, gender), smoking status, IBD phenotype (Montreal classification), extra-intestinal manifestations of IBD, prior surgery related to IBD, significant comorbidities, details of VZV/HZV screening (prior antibody testing), details of prior HZV vaccine, site of HZV infection, complications and outcome of HZV infection, details of immunosuppressive treatment (dose and duration) at time of onset of HZV, any change to immunosuppressive therapy upon diagnosis of HZV, and treatment for HZV infection.
Thirty cases of HZV were identified: Crohn’s disease (CD) (n = 25) and ulcerative colitis (UC) (n = 5). The mean age was 42 years (range 21 to 81 years), and 43% were male. No patient had previously received the available live-attenuated HZ vaccine. Ninety percent (27/30) of patients were on at least one form of immunosuppressive therapy. Twenty percent (6/30) of patients were on thiopurine therapy alone. Ten percent (3/30) were on anti-TNF monotherapy. Further, 47% (14/30) were on dual therapy, and of these, 93% (13/14) on thiopurine therapy plus anti-TNF therapy; 7% (1/14) on methotrexate plus anti-TNF therapy. Thirteen percent (4/30) were on corticosteroids plus thiopurines. Time from commencement of immunosuppressive therapy to HZV infection was highly variable (range 3 months to over 10 years). Eighty percent (20/25) of the CD patients had penetrating, stricturing, or perianal disease.
As previously reported, we demonstrate an association between HZ infection and both, IBD patients with more severe disease and patients treated with dual immunosuppressive therapy. Thiopurine medications had the strongest association. The increased immunosuppression required in more severe disease is likely the primary driver of the association although it may also be due to the further secondary dysregulation of innate immunity a higher inflammatory load would produce. These are the patients who could potentially be targeted for immunisation with the new non-live, non-attenuated vaccine. Age and length of immunosuppressive therapy do not predict HZV infection.