Serology of Viral Infections and Tuberculosis Screening in an IBD Population Referred to a Tertiary Centre of Southern Italy

Abstract

Background With the introduction of more potent immunosuppressive agents in inflammatory bowel disease, prevention of opportunistic infections has become necessary by introducing screening programs. Prevalence of the most important infectious agents may vary in different geographical areas. The aim of our study was to assess the immune status for hepatitis B, varicella, mononucleosis, and cytomegalovirus infection together with the determination of the hepatitis C and tuberculosis status in Southern Italy. Methods Prevalence of latent tuberculosis, together with serology of hepatitis B and C, Epstein-Barr virus, varicella zoster, and cytomegalovirus were collected by analysing retrospectively the clinical charts of IBD patients. Data were integrated with demographic and clinical features. Results Data from 509 IBD patients divided in two age groups showed a prevalence of HBV infection in nonvaccinated patients of 9%. Seroprotection (HBsAb) in vaccinated IBD patients was lower (p < 0.0001) compared with that in controls. Prevalences of herpesvirus infections fluctuate between 51% (CMV) and 85% (EBV) and 84% (VZV) in younger patients. Latent tuberculosis and hepatitis C infection were found only in patients > 37 years of age. Conclusions In younger patients, high susceptibility rates for primary herpesvirus infections should determine the choice of treatment. Loss of HBV seroprotection in already vaccinated patients should be considered for booster vaccination programs.

Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 2: Inactivated Vaccines

“…Key evidence: Data were available from 10 cross-sectional studies. [39][40][41][42][43][44][45][46][47][48] Although older studies in Western countries showed a higher prevalence of past hepatitis B virus (HBV) infection among patients with IBD compared to the general population, this is not reported in more recent studies. In Eastern countries where HBV is endemic, the prevalence rates of past HBV among patients with IBD appeared to be higher than in the general population.…”

Prevalence of hepatitis B virus and hepatitis C virus infection in patients with inflammatory bowel disease: a systematic review and meta-analysis

“…Among these, 17 studies were prospective [18][19][20][21][22][23][24][25]30,31,34,39,45,[48][49][50][51] and 17 were retrospective in nature. [26][27][28][29]32,33,[35][36][37][38][40][41][42][43][44]46,47 The majority of the studies were from Europe 18,20,[24][25][26][27]31,34,36,39,40,47,49 and Asia. 28,30,33,35,37,…”

“…28,30,33,35,37,38,41,42,45,46,51 The number of patients in the studies varied from 74 to 5,096 with a mean age from 32.9 to 50.8 years. Majority of the studies included consecutive patients with IBD while 7 studies 20,29,31,34,36,40,44 analyzed data of patients being planned for biologicals. Prior risk factors for viral hepatitis and vaccination history were reported in 9 studies 21,25,26,30,31,33,38,43,51 and 10 studies, 25,30,31,33,34,37,39,41,45,49 respectively.…”

“…The presence of detectable HBV DNA was reported in 15 studies with 10,663 patients. 21,[24][25][26]28,[31][32][33][34]38,40,41,43,50,51 The pooled prevalence of detectable HBV DNA in patients with IBD and IBD with HBsAg positive cases were 1.0% (95% CI, 0.6-1.4; I 2 = 75.0%) and 61.0% (95% CI, 42.1-79.9; I 2 = 91.6%), respectively (Supplementary Fig. 6).…”

“…The prevalence of anti-HBc (with or without HBsAg) in patients with IBD was reported in 25 studies with 12,265 patien ts. [19][20][21][23][24][25]27,[29][30][31][32][33][34]37,[39][40][41][43][44][45][47][48][49][50][51] The pooled anti-HBc positivity in IBD patients was 14.2% (95% CI, 10.6-17.8; I 2 = 98.2%), with significant heterogeneity among the studies (Supplementary Fig. 7).…”