The Epidemiology of Herpes Zoster in Immunocompetent, Unvaccinated Adults ≥50 Years Old: Incidence, Complications, Hospitalization, Mortality, and Recurrence

Abstract

Background Data on the epidemiology of herpes zoster (HZ), particularly in the unvaccinated immunocompetent population, are needed to assess disease burden and the potential impact of vaccination. Methods The study at a large health care organization comprised: (1) incidence estimated from immunocompetent adults aged ≥50 years unvaccinated with zoster vaccine live who had incident HZ in 2011–2015; (2) proportion of HZ-related nonpain complications assessed by double abstraction of electronic health records (EHRs) of 600 incident patients 2011–2015; (3) HZ-related hospitalizations among HZ patients diagnosed in 2015; (4) HZ-related death determined from automated data and EHRs; and (5) recurrent HZ identified from a cohort initially diagnosed with HZ in 2007–2008 and followed through 2016. Results HZ incidence rate was 9.92/1000 person-years (95% confidence interval [CI], 9.82–10.01). Proportions of cutaneous, neurologic, and other complications were 6.40% (95% CI,1.73%–11.07%), 0.77% (95% CI, .00%–2.36%), and 1.01% (95% CI, .00%–2.93%), respectively. Only 0.86% of patients had an HZ-related hospitalization. The case-fatality rate was 0.04%. Recurrence rate was 10.96/1000 person-years (95% CI, 10.18–11.79) with 10-year recurrence risk of 10.26% (95% CI, 9.36%–11.23%). Conclusions These recent HZ epidemiology data among an immunocompetent, unvaccinated population measure real-world disease burden.

Varicella-zoster virus VLT-ORF63 fusion transcript induces broad viral gene expression during reactivation from neuronal latency

“…VZV reactivates in about one-third of latently infected individuals to cause herpes zoster (HZ), a debilitating disease often complicated by post-herpetic neuralgia (PHN) 3 , 4 . The incidence and severity of HZ are closely related to declining VZV-specific T-cell immunity by natural senescence 5 , and immunosuppressive diseases 6 . However, the mechanisms governing how VZV reestablishes a lytic infection from latency in neurons, especially the identity of the viral gene(s) that initiate reactivation in response to cellular signaling, remain unknown.…”

Zoster sine herpete: a review

“…In China, the prevalence of HZ is 7.7% in hospital patients aged ≥ 40 years [ 11 ]. In the old (≥ 50 yr), immunocompetent, unvaccinated population, the HZ incidence rate was ~10/1,000 person-years [ 12 ]. In North America and Europe, more than 95% of young adults are positive for the VZV, which means they are at risk for ZSH and HZ [ 13 ].…”

Expression of varicella-zoster virus VLT-ORF63 fusion transcript induces broad viral gene expression during reactivation from neuronal latency

“…VZV reactivates in about one third of latently infected individuals to cause herpes zoster HZ , a debilitating disease often complicated by post herpetic neuralgia PHN 3,4 . The incidence and severity of HZ is closely related to declining VZV specific T cell immunity by natural senescence 5 , and immunosuppressive diseases 6 . However, the mechanisms governing how VZV reestablishes a lytic infection from latency in neurons, especially the identity of the viral gene(s) that facilitate reactivation in response to cellular signaling, remain unknown.…”