Varicella immunity in inflammatory bowel disease

Objectives: Varicella zoster is a childhood disease that can cause devastating illness and death in immunocompromised individuals, including those who are taking steroids. Inflammatory bowel disease (IBD) is managed by decreasing or controlling the inflammation using immunosuppression. Our objective was to show that at least 90% of patients newly diagnosed as having IBD had antibodies against varicella zoster and were protected by vaccination or natural disease. Materials and Methods: Retrospective review of all of the charts of the patients diagnosed with IBD at the University of Buffalo's Digestive Diseases and Nutrition Center for 5 years from January 1, 2005 to December 31, 2009. Results: There were 163 new diagnoses of IBD during this time; 57% were boys. Mean age was 12 years (range 1-19 years); 62% had Crohn disease, 33% ulcerative colitis, and 5% indeterminate colitis. A total of 66% of all of the patients had a history of disease or vaccination. Measurable titers against varicella were found in only 77% of all of the patients. Conclusions: Lack of varicella immunity is common in children and adolescents at the time of diagnosis of IBD. Routine screening for varicella immune status may be warranted. Offering immunization to susceptible patients should confer protection, but this may be difficult to achieve once immune suppression has begun.