SHINGLES (HERPES ZOSTER) IS INCREASED IN IBD

Herpes zoster (commonly known as shingles) is a common viral infection in older adults, affecting as many as 1 million people in the United States each year. You may have seen the raised rash, that usually travels along a nerve's pathway or you may have suffered the itching or burning pain that can continue 10-18% of the time even after the virus has left. 

IBD Patients Have Shingles More Often and At a Younger Age

Even though shingles usually attacks those over 50, because of lower immunity, IBD patients can get the infection when they are younger and they get it more frequently—and that may have to do with their immune systems too. And certain medications may increase the risk of getting the virus. Depending on which data is used:

• Crohn's disease raises the risk of getting zoster anywhere from 20% more to as much twice as likely compared to healthy adults
• Ulcerative colitis increases the risk 60-75% compared to healthy adults
• Those of Asian descent are 50 % or more likely to get zoster
• All of these percentages and risks increase as those with IBD get older
• Those on steroids, azathioprine, Imuran or 6-MP are at 50% more risk   
• Those on one of the TNF blockers are at 65% more risk on average
• A new therapy, tofacitinib, that blocks JAK (Janus kinase) and a particular immune pathway, seems to increase the risk 4 times.  
• Vedolizumab, that only acts on the immune system with in the intestine, does not seem to increase the risk for zoster.

Zoster Infections Can Be Treated and Possibly Prevented

Fortunately, shingles usually responds to a antiviral medicine that can shorten the infection and help to prevent complications. Those with shingles should keep the area clean and dry. If they are around others, cover the area and wear loose clothing to lessen the irritation. As a courtesy to others, they should avoid pregnant women and anyone else with immune problems.   

Vaccines (immunizations) are available and commonly prescribed to healthy adults who are over 50 years old. However, the standard vaccine is a live virus and not recommended for patients with IBD or other immune problems. But fortunately, there's a new vaccine available that may be suitable.