Herpes zoster in immunocompromised patients: Incidence, timing, and risk factors

Wung, Peter K.; Holbrook, Janet T.; Hoffman, Gary S.; Tibbs, Andrea K.; Specks, Ulrich; Min, Yuan‐I; Merkel, Peter A.; Spiera, Robert; Davis, John C.; Clair, E. William St.; McCune, Joseph W.; Ytterberg, Steven R.; Allen, Nancy B.; Stone, John H.

doi:10.1016/j.amjmed.2005.06.012

Cited by 75 publications

(56 citation statements)

References 38 publications

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“…Our findings in cancer patients are consistent with previous reports of a high risk of HZ among individuals who are immunocompromised, such as patients infected with HIV (37-39), patients receiving hematopoeitic stem cell transplant or solid organ transplant, or patients with autoimmune diseases treated by immunosuppressing therapies (40)(41)(42)(43)(44)(45)(46)(47).…”

Section: Discussionsupporting

confidence: 82%

The Epidemiology of Herpes Zoster in Patients with Newly Diagnosed Cancer

Habel

Ray

Silverberg

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Given the limited literature, we conducted a study to examine the epidemiology of herpes zoster (HZ) among newly diagnosed cancer patients.Methods: We identified adult health plan members of Kaiser Permanente Northern California diagnosed with invasive cancer from 2001 to 2005. Electronic health records with inpatient and outpatient diagnoses, laboratory tests, and antiviral medications were used to identify HZ diagnoses from 2001 to 2006. HZ diagnoses and associated complications were confirmed by medical chart review. Treatment with chemotherapy and corticosteroids was used to classify patients by immunosuppression level.Results: Among 14,670 cancer patients, 424 were diagnosed with HZ during follow-up (median 22 months). The incidence of HZ was 31/1,000 person-year (PY) in patients with hematologic malignancies and 12/1,000 PY in patients with solid tumors. The corresponding 2-year cumulative incidence of HZ was approximately 6% and 2%, respectively. Compared with incidence rates of HZ reported in a general US population, the age-and sex-standardized rates of HZ were 4.8 times higher [95% confidence interval (CI), 4.0-5.6] in patients with hematologic malignancies and 1.9 times higher (95% CI, 1.7-2.1) in those with solid tumors. HZ risk increased with increasing level of immunosuppression. Among HZ cases, 19% with hematologic malignancies and 14% with solid tumors had HZ-associated pain for at least 30 days. The corresponding numbers for nonpain-related complications were 30% and 18%, respectively.Conclusions: Cancer patients are at substantially increased risk of HZ and among those with HZ, complications are relatively common.Impact: Better HZ prevention and treatment options for cancer patients are needed. Cancer Epidemiol Biomarkers Prev; 22(1); 82-90. Ó2012 AACR.

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Section: Discussionsupporting

confidence: 82%

The Epidemiology of Herpes Zoster in Patients with Newly Diagnosed Cancer

Habel

Ray

Silverberg

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Herpes zoster has also been associated with other autoimmune diseases. For example, an incidence rate of 45 cases per 1,000 patient-years (95% CI 27-70) was reported in 180 patients with Wegener's granulomatosis; however, contrary to expectation, most episodes of herpes zoster infection occurred outside the periods of most intensive immunosuppression (19). An increased risk of herpes zoster infection has also been observed in patients with inflammatory bowel disease as compared with the general population (20), with incidence rate ratios of 1.21 (95% CI 1.05-1.40) for ulcerative colitis and 1.61 (95% CI 1.35-1.92) for Crohn's disease.…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 84%

Viral infection and reactivation in autoimmune disease

Chakravarty

2008

Arthritis & Rheumatism

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“…B-lymphocyte depletion has the potential to aggravate or reactivate latent viral infections (53). However, both of our patients had been treated with other immunosuppressive agents preceding enrollment into the trial, and herpes zoster eruptions are a recognized problem in patients with WG on treatment (54,55).…”

Section: Safetymentioning

confidence: 99%