P019 One shingle at a time: The importance of improving zoster vaccination rates in the IBD population
Authors: Nadeem Tabbara , Adam Greenfest , Daniel Szvarca , Lindsay Clarke , Tina Boortalary , Rahma Aldhaheri , Sarah Turki , Marie Borum 
Published: July 2019

BACKGROUND:
Patients with Inflammatory bowel disease (IBD), especially those on immunosuppressants or biologics, are at increased risk for Herpes Zoster (HZ). While the CDC recommends that adults greater than or equal to 50 years be vaccinated with recombinant zoster vaccine, it is especially important for IBD patients who can have more frequent and severe complications. In addition, it has been suggested that HZ may occur at a younger age in IBD patients. However, physician adherence to these guidelines and the rate of HZ vaccination is unclear. This study investigated the rate of HZ vaccination and immunization documentation with respect to current guidelines among IBD patients at a university medical center.

METHODS:
A retrospective chart review evaluating all IBD patients seen in the gastroenterology clinic of a university medical center throughout a 5-year period was performed. Patient age, gender, IBD diagnosis, overall vaccination documentation, and HZ vaccination status were recorded and a database was generated using Microsoft Excel. Statistical analysis was performed using Fisher's Exact Test with significance set at P < 0.05. The study was approved by the IRB.

RESULTS:
393 IBD patients were analyzed. 279 (71.0%) had Ulcerative Colitis (UC), 96 (24.4%) had Crohn's disease (CD), 7 (1.8%) with unspecified colitis, and 11 (2.8%) had microscopic colitis. There were 175 men and 218 women, with mean age of 44.4 (age range: 20–82). 135 (34.4%) of patients were >50 years old. 195 patients (49.6%) had a documented vaccination history of any kind. 17 of 393 (4.33%) patients had a documented varicella-zoster vaccine (VZV) with an average age of vaccination of 60.35 years (age range: 25–73). There was no significant difference in the rate of VZV between men and women (P = 0.327). Ulcerative colitis patients were vaccinated at a significantly higher rate when compared to those with Crohn's disease (P = 0.0016) and microscopic colitis (P = 0.0001).

CONCLUSION(S):
Although patients with IBD have an increased susceptibility of HZ outbreaks due to immunosuppressant therapy and factors intrinsic to the disease itself, this study revealed that patients are infrequently recommended the VZV despite current guidelines. While this study may be limited based upon single institutional design and reliance on documentation, it is important that all vaccination recommendations, history of immunization and administration of vaccines are documented in the medical record. While over one third of the patients in our cohort were greater than 50 years of age, vaccination rates were modest. In IBD patients younger than 50 years, HZ immunization may have been limited based upon insurance coverage. This study supports the need for increased efforts to administer HZ vaccines in IBD patients and consider earlier administration in at risk IBD patients less than 50 in effort to reduce morbidity and optimize patient outcomes.