Herpes zoster risk and burden of disease in immunocompromised populations: a population-based study using health system integrated databases, 2009–2014

Abstract

Background Estimate the incidence of herpes zoster (HZ), its complications and healthcare utilization rates in adults (≥ 18-years-old) with a wide range of immunocompromised (IC) conditions compared to IC-free cohort. Method A population-based retrospective study using the Valencia healthcare Integrated Databases (VID) (2009–2014). HZ and IC were defined using ICD-9 codes in primary care (PC) and hospitalization registers. Incidence rates (IR), risk of HZ, HZ-recurrence, HZ-complications and healthcare utilization rates were estimated in the IC-cohort compared to IC-free. Results The study population consisted of 4,382,590 subjects, of which 578,873 were IC (13%). IR (in 1000 persons-year) of HZ overall, in IC and in IC-free cohort was 5.02, 9.15 and 4.65, respectively. IR of HZ increased with age in both cohorts and it was higher for all IC conditions studied, reaching up to twelvefold in subjects with stem cell transplantation. IC subjects had 51% higher risk of developing HZ, 25% higher HZ-recurrence and the risk of HZ-complications was 2.37 times higher than in IC-free. HZ-related healthcare utilization was higher in the IC-cohort than in IC-free (number of hospitalizations 2.93 times greater, hospital stays 12% longer, 66% more HZ-specialist visits, 2% more PC visits, sick leaves 18% longer and 20% higher antiviral dispensation). Conclusions Patients suffering from all the IC conditions studied are at higher risk of developing HZ, HZ-recurrence and post-herpetic complications, which implies a substantial morbidity and a high consumption of resources. These results should be considered for vaccine policy implementation.

Burden of Herpes Zoster in Adult Patients with Underlying Conditions: Analysis of German Claims Data, 2007–2018

“…Furthermore, there are no other studies reporting the risk for a second recurrence or recurrence for patients with UCs. However, a recent study from Spain reported significantly higher recurrence rates in immunocompromised patients [ 58 ]. This result is in line with the results presented here which show that patients with UCs have a higher risk of recurrence.…”

Economic Burden and Impact on Quality of Life of Herpes Zoster in Spanish Adults Aged 50 Years or Older: A Prospective Cohort Study

“…Data from Spain is similar; large retrospective studies have reported incidence rates of 5.0/1000 PY in adults aged 18 years or older [ 16 ], and 7.2/1000 PY in those aged 50 years or older [ 17 ]. Similar to other countries, higher incidence is reported in women and in the immunocompromised, and in patients with specific comorbidities such as COPD [ 16 – 18 ]. PHN is estimated to develop in between 12% and 16% of patients [ 19 , 20 ].…”

“…The proportion of those patients with HZ who develop PHN in recent studies from Italy, Germany, and the UK ranges between 10% and 12% [13][14][15]. Data from Spain is similar; large retrospective studies have reported incidence rates of 5.0/ 1000 PY in adults aged 18 years or older [16], and 7.2/1000 PY in those aged 50 years or older [17]. Similar to other countries, higher incidence is reported in women and in the immunocompromised, and in patients with specific comorbidities such as COPD [16][17][18].…”

“…In Spain, data on the impact of HZ and complications such as PHN on HRQL and healthcare costs are limited, and studies are mainly retrospective in approach [16,[20][21][22][23]. As such additional data are of value to provide a better understanding of the impact of these aspects in Spain.…”

Herpes Zoster in Solid Organ Transplantation: Incidence and Risk Factors

“…Virus reactivation occurs when the immune system is suppressed. Increased HZ incidence, attributed to a decline in immunity, is observed in elderly people and in patients using immunosuppressive medication (2)(3)(4)(5)(6)(7)(8)(9)(10). The latter certainly applies to solid organ transplant recipients.…”