Epidemiology and costs of herpes zoster: Background data to estimate the impact of vaccination
TL;DR: A study in Piemonte (Italy) to describe incidence, treatment, hospitalizations and costs of herpes zoster (HZ), in population over 14 years of age, and to provide background data for setting-up either mathematical models aimed to estimate the impact of vaccination on HZ, and the cost-benefit analyses of various preventive and therapeutic scenarios.
About: This article is published in Vaccine.The article was published on 2007-10-23. It has received 50 citations till now. The article focuses on the topics: Population & Incidence (epidemiology).
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TL;DR: HZ is a significant global health burden that is expected to increase as the population ages, with higher rates among elderly populations, and future research with rigorous methods is important.
Abstract: Objective The objective of this study was to characterise the incidence rates of herpes zoster (HZ), also known as shingles, and risk of complications across the world. Design We systematically reviewed studies examining the incidence rates of HZ, temporal trends of HZ, the risk of complications including postherpetic neuralgia (PHN) and HZ-associated hospitalisation and mortality rates in the general population. The literature search was conducted using PubMed, EMBASE and the WHO library up to December 2013. Results We included 130 studies conducted in 26 countries. The incidence rate of HZ ranged between 3 and 5/1000 person-years in North America, Europe and Asia-Pacific, based on studies using prospective surveillance, electronic medical record data or administrative data with medical record review. A temporal increase in the incidence of HZ was reported in the past several decades across seven countries, often occurring before the introduction of varicella vaccination programmes. The risk of developing PHN varied from 5% to more than 30%, depending on the type of study design, age distribution of study populations and definition. More than 30% of patients with PHN experienced persistent pain for more than 1 year. The risk of recurrence of HZ ranged from 1% to 6%, with long-term follow-up studies showing higher risk (5–6%). Hospitalisation rates ranged from 2 to 25/100 000 person-years, with higher rates among elderly populations. Conclusions HZ is a significant global health burden that is expected to increase as the population ages. Future research with rigorous methods is important.
530 citations
University of California, Los Angeles1, Johns Hopkins University2, University of Michigan3, National Institutes of Health4, University of Colorado Denver5, Yale University6, Harvard University7, Duke University8, American Geriatrics Society9, Infectious Diseases Society of America10, Wake Forest University11
TL;DR: Researchers in infectious diseases, geriatrics, immunology, and gerontology met to review what is known about HIV infection and aging, to identify research gaps, and to suggest high priority topics for future research.
Abstract: Highly active antiretroviral treatment has resulted in dramatically increased life expectancy among patients with HIV infection who are now aging while receiving treatment and are at risk of developing chronic diseases associated with advanced age. Similarities between aging and the courses of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome suggest that HIV infection compresses the aging process, perhaps accelerating comorbidities and frailty. In a workshop organized by the Association of Specialty Professors, the Infectious Diseases Society of America, the HIV Medical Association, the National Institute on Aging, and the National Institute on Allergy and Infectious Diseases, researchers in infectious diseases, geriatrics, immunology, and gerontology met to review what is known about HIV infection and aging, to identify research gaps, and to suggest high priority topics for future research. Answers to the questions posed are likely to help prioritize and balance strategies to slow the progression of HIV infection, to address comorbidities and drug toxicity, and to enhance understanding about both HIV infection and aging.
507 citations
Cites background from "Epidemiology and costs of herpes zo..."
...For example, the incidence and severity of VZV reactivation increase with age [48–60]....
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TL;DR: HZ incidence has been increasing from 1993-2006 and there is no evidence to attribute the increase to the varicella vaccine program, although rates were higher for females than males throughout the study period.
Abstract: BACKGROUND herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus and is often associated with substantial pain and disability. Baseline incidence of HZ prior to introduction of HZ vaccine is not well described, and it is unclear whether introduction of the varicella vaccination program in 1995 has altered the epidemiology of HZ. We examined trends in the incidence of HZ and impact of varicella vaccination on HZ trends using a large medical claims database. METHODS medical claims data from the MarketScan databases were obtained for 1993-2006. We calculated HZ incidence using all persons with a first outpatient service associated with a 053.xx code (HZ ICD-9 code) as the numerator, and total MarketScan enrollment as the denominator; HZ incidence was stratified by age and sex. We used statewide varicella vaccination coverage in children aged 19-35 months to explore the impact of varicella vaccination on HZ incidence. RESULTS HZ incidence increased for the entire study period and for all age groups, with greater rates of increase 1993-1996 (P < .001). HZ rates were higher for females than males throughout the study period (P < .001) and for all age groups (P < .001). HZ incidence did not vary by state varicella vaccination coverage. CONCLUSIONS HZ incidence has been increasing from 1993-2006. We found no evidence to attribute the increase to the varicella vaccine program.
195 citations
TL;DR: It is confirmed that in Europe HZ incidence increases with age, and quite drastically after 50 years of age, while in all of the 21 studies included in the present review, incidence rates were higher among women than men, and this difference increased with age.
