Burden of disease from shingles and post-herpetic neuralgia in the over 80 year olds in the UK

Abstract

Background The current UK vaccination programme for herpes zoster (HZ) excludes people aged �80 years. This study aimed to quantify the number of individuals �80 years who missed HZ vaccination and the consequent epidemiological and economic burden of HZ and post-herpetic neuralgia (PHN). Methods Immunocompetent individuals aged �80 years between 1 st September 2013 and 31 st December 2017 in the Clinical Practice Research Datalink were selected and linked to Hospital Episodes Statistics, where available. Rates of HZ and PHN and healthcare resource utilisation were investigated for the overall study population and by age group (80-84, 85-89, �90 years old) and the burden of HZ and PHN was projected to the UK population. Results 4,858 HZ episodes and 464 PHN cases were identified in 255,165 individuals over 576,421 person-years (PY). Rates of HZ and PHN were 8.43 (95% confidence interval [CI] 8.19-8.66) and 0.80 (0.73-0.87) per 1,000 PY respectively and lowest in those aged �90 (HZ rate 7.37/1,000 PY; PHN rate 0.56/1,000 PY). Within HZ episodes, 10.27% of GP visits, 5.82% of prescribed medications and 21.65% of hospitalisations were related to HZ/PHN. Median length of hospitalisation increased from 7.0 days for all-cause to 10.5 days for HZ/ PHN related hospitalisations. Individuals �90 stayed in hospital a median of 3-4 days longer than younger groups. Approximately 2.23 million individuals in the UK missed HZ vaccination since 2013 (1.86 million had never been eligible and 365,000 lost eligibility for HZ vaccination), resulting in an estimated 43,149 HZ episodes.

Hospitalization Burden Related to Herpes Zoster Infection in Spain (2016–2019)

“…Regarding HZ vaccination, the positive impact on epidemiologic indicators has been seen in the reduction of HZ incidence in children vaccinated against varicella [ 28 ]. Some studies propose that this impact may be greater among the elderly with high coverage (currently between 58 and 72% of the population) [ 29 , 30 ]. In Spain, it is estimated that 97% of the child population is vaccinated against varicella, but in the elderly this coverage decreases to 57%.…”

Acceptability and perception of the herpes zoster vaccine in the 65 and over population: A French observational study

“…Indeed, this vaccine proved its efficacy in a pivotal randomized clinical trial by reducing the incidence of HZ and PHN by 51% and 67% respectively [10]. More recent studies have demonstrated higher vaccine effectiveness against incident HZ and PHN [11,12].…”

Acupuncture and moxibustion combined with cupping for the treatment of post-herpetic neuralgia

“…[3] As the sequelae neuralgia usually lasts from a few months to half a year, it will seriously affect the patient's daily life and work. [4] Research also shows that 45% of patients have symptoms such as anxiety, depression, and lack of concentration. [5] Modern medicine believes that the pathogenesis of PHN mainly includes peripheral nerve and central nerve pathogenesis.…”

“…According to relevant survey statistics, the incidence of shingles is about 10% to 19%, which is even higher for the elderly [3] . As the sequelae neuralgia usually lasts from a few months to half a year, it will seriously affect the patient's daily life and work [4] . Research also shows that 45% of patients have symptoms such as anxiety, depression, and lack of concentration [5] …”