Zoster Vaccine and the Risk of Postherpetic Neuralgia in Patients Who Developed Herpes Zoster Despite Having Received the Zoster Vaccine

Tseng, Hung Fu; Lewin, Bruno; Hales, Craig M.; Sy, Lina S.; Harpaz, Rafael; Bialek, Stephanie R.; Luo, Yi; Jacobsen, Steven J.; Reddy, K. V. S. R.; Huang, Po-yin; Zhang, Jeff; Anand, Sean; Bauer, Erin Mary; Chang, Jennifer; Tartof, Sara Y.

doi:10.1093/infdis/jiv244

Cited by 26 publications

(16 citation statements)

References 16 publications

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“… 22 Furthermore, previous research has reported that health-care utilization tends to be higher among vaccinated individuals. 10 Our results support this as well, with marked discordance between the two methods among unvaccinated participants (chart review: 7.08%, self-report: 15.42%), and a much smaller difference among vaccinated individuals (chart review: 7.58%, self-report: 9.18%).…”

Section: Discussionsupporting

confidence: 84%

“…While manual review of EHR can provide a good estimate of health-care utilization related to pain, this approach is susceptible to human error and may underreport PHN cases among individuals who seek care less often. 10 Although arguably the best assessment of an individual’s experience, self-reported pain is multi-dimensional and highly subjective and may be impacted by a variety of other factors, such as additional comorbidities, level of education, and quality of life. 11 – 13 …”

Section: Introductionmentioning

confidence: 99%

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<p>Differences in Estimates of Post-Herpetic Neuralgia Between Medical Chart Review and Self-Report</p>

Tanenbaum¹,

Lawless²,

Sy³

et al. 2020

JPR

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Purpose Post-herpetic neuralgia (PHN) is a common herpes zoster (HZ) complication, where pain persists 90 days after the initial HZ diagnosis. Evaluating PHN risk is essential for determining the burden on patients and health-care systems, but research shows variable estimates. The extent to which these differences are related to the assessment method has not been examined. The purpose of this study is to compare the proportion of PHN among HZ patients measured by medical chart review and self-report surveys. Methods PHN risk was assessed among a sample of Kaiser Permanente Southern California members with HZ. Chart reviews identified lingering pain 90–180 days post-HZ diagnosis and the Zoster Brief Pain Inventory was administered 90 days post-HZ diagnosis by telephone. Frequencies of PHN identified with each approach were cross-tabulated and stratified by sex, age group, and zoster vaccine live vaccination status. Results Chart review and self-report were largely concordant (n=875, 89.20%); however, chart review yielded lower PHN risk overall and for the stratified subgroups. PHN from self-report was substantially higher (6.30–8.33%) among patients who were male, ≥70 years, or unvaccinated. Among those who typically seek care more often (female, younger, vaccinated), the discrepancy between each method was notably lower (1.60–2.92%). Conclusion Our findings suggest that chart review underestimates cases among those less likely to seek health care, including males, the elderly, and unvaccinated individuals. The agreement between the methods indicates that each can provide a reasonable approximation of PHN, but analyses should carefully control for health-care utilization.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

<p>Differences in Estimates of