Abstract: Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ≥50 years. The forthcoming European launch of a vaccine against HZ (Zostavax®) prompts the need for a better understanding of the epidemiology of HZ in Europe. Therefore the aim of this systematic review was to summarize the available data on HZ incidence in Europe and to describe age-specific incidence. The Medline database of the National Library of Medicine was used to conduct a comprehensive literature search of population-based studies of HZ incidence published between 1960 and 2010 carried out in the 27 member countries of the European Union, Iceland, Norway and Switzerland. The identified articles were reviewed and scored according to a reading grid including various quality criteria, and HZ incidence data were extracted and presented by country. The search identified 21 studies, and revealed a similar annual HZ incidence throughout Europe, varying by country from 2.0 to 4.6/1 000 person-years with no clearly observed geographic trend. Despite the fact that age groups differed from one study to another, age-specific HZ incidence rates seemed to hold steady during the review period, at around 1/1 000 children <10 years, around 2/1 000 adults aged <40 years, and around 1–4/1 000 adults aged 40–50 years. They then increased rapidly after age 50 years to around 7–8/1 000, up to 10/1 000 after 80 years of age. Our review confirms that in Europe HZ incidence increases with age, and quite drastically after 50 years of age. In all of the 21 studies included in the present review, incidence rates were higher among women than men, and this difference increased with age. This review also highlights the need to identify standardized surveillance methods to improve the comparability of data within European Union Member States and to monitor the impact of VZV immunization on the epidemiology of HZ. Available data in Europe have shortcomings which make an accurate assessment of HZ incidence and change over time impossible. However, data are indicative that HZ incidence is comparable, and increases with age in the same proportion across Europe.
189 citations
Cites background from "Epidemiology and costs of herpes zo..."
...11 [30] Italy 2004 Di Legami A1 Population of Piemonte (26 934 patients) ≥14y Notified by GPs Individual GPs 46 1....
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...Additional file 1: Incidence rates of herpes zoster (HZ) by age group and by sex when available (/1 000) [20,22,23,25,29-32,34,35,37,39,40,64]....
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01 Dec 2017
TL;DR: It is revealed that female sex, race/ethnicity, family history, and comorbidities are risk factors for HZ, and efforts are needed to increase the uptake of zoster vaccination.
Abstract: Objective To systematically review studies examining risk factors for herpes zoster (HZ). Methods We performed a literature search using PubMed, EMBASE, and Web of Science for articles published from January 1, 2003, to February 1, 2017. A random-effects model was used to summarize the risk ratio (RR) or odds ratio (OR) and 95% CI. Results Of the 3450 studies screened, we included 84 studies in the systematic review and conducted meta-analysis in 62 studies. Women were at increased risk of HZ compared with men (pooled adjusted RR, 1.31; 95% CI, 1.27-1.34). Black individuals had almost half the risk of HZ as white individuals (pooled RR, 0.54; 95% CI, 0.47-0.63). Family history was found to be a risk factor for HZ (pooled OR, 3.59; 95% CI, 2.39-5.40). Autoimmune diseases, including rheumatoid arthritis (pooled RR, 1.67; 95% CI, 1.41-1.98) and systemic lupus erythematosus (pooled RR, 2.10; 95% CI, 1.40-3.15), were associated with an elevated risk of HZ. Other comorbidities were associated with an increased risk of HZ, with the pooled RRs ranging from 1.25 (95% CI, 1.13-1.39) for asthma to 1.30 (95% CI, 1.17-1.45) for diabetes mellitus and 1.31 (95% CI, 1.22-1.41) for chronic obstructive pulmonary disease. Conclusion Our review revealed that female sex, race/ethnicity, family history, and comorbidities are risk factors for HZ. Efforts are needed to increase the uptake of zoster vaccination.
160 citations
Cites background from "Epidemiology and costs of herpes zo..."
...Demographic Characteristics and Family History Twenty-seven studies that reported the incidence of HZ by sex were conducted in North America (United States and Canada), Europe (United Kingdom, Spain, France, Germany, Italy, Netherlands, and Israel), Australia, and Asia (Japan, Taiwan, and China) (Supplemental Table).(3,10,11,16-39) Almost all studies consistently reported that women are at increased risk of HZ compared with men (pooledRR, 1....
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...Table 1: Cytokine levels, demographic and laboratory characteristics in patients with severe and mild/moderate cases with CCHF. Features Severe cases n = 46 Mild/moderate cases n = 108 P-value Age 50.6 ± 20.3 49.8 ± 21.0 0.682 Female gender, n (...
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...org).(3,10,11,16-39) The characteristics of 43 studies that examined race/ethnicity, family...
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...In patients with severe CCHF, significantly higher serum levels of TNF-alpha (68.2 ± 23.5; P = 0.008) and IL-6 (73.1 ± 41.6; P = 0.003) were detected, compared with cytokine levels in patients who mild/moderate CCHF (Table 1)....
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References
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TL;DR: Herpes zoster represents an adaptation enabling varicella virus to survive for long periods, even without a continuous supply of persons susceptible to chickenpox.
