Incidence of herpes zoster amongst adults varies by severity of immunosuppression

Schröder, Carsten; Enders, Dirk; Schink, Tania; Riedel, Oliver

doi:10.1016/j.jinf.2017.06.010

Cited by 46 publications

(52 citation statements)

References 38 publications

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“… 6 Here, PHN was identified based on diagnosis codes whereas other studies used algorithms combining PHN diagnosis codes and/or pain medication prescriptions. 29-31 The conservative approach used here may have led to an underestimation of PHN in certain IC populations. We used an equally conservative approach to identify HZ-related complications other than PHN.…”

Section: Discussionmentioning

confidence: 90%

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

Yanni

Ferreira²,

Guennec³

et al. 2018

BMJ Open

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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.

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Section: Discussionmentioning

confidence: 90%

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

Yanni

Ferreira²,

Guennec³

et al. 2018

BMJ Open

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“…The reason relies on the fact that VZV-specific, cell-mediated immunity declines with age or immunosuppression, and it is the adaptive T cell response that is crucial for preventing the reactivation of the latent virus [ [7] , [8] , [9] ]. A recent study demonstrated that the incidence of herpes zoster was twice as high in immunocompromised than in immunocompetent hosts, and that higher incidences were observed among individuals with severe immunosuppression [ 10 ]. Higher incidences were also observed among women and older patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study demonstrated that the incidence of herpes zoster was twice as high in immunocompromised than in immunocompetent hosts, and that higher incidences were observed among individuals with severe immunosuppression [ 10 ]. Higher incidences were also observed among women and older patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Varicella-zoster virus meningitis with hypoglycorrhachia in a young immunocompetent adult without rash: A case report and literature review

Spernovasilis

Milioni

Gialamas

et al. 2018

IDCases

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Overt aseptic meningitis rarely complicates varicella-zoster virus (VZV) reactivation in young and immunocompetent adults. Many of the cases of VZV meningitis are associated with an exanthem. We describe an otherwise healthy 36-year-old adult who had aseptic meningitis without skin rash, caused by reactivation of varicella-zoster virus. Cerebrospinal fluid (CSF) analysis revealed lymphocytosis, increased total protein, and low glucose. Diagnosis was made by polymerase chain reaction in CSF. The present case highlights the fact that VZV should be considered as a cause of aseptic meningitis with hypoglycorrhachia in healthy and young individuals, even in the absence of an exanthem.

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“…In the Netherlands, where varicella vaccination has not been implemented, over 95% of the population is infected with VZV before the age of 6 years [ 2 ]. The average incidence of HZ in the Netherlands was 520 per 100,000 person-years in the period 2012–2015, and older age and a compromised immune system are the most important risk factors [ 1 , 3 , 4 ]. However, given the ageing population, it is expected that the incidence of HZ will increase in the near future [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of vaccination of immunocompetent older adults against herpes zoster in the Netherlands: a comparison between the adjuvanted subunit and live-attenuated vaccines

Boer

Lier

Melker

et al. 2018

BMC Med

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BackgroundThe newly registered adjuvanted herpes zoster subunit vaccine (HZ/su) has a higher efficacy than the available live-attenuated vaccine (ZVL). National decision-makers soon need to decide whether to introduce HZ/su or to prefer HZ/su above ZVL.MethodsUsing a Markov model with a decision tree, we conducted a cost-effectiveness analysis of vaccination with HZ/su (two doses within 2 months) or zoster vaccine live (ZVL) (single dose, or single dose with a booster after 10 years) for cohorts of 50-, 60-, 70- or 80-year-olds in the Netherlands. The model was parameterized using vaccine efficacy data from randomized clinical trials and up-to-date incidence, costs and health-related quality of life data from national datasets. We used a time horizon of 15 years, and the analysis was conducted from the societal perspective.ResultsAt a coverage of 50%, vaccination with two doses of HZ/su was estimated to prevent 4335 to 10,896 HZ cases, depending on the cohort age. In comparison, this reduction was estimated at 400–4877 for ZVL and 427–6466 for ZVL with a booster. The maximum vaccine cost per series of HZ/su to remain cost-effective to a willingness-to-pay threshold of €20,000 per quality-adjusted life year (QALY) gained ranged from €109.09 for 70-year-olds to €63.68 for 50-year-olds. The cost-effectiveness of ZVL changed considerably by age, with corresponding maximum vaccine cost per dose ranging from €51.37 for 60-year-olds to €0.73 for 80-year-olds. Adding a ZVL booster after 10 years would require a substantial reduction of the maximum cost per dose to remain cost-effective as compared to ZVL single dose. Sensitivity analyses on the vaccine cost demonstrated that there were scenarios in which vaccination with either HZ/su (two doses), ZVL single dose or ZVL + booster could be the most cost-effective strategy.ConclusionsA strategy with two doses of HZ/su was superior in reducing the burden of HZ as compared to a single dose or single dose + booster of ZVL. Both vaccines could potentially be cost-effective to a conventional Dutch willingness-to-pay threshold for preventive interventions. However, whether HZ/su or ZVL would be the most cost-effective alternative depends largely on the vaccine cost.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1213-5) contains supplementary material, which is available to authorized users.

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Incidence of herpes zoster amongst adults varies by severity of immunosuppression

Abstract: Our results show that immunocompromised individuals are affected by the disease in particular and that the burden of herpes zoster is highest in severely immunocompromised patients.

Cited by 46 publications

References 38 publications

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

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

Varicella-zoster virus meningitis with hypoglycorrhachia in a young immunocompetent adult without rash: A case report and literature review

Cost-effectiveness of vaccination of immunocompetent older adults against herpes zoster in the Netherlands: a comparison between the adjuvanted subunit and live-attenuated vaccines

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