Systematic review of incidence and complications of herpes zoster: towards a global perspective

Abstract

ObjectiveThe objective of this study was to characterise the incidence rates of herpes zoster (HZ), also known as shingles, and risk of complications across the world.DesignWe systematically reviewed studies examining the incidence rates of HZ, temporal trends of HZ, the risk of complications including postherpetic neuralgia (PHN) and HZ-associated hospitalisation and mortality rates in the general population. The literature search was conducted using PubMed, EMBASE and the WHO library up to December 2013.ResultsWe included 130 studies conducted in 26 countries. The incidence rate of HZ ranged between 3 and 5/1000 person-years in North America, Europe and Asia-Pacific, based on studies using prospective surveillance, electronic medical record data or administrative data with medical record review. A temporal increase in the incidence of HZ was reported in the past several decades across seven countries, often occurring before the introduction of varicella vaccination programmes. The risk of developing PHN varied from 5% to more than 30%, depending on the type of study design, age distribution of study populations and definition. More than 30% of patients with PHN experienced persistent pain for more than 1 year. The risk of recurrence of HZ ranged from 1% to 6%, with long-term follow-up studies showing higher risk (5–6%). Hospitalisation rates ranged from 2 to 25/100 000 person-years, with higher rates among elderly populations.ConclusionsHZ is a significant global health burden that is expected to increase as the population ages. Future research with rigorous methods is important.

Herpes zoster vaccine: a shot to maintain wellbeing

“…In this issue, Stefania Maggi and collaborators present a comprehensive and upto-date review of how the HZ vaccine improves healthy ageing [8]. This paper raises some questions concerning the global epidemiology of the disease, improved knowledge of HZ risk factors, the well-known and more surprising consequences of the disease, as well as the increasing dilemma about age and the new indications for the currently available vaccine.The incidence rate (IR) of HZ in Italy, at 6.3 per thousand person-years [8,9], is higher than the mean incidence rate of 3-5 per thousand person-years reported in an analysis of 130 studies conducted in 26 countries in North America, Europe, and Asia-Pacific [10]. This could be related to a temporal increase in the incidence of HZ, often occurring before the introduction of varicella vaccination programmes [11], as in Finland [11] and Germany [12].…”

“…The incidence rate (IR) of HZ in Italy, at 6.3 per thousand person-years [8,9], is higher than the mean incidence rate of 3-5 per thousand person-years reported in an analysis of 130 studies conducted in 26 countries in North America, Europe, and Asia-Pacific [10]. This could be related to a temporal increase in the incidence of HZ, often occurring before the introduction of varicella vaccination programmes [11], as in Finland [11] and Germany [12].…”

Varicella and herpes zoster vaccine development: lessons learned

“…Overall zoster incidence is 2.0–4.6 cases per 1000 person years rising to 10.0–12.8 cases per 1000 person years in people aged 80 years or over [27,28]. Both the incidence and severity of zoster increase with age, with complications occurring in almost half of older people with zoster [29]. Post-herpetic neuralgia, a debilitating neuropathic pain syndrome, is the commonest complication, increasing notably with age – typically rates start to rise from around age 50 years – and among people with severe immunosuppression [30].…”

Preventing and managing herpes zoster: key actions to foster healthy aging

“…The risk of developing PHN varies from 5 % to more than 30 % [19]. According to the Shingles Prevention Study, the proportion of HZ patients who develop PHN is 12.5 % at 3 months and 5.1 % at 6 months.…”