Abstract: Dr Hope-Simpson presents a study of all cases of herpes zoster occurring in his general practice during a sixteen-year period. The rate was 3.4 per thousand per annum, rising with age, and the distribution of lesions reflected that of the varicella rash.It was found that severity increased with age, but that the condition did not occur in epidemics, and that there was no characteristic seasonal variation. A low prevalence of varicella was usually associated with a high incidence of zoster.Dr Hope-Simpson suggests that herpes zoster is a spontaneous manifestation of varicella infection. Following the primary infection (chickenpox), virus becomes latent in the sensory ganglia, where it can be reactivated from time to time (herpes zoster). Herpes zoster then represents an adaptation enabling varicella virus to survive for long periods, even without a continuous supply of persons susceptible to chickenpox.
1,100 citations
TL;DR: The dermatomal distribution of herpes zoster observed in Rochester was quite similar to previous studies, despite their inherent biases in case ascertainment, except for a lower proportion with cranial nerve zoster.
836 citations
TL;DR: The recorded incidence of herpes zoster was 64% higher than that reported 30 years ago; the age-standardized rate was more than twofold higher and immunosuppressive conditions had little impact on overall incidence, although they were strongly associated with early recurrences.
Abstract: Background: There are few population-based studies of the natural history and epidemiology of herpes zoster. Although a relatively common cause of morbidity, especially among the elderly, contemporary estimates of herpes zoster incidence are lacking. Herein we describe a population-based investigation of incident and recurrent herpes zoster from 1990 through 1992 in a health maintenance organization. Methods: The health maintenance organization's automated medical records contain clinical and administrative information about care rendered to patients in ambulatory settings, emergency departments, and hospitals. Cases of herpes zoster were ascertained by screening the medical record for coded diagnoses. The predictive value of a herpes zoster diagnosis code was determined by review of a sample of patient records. Records from all patients with potential recurrences were also reviewed. Results: The overall incidence, based on 1075 cases in 500 408 person-years, was 215 per 100 000 person-years (95% confidence interval, 192 to 240 per 100 000) and did not vary by gender. Although the rate increased sharply with age, approximately 5% of the cases occurred among children younger than 15 years. Infection with human immunodeficiency virus was documented in 5% of the persons with incident herpes zoster and cancer in 6%. Four persons had confirmed recurrences of herpes zoster (744 per 100 000 person-years; 95% confidence interval, 203 to 1907); three of these persons were infected with the human immunodeficiency virus. Conclusions: The recorded incidence of herpes zoster was 64% higher than that reported 30 years ago; the age-standardized rate was more than twofold higher. Immunosuppressive conditions had little impact on overall incidence, although they were strongly associated with early recurrences. (Arch Intern Med. 1995;155:1605-1609)
665 citations
TL;DR: A systematic review of studies of zoster epidemiology in adults and data from a large morbidity study are analysed to identify factors that might be modulated to reduce the risk ofZoster.
Abstract: Reactivation of latent varicella zoster virus as herpes zoster is thought to result from waning of specific cell-mediated immunity, but little is known about its determinants in individuals with no underlying immunosuppression. We systematically reviewed studies of zoster epidemiology in adults and analysed data from a large morbidity study to identify factors that might be modulated to reduce the risk of zoster. Annual zoster incidence in population-based studies varied from 3.6-14.2/10(3) in the oldest individuals. Risk factors identified in analytical studies that could explain this variation included age, sex, ethnicity, genetic susceptibility, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. Our review highlights the lack of information about risk factors for zoster. We suggest areas of research that could lead to interventions to limit the incidence of zoster. Such research might also help to identify risk factors for age-related immune decline.
503 citations
TL;DR: A comprehensive picture of the pre-vaccine epidemiology of the varicella zoster virus (VZV) is provided to aid in the design of immunization programs and to adequately measure the impact of vaccination.
Abstract: Many countries are currently studying the possibility of mass vaccination against varicella. The objective of this study was to provide a comprehensive picture of the pre-vaccine epidemiology of the varicella zoster virus (VZV) to aid in the design of immunization programs and to adequately measure the impact of vaccination. Population-based data including physician visit claims, sentinel surveillance and hospitalization data from Canada and the United Kingdom were analysed. The key epidemiological characteristics of varicella and zoster (age specific consultation rates, seasonality, force of infection, hospitalization rates and inpatient days) were compared. Results show that the overall epidemiology of varicella and zoster is remarkably similar between the two countries. The major difference being that, contrary to Canada, the epidemiology of varicella seems to be changing in the United Kingdom with an important decrease in the average age at infection that coincides with a significant increase in children attending preschool. Furthermore, differences exist in the seasonality between the United Kingdom and Canada, which seem to be primarily due to the school calendar. These results illustrate that school and preschool contact patterns play an important role in the dynamics of varicella. Finally, our results provide baseline estimates of varicella and zoster incidence and morbidity for VZV vaccine effectiveness and cost-effectiveness studies.
399 citations