Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

Abstract

BackgroundResearch has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece.MethodsThe current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST).ResultsThe crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029).ConclusionsThe implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

The humanistic, economic and societal burden of Herpes Zoster in Europe: a critical review

“…Across studies, a range of instruments have been used to assess the impact of HZ and PHN on mood, including the Hospital Anxiety and Depression scale (HADS) [7,15], 10,47 Short Italian Questionnaire (SIQ) [75,76], the Short Anxiety Screening Test (SAST) [56] and bespoke questions [58,77]. Up to 29% of patients with HZ reported feelings of moderate anxiety or depression, rising to 43% in patients with PHN.…”

Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster

“…2,8,27,28,[32][33][34][35][36][37][38][39] Gender differences in the incidence of herpes simplex add strong support to the hypothesis that females have a differing response to latent viral infection and that this may account for their increased risk compared with men. 16 Studies conducted in numerous settings, and with various designs, have indicated an association between age and increasing zoster incidence.…”

The effect and safety of ozone autohemotherapy combined with pharmacological therapy in postherpetic neuralgia

“…The anatomy of the primary afferent receptor is complete; however, the state is kept as abnormally hyperactive, which plays an important role in causing pain and maintaining abnormal pain25; this can be described as an “irritant receptor.” In addition, PHN is described as a central nervous system (CNS) abnormality (CNS sensitization), and abnormal pain and generalized C fibrosis are present at the same time; the completed and low-threshold A² fiber enters into the superficial layer of the dorsal horn of the spinal cord, directly connected with the two-stage pain-transmitting neuron, causing the pain 26,27. Moreover, for PHN, in the areas with obvious sensory deficits but no abnormal pain, there is persistent pain, or loss of sensory pain, which can be described as “afferent nerve block.”28 Finally, some studies have also shown that PHN is related to mental factors, as stress and anxiety can also lead to PHN 29…”