Varicella and Herpes Zoster. Part 1: Virology, Epidemiology, Clinical Picture, Laboratory Diagnostics

Wittek, Miriam; Allwinn, Regina

doi:10.1007/s00063-010-1061-3

Cited by 11 publications

(11 citation statements)

References 36 publications

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“…After recovery from varicella, the virus remains latent life-long in individual’s dorsal root ganglia [3]. Later in life, the VZV can reactivate and manifest as shingles (herpes zoster, HZ) as a result of decreasing VZV-specific T-cell-immunity [4,5]. Natural waning immunity and other causes like psychological stress or immunosuppression can contribute to a VZV-reactivation, too [6].…”

Section: Introductionmentioning

confidence: 99%

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Health economic evaluation of vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia in Germany

Ultsch

Weidemann

Reinhold

et al. 2013

BMC Health Serv Res

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BackgroundHerpes zoster (HZ) is a self-limiting painful skin rash affecting mostly individuals from 50 years of age. The main complication is postherpetic neuralgia (PHN), a long-lasting pain after rash has resolved. A HZ-vaccine has recently been licensed in Europe for individuals older than 50 years. To support an informed decision-making for a potential vaccination recommendation, we conducted a health economic evaluation to identify the most cost-effective vaccination strategy.MethodsWe developed a static Markov-cohort model, which compared a vaccine-scenario with no vaccination. The cohort entering the model was 50 years of age, vaccinated at age 60, and stayed over life-time in the model. Transition probabilities were based on HZ/PHN-epidemiology and demographic data from Germany, as well as vaccine efficacy (VE) data from clinical trials. Costs for vaccination and HZ/PHN-treatment (in Euros; 2010), as well as outcomes were discounted equally with 3% p.a. We accounted results from both, payer and societal perspective. We calculated benefit-cost-ratio (BCR), number-needed-to-vaccinate (NNV), and incremental cost-effectiveness ratios (ICERs) for costs per HZ-case avoided, per PHN-case avoided, and per quality-adjusted life-year (QALY) gained. Different target age-groups were compared to identify the most cost-effective vaccination strategy. Base-case-analysis as well as structural, descriptive-, and probabilistic-sensitivity-analyses (DSA, PSA) were performed.ResultsWhen vaccinating 20% of a cohort of 1 million 50 year old individuals at the age of 60 years, approximately 20,000 HZ-cases will be avoided over life-time. The NNV to avoid one HZ (PHN)-case was 10 (144). However, with a BCR of 0.34 this vaccination-strategy did not save costs. The base-case-analysis yielded an ICER of 1,419 (20,809) Euros per avoided HZ (PHN)-case and 28,146 Euros per QALY gained. Vaccination at the age of 60 was identified in most (sensitivity) analyses to be the most cost-effective vaccination strategy. In DSA, vaccine price and VE were shown to be the most critical input-data.ConclusionsAccording to our evaluation, HZ-vaccination is expected to avoid HZ/PHN-cases and gain QALYs to higher costs. However, the vaccine price had the highest impact on the ICERs. Among different scenarios, targeting individuals aged 60 years seems to represent the most cost-effective vaccination-strategy.

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Section: Introductionmentioning

confidence: 99%

“…The main complication of HZ is postherpetic neuralgia (PHN) a long-lasting pain in the formerly HZ-affected skin region after rash has resolved [5,10-12]. Both, HZ and PHN cause limitations on quality of life (QoL) [13-16].…”

Section: Introductionmentioning

confidence: 99%

Health economic evaluation of vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia in Germany

Ultsch

Weidemann

Reinhold

et al. 2013

BMC Health Serv Res

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“…The virus persists lifelong in the dorsal roots of the cranial and spinal ganglia of humans. Especially in the elderly, the virus can reactivate as herpes zoster (HZ) due to decreasing VZV-specific T-cell-immunity [2,3]. Besides a 20-30% risk of developing HZ over lifetime, the risk of HZ increases distinctly from the fifth decade in life [1,4-6].…”

Section: Introductionmentioning

confidence: 99%

“…Besides a 20-30% risk of developing HZ over lifetime, the risk of HZ increases distinctly from the fifth decade in life [1,4-6]. The main complication of HZ is postherpetic neuralgia (PHN), a long-lasting and occasionally recurring pain [3,6,7]. Both HZ and PHN cause limitation of the quality of life of affected individuals [8-11].…”

