Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

Abstract

BackgroundHerpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.MethodsWe searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.ResultsFrom 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand.HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation.ConclusionsSeveral countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.

An Evaluation of Efficacy and Safety of Commonly Prescribed Drugs and Effect of These Drugs on Quality of Sleep in Patients Suffering From Zoster‐Associated Pain

“…Among the documented risk factors for development of herpes zoster, diabetes, renal disease, cancer, HIV infection, and active tuberculosis were observed in the study population (20%). Apart from increasing the risk of development of herpes zoster, these factors are suggested to promote the progression of zoster‐associated pain to the stage of postherpetic neuralgia . A total of 46.7% of patients with risk factors in the current study progressed to develop postherpetic neuralgia, which supports the report by Chen et al …”

“…Apart from increasing the risk of development of herpes zoster, these factors are suggested to promote the progression of zosterassociated pain to the stage of postherpetic neuralgia. 20 A total of 46.7% of patients with risk factors in the current study progressed to develop postherpetic neuralgia, which supports the report by Chen et al 20 NSAIDs (83.3%), gabapentin (38.5%), amitriptyline (34.6%), and amitriptyline + gabapentin combination therapy (26.9%) were the commonly prescribed drugs for zoster associated pain similar to reports by Tsai et al 21 and van Seventer et al 22 Tsai et al 21 conducted the study over a period of 15 months to assess severity and duration of herpes zoster-associated pain in 150 patients in Taiwan. Van Seventer et al 22 conducted a cross-sectional survey of health impairment and treatment pattern of postherpetic neuralgia in 84 patients from the United Kingdom.…”

Risk of cutaneous herpes zoster in patients with spondyloarthritis treated with conventional and biologic disease‐modifying antirheumatic drugs

“…In a study using the USAs’ Multipayer Claims Database, the age‐ and sex‐standardized incidence rate per 1000 person‐years of HZ were 12.5 in patients with RA and 9.3 for patients with AS . In this study, the incidence rate per 1000 person‐years were 6.5 in patients with RA and 3.8 in patients with SpA, consistent with previous epidemiological data of lower rates in Hong Kong compared with other Asian countries . Our incidence rate in patients with SpA was also lower than that reported in Taiwan .…”

“…18 In this study, the incidence rate per 1000 person-years were 6.5 in patients with RA and 3.8 in patients with SpA, consistent with previous epidemiological data of lower rates in Hong Kong compared with other Asian countries. 19 Our incidence rate in patients with SpA was also lower than that reported in Taiwan. 20 The inclusion of only cutaneous forms of HZ may have been another factor.…”

Modalities in managing postherpetic neuralgia

“…A systematic review conducted in 2014, reported that an estimated incidence of HZ ranged between 3–5/1000 person/year in Europe, North America, and Asia-Pacific with a rise above 50 years of age, and the occurrence of PHN in HZ patients is 5%–30% [ 7 ]. In another study, Chen et al [ 8 ] estimated that in Asia-Pacific alone, the incidence of HZ is 3–10/1000 person/year which rises steeply above age 40 and peaks between 70–80 years and the incidence of PHN is 10%–25%. The PHN incidence is 10% in people over 40 years, 20%–50% of people over 60 years and rarely seen in people less than 30 years.…”