Children with inflammatory bowel disease (IBD) are often receiving chronic immunosuppressive therapy to stay in clinical remission; however, these therapies also put patients at risk for infections. Therefore, it is important to immunize children to minimize vaccine-preventable infections. However, there is a paucity of data on immune response to vaccines in patients with IBD. Current guidelines recommend that patients with IBD receive inactivated vaccines but suggest against immunizing immunosuppressed patients having IBD with live vaccines such as varicella. Unfortunately, the recommendation to not vaccinate with varicella was not based on any data. We present a case series of children with IBD receiving immunosuppressive therapy who tolerated and had a good immune response to varicella vaccine. We also review the literature and demonstrate that studies in other immunocompromised populations suggest that varicella vaccine is generally well tolerated and immunogenic. We also argue that it is important to weigh the benefits against risks with individual patients having IBD to decide whether varicella vaccination should be considered. Additional studies evaluating the safety and immunogenicity of varicella vaccine in patients with IBD are needed.
Inflammatory Bowel Disease Center, Division of Gastroenterology, Children's Hospital Boston, Boston, MA, USA.
Received 11 April, 2009
Accepted 30 July, 2009
Address correspondence and reprint requests to Athos Bousvaros, MD, MPH, GI Division–Inflammatory Bowel Disease Center, Hunnewell Ground, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115 (e-mail: firstname.lastname@example.org).
Dr Lu is supported by the Thrasher Foundation and by NIH NIDDK training grant 2T32DK007477. Dr Bousvaros is the recipient of a grant from Merck & Co, Inc to examine the human papillomavirus vaccine in immune-compromised hosts. Merck also manufactures the varicella vaccine. Dr Bousvaros is on the speakers' bureau and a consultant to Abbott. He is also a consultant to Millennium Pharmaceuticals.