Section: Introductionmentioning

confidence: 99%

Herpes zoster in Germany: Quantifying the burden of disease

et al. 2011

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BackgroundHerpes zoster (HZ) is caused by a reactivation of the varicella-zoster-virus (VZV) and mainly affects individuals aged ≥ 50 years. Vaccines have been licensed or are under development that can protect against HZ and its main complication postherpetic neuralgia (PHN). In Germany, the burden of disease caused by HZ is not well known. To support the decision making process related to a potential vaccination recommendation, we estimated annual HZ disease burden in people aged ≥ 50 years in Germany by utilizing various data sources.MethodsWe assessed for 2007 and 2008 HZ-outpatient incidence (number of cases per 1,000 person-years, PY) by utilizing the Association of Statutory Health Insurance Physicians (ASHIP) database, which contains nationwide routine outpatient data. For the same time period annual number of HZ-inpatients and HZ-associated deaths were identified by using the Federal Health Monitoring System (FHM). PHN-incidence and loss of quality-adjusted life years (QALYs) caused by HZ were calculated by multiplying number of identified HZ-patients with upper and lower limit estimates for proportion of HZ-cases developing PHN and HZ-related QALY, respectively.ResultsFor the study period we identified an annual average of 306,511 HZ-outpatients aged 50+, resulting in a HZ-incidence of 9.6/1,000 PY. A total 14,249 HZ-associated inpatients and 66 deaths were reported in both years on average. HZ-incidence increased by age from 6.21 in people 50-54 years to 13.19 per 1,000 PY in people aged ≥ 90 years. Females were significantly more frequently affected than males in terms of outpatient HZ-incidence (11.12 vs. 7.8 per 1,000 PY), inpatient HZ-incidence (0.51 vs. 0.38 per 1,000 PY) and mortality (0.29 vs. 0.10 per 100,000 PY). PHN-incidence was estimated to range between 0.43 and 1.33 per 1,000 PY. Based on these figures, there were between 3,065 to 24,094 QALYs lost due to HZ in persons aged ≥ 50 years in Germany per annum.ConclusionOur study provides important baseline estimates for HZ-related disease burden in Germany. HZ poses a considerable burden on the health care system in Germany both in terms of outpatient and inpatient services. Follow-up assessments of HZ disease burden are needed to monitor the impact of VZV-vaccinations in Germany.

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“…The third model considers the timing of childhood infections. Deviations from typical timing, in particular delayed childhood infectious diseases such as chickenpox, measles, mumps, or rubella, are well known to lead to a more severe disease course with more complications (11–14). This also applies to delayed EBV infections, which increase the risk for mononucleosis and probably also for MS (15).…”

Section: Introductionmentioning

confidence: 99%

Social Phobia Is Associated with Delayed Onset of Chickenpox, Measles, and Mumps Infections

et al. 2016

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ObjectiveEvidence showing that infectious diseases in childhood play an important role in the etiopathogenesis of neurodevelopmental and other mental disorders is growing. The aim of this study was to explore the timing of common childhood diseases in early-onset anxiety disorders.Materials and methodsWe analyzed data from PsyCoLaus, a large Swiss Population Cohort Study (N = 3720). In this study, we regressed overanxious disorder, separation anxiety disorder, social phobia, and specific phobias on the age of onset of several childhood diseases, always adjusting for the other anxiety disorders listed above and for sex.ResultsThe timing of viral childhood diseases (chickenpox, measles, and mumps) was consistently delayed in social phobia, notably both in men and women. We found no evidence for a reversed sequence of onset of phobia symptoms before that of the infections included.ConclusionSocial phobia was the only early anxiety disorder to show an association with a delayed onset of common viral childhood diseases.

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Varicella and Herpes Zoster. Part 1: Virology, Epidemiology, Clinical Picture, Laboratory Diagnostics

Cited by 11 publications

References 36 publications

Health economic evaluation of vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia in Germany

Health economic evaluation of vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia in Germany

Herpes zoster in Germany: Quantifying the burden of disease

Social Phobia Is Associated with Delayed Onset of Chickenpox, Measles, and Mumps Infections

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