Herpes zoster epidemiology in Latin America: A systematic review and meta-analysis

Abstract

The epidemiology and burden of Herpes Zoster (HZ) are largely unknown, and there are no recent reviews summarizing the available evidence from the Latin America and Caribbean (LAC) region. We conducted a systematic review and meta-analysis to characterize the epidemiology and burden of HZ in LAC. Bibliographic databases and grey literature sources were consulted to find studies published (January 2000 –February 2020) with epidemiological endpoints: cumulative incidence and incidence density (HZ cases per 100,000 person-years), prevalence, case-fatality rates, HZ mortality, hospitalization rates, and rates of each HZ complication. Twenty-six studies were included with most studies coming from Brazil. No studies reported the incidence of HZ in the general population. In population at higher risk, the cumulative incidence ranged from 318–3,423 cases of HZ per 100,000 persons per year of follow-up. The incidence density was 6.4–36.5 cases per 1,000 person-years. Age was identified as a major risk factor towards HZ incidence which increase significantly in people >50 years of age. Hospitalization rates ranged from 3%–35.7%. The in-hospital HZ mortality rate ranged from 0%–36%. Overall, HZ mortality rates were found to be higher in females across all age groups and countries. The incidence of HZ complications (such as post-herpetic neuralgia, ophthalmic herpes zoster, and Ramsay Hunt syndrome) was higher in the immunosuppressed compared to the immunocompetent population. Acyclovir was the most frequently used therapy. Epidemiological data from Ministry of Health databases (Argentina, Brazil, Colombia, Chile y Mexico) and Institute for Health Metrics and Evaluation’s Global Burden of Disease project reported stable rates of hospitalizations and deaths over the last 10 years. High-risk groups for HZ impose a considerable burden in LAC. They could benefit from directed healthcare initiatives, including adult immunization, to prevent HZ occurrence and its complications.

Herpes zoster: A Review of Clinical Manifestations and Management

“…According to the Global Burden of Disease database, the mortality rate due to HZ in patients >65 years ranges from 0.0022 to 82.21 per 100,000 population [17]. According to 2007 and 2008 HZ-outpatient incidence data from Germany, the annual mortality rate of HZ has been estimated as 0.29 (women) and 0.10 (males) per 100,000 patient years [18].…”

Colombian Ocular Infectious Epidemiology Study (COIES): Herpes Zoster Ophthalmicus prevalence and sociodemographic characterization, 2015-2019

“…One study conducted at the Universidad Militar Nueva Granada in Colombia reported a prevalence of 0.94% in 4.323 patients (Paternina Barón and Bermudez Melendez, 2020). Our data showed a lower prevalence, possibly due to vaccination use, which has been demonstrated as a cost-effective strategy with a significant reduction of the disease burden in Latin American countries (Arlant et al, 2019;Bardach et al, 2021). However, other factors could impact our results, such as the population pyramid in Colombia and the misclassification bias in the database (Censo Nacional de Población y Vivienda, 2018).…”

Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review

“…The incidence of HZ among the general population in Latin America and the Caribbean is unknown, but the incidence of HZ among high-risk individuals is estimated to range between 6.4 and 36.5 cases per 1000 person years. 116 High risk is defined as those who are immunosuppressed through disease or medication (e.g. systemic corticosteroids).…”