Incidence and Risk Factors for Herpes Zoster Among Patients With Inflammatory Bowel Disease

Gupta, Gauree; Lautenbach, Ebbing; Lewis, James D.

doi:10.1016/j.cgh.2006.09.019

Cited by 182 publications

(110 citation statements)

References 38 publications

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“…Risk of zoster was highest with combination anti-TNF and thiopurine therapy (OR: 3.29, 95% CI: 2.33-4.65). In addition, herpes zoster also occurs at a younger age in IBD patients ( 71 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Th e risk of herpes-zoster is higher in patients with IBD regardless of duration of disease. Gupta performed a retrospective cohort and a nested case-control study using 1988-1997 data from the General Practice Research Database ( 71 ). In the cohort study, 7,823 CD and 11,930 UC patients were matched on age, sex, and primary care practice to 79,563 randomly selected controls without CD or UC.…”

Section: Summary Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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“…Risk of zoster was highest with combination anti-TNF and thiopurine therapy (OR: 3.29, 95% CI: 2.33-4.65). In addition, herpes zoster also occurs at a younger age in IBD patients ( 71 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

View full text Add to dashboard Cite

show abstract

“…For example, an incidence rate of 45 cases per 1,000 patient-years (95% CI 27-70) was reported in 180 patients with Wegener's granulomatosis; however, contrary to expectation, most episodes of herpes zoster infection occurred outside the periods of most intensive immunosuppression (19). An increased risk of herpes zoster infection has also been observed in patients with inflammatory bowel disease as compared with the general population (20), with incidence rate ratios of 1.21 (95% CI 1.05-1.40) for ulcerative colitis and 1.61 (95% CI 1.35-1.92) for Crohn's disease. Receipt of a prescription for corticosteroids (adjusted odds ratio 1.5, 95% CI 1.1-2.2) or for azathioprine/6-mercaptopurine (adjusted odds ratio 3.1, 95% CI 1.7-5.6) were both associated with VZV in that analysis (20).…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 98%

“…An increased risk of herpes zoster infection has also been observed in patients with inflammatory bowel disease as compared with the general population (20), with incidence rate ratios of 1.21 (95% CI 1.05-1.40) for ulcerative colitis and 1.61 (95% CI 1.35-1.92) for Crohn's disease. Receipt of a prescription for corticosteroids (adjusted odds ratio 1.5, 95% CI 1.1-2.2) or for azathioprine/6-mercaptopurine (adjusted odds ratio 3.1, 95% CI 1.7-5.6) were both associated with VZV in that analysis (20).…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 98%

Viral infection and reactivation in autoimmune disease

Chakravarty

2008

Arthritis & Rheumatism

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“…7,8 There is increasing evidence that COPD is an autoimmune disease, with chronic systemic inflammation involving more than just the airways and lungs. 6 Given that various immune-mediated diseases (e.g., rheumatoid arthritis, inflammatory bowel disease) have been reported to be associated with an increased risk of herpes zoster, 4,9,10 it is reasonable to hypothesize that the immune dysregulation found in COPD may put patients at higher risk of developing herpes zoster. In addition, inhaled or systemic corticosteroids used for management of COPD can increase susceptibility to herpes zoster by suppressing normal immune function.…”

mentioning

confidence: 99%

Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study

Yang¹,

Chen²,

Wang³

et al. 2011

Canadian Medical Association Journal

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H erpes zoster is caused by a reactivation of latent varicella-zoster virus residing in sensory ganglia after an earlier episode of varicella.1 Herpes zoster is characterized by a painful vesicular dermatomal rash. It is commonly complicated with chronic pain (postherpetic neuralgia), resulting in reduced quality of life and functional disability to a degree comparable to that experienced by patients with congestive heart failure, diabetes mellitus and major depression. 1,2Patients with herpes zoster experience more substantial role limitations resulting from emotional and physical problems than do patients with congestive heart failure or diabetes.3 Pain scores for postherpetic neuralgia have been shown to be as high as those for chronic pain from osteoarthritis and rheumatoid arthritis.3 Although aging is the most well-known risk factor for herpes zoster, people with diseases associated with impaired immunity, such as malignancy, HIV infection, diabetes and rheumatic diseases, are also at higher risk for herpes zoster. 4,5Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation that is associated with an abnormal inflammatory response by the small airways and alveoli to inhaled particles and pollutants.6 Disruption of local defence systems (e.g., damage to the innate immune system, impaired mucociliary clearance) predispose patients with COPD to respiratory tract infections. Each infection can cause exacerbation of COPD and further deterioration of lung function, which in turn increase predisposition to infection. 7,8 There is increasing evidence that COPD is an autoimmune disease, with chronic systemic inflammation involving more than just the airways and lungs.6 Given that various immune-mediated diseases (e.g., rheumatoid arthritis, inflammatory bowel disease) have been reported to be associated with an increased risk of herpes zoster, 4,9,10 it is reasonable to hypothesize that the immune dysregulation found in COPD may put patients at higher risk of developing herpes zoster. In addition, inhaled or systemic corticosteroids used for management of Research CMAJ Background: Systemic inflammation and dysregulated immune function in chronic obstructive pulmonary disease (COPD) is hypothesized to predispose patients to development of herpes zoster. However, the risk of herpes zoster among patients with COPD is undocumented. We therefore aimed to investigate the risk of herpes zoster among patients with COPD. Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study Methods:We conducted a cohort study using data from the Taiwan Longitudinal Health Insurance Database. We performed Cox regressions to compare the hazard ratio (HR) of herpes zoster in the COPD cohort and in an age-and sex-matched comparison cohort. We divided the patients with COPD into three groups according to use of steroid medications and performed a further analysis to examine the risk of herpes zoster. Results:The study included 8486 patients with COPD and 3...

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Incidence and Risk Factors for Herpes Zoster Among Patients With Inflammatory Bowel Disease

Cited by 182 publications

References 38 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Viral infection and reactivation in autoimmune disease

Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study

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