Burden of herpes zoster in 16 selected immunocompromised populations in England: a cohort study in the Clinical Practice Research Datalink 2000–2012

Abstract

ObjectivesHerpes zoster (HZ) is caused by reactivation of varicella-zoster virus which remains latent in individuals after a varicella infection. It is expected that HZ will be more frequent in immunocompromised (IC) individuals than in immunocompetent (IC-free). This study assessed the incidence rate (IR) of HZ in individuals with a wide set of IC conditions and in IC-free individuals.SettingA retrospective cohort study was conducted in England using data (January 2000 to March 2012) from the Clinical Practice Research Datalink with linkage to the Hospital Episodes Statistics.ParticipantsA cohort of 621 588 individuals with 16 selected IC conditions and a gender/age-matched cohort of IC-free individuals were identified. The IC conditions included haematopoietic stem cell transplant (HSCT), solid organ transplant, malignancies, autoimmune diseases and users of immunosuppressive medications.OutcomesIR of HZ per 1000 person-years (PY) was estimated. Proportions of postherpetic neuralgia (PHN) and other HZ complications within 90 days of HZ onset were also estimated among patients with HZ. Risk factors for PHN in IC individuals with HZ were assessed by a multivariate regression model.ResultsThe overall IR of HZ in the IC cohort was 7.8/1000 PY (95% CI 7.7 to 7.9), increasing with age from 3.5/1000 PY (3.4–3.7) in individuals aged 18–49 years to 12.6/1000 PY (12.2–13.0) in individuals aged ≥80 years. This IR in the IC-free cohort was 6.2/1000 PY (6.1–6.3). The overall IR of HZ varied across IC conditions, ranging from 5.3 (5.1–5.5) in psoriasis to 41.7/1000 PY (35.7–48.4) in HSCT. The proportions of PHN and other HZ complications were 10.7% (10.2–11.1) and 2.9% (2.7–3.2) in the IC cohort, but 9.1% (8.7–9.5) and 2.3% (2.1–2.6) in the IC-free cohort, respectively.ConclusionIC population contributes to the public health burden of HZ in England. Vaccination might be the most preferable HZ preventive measure for the IC population.

Risk of herpes zoster in the Japanese population with immunocompromising and chronic disease conditions: Results from a claims database cohort study, from 2005 to 2014

“…Previously, for this same study population we found that IRs for HZ were higher in females compared with males and increased with greater age, and were highest in patients with IC conditions (and in particular those undergoing HSCT, subjects with HM and those with SLE), and somewhat lower in subjects with chronic medical conditions . Those findings are consistent with those from other epidemiological studies which report an increasing incidence of HZ with older age, and also a higher incidence in patients with malignancy, and other IC conditions such as SLE . In the further data we present here, we show that the influence of age and sex is also apparent in patients with different IC and chronic medical conditions.…”

“…Declining VZV‐specific cell‐mediated immunity, which predisposes an individual to VZV reactivation and clinical HZ, occurs as a result of age‐related “immunosenescence”, which may explain the greater risk and higher incidence of HZ in individuals aged 50 years or more . Incidence and risk is greater in women, in individuals with immunocompromised (IC) medical conditions (e.g., patients with hematological or solid tumors or those receiving immunosuppressive therapies) and also in individuals with certain chronic medical conditions . Older adults and those with IC conditions (where complications may be more severe) and with chronic medical conditions are also at greater risk of HZ‐associated complications, most commonly postherpetic neuralgia (PHN), but also other neurological complications, ocular complications, and disseminated HZ …”

“…2,6,7 Incidence and risk is greater in women, 2,6 in individuals with immunocompromised (IC) medical conditions (e.g., patients with hematological or solid tumors or those receiving immunosuppressive therapies) and also in individuals with certain chronic medical conditions. 6,[8][9][10][11][12][13][14] Older adults and those with IC conditions (where complications may be more severe) and with chronic medical conditions are also at greater risk of HZ-associated complications, most commonly postherpetic neuralgia (PHN), but also other neurological complications, ocular complications, and disseminated HZ. 2,8,13,15 Previously, we reported on the HZ disease burden in the general adult Japanese population and in those patients with IC and chronic medical conditions, using data derived from the Japan Medical Data Center claims database (JMDC-CDB).…”

Herpes zoster infection

“…Risk of herpes zoster increases with age, and with any condition or treatment causing immunosuppression 26…”

“…Other immunosuppression: eg, chronic use of corticosteroids,12 lymphoproliferative malignancies,13 or chemotherapy6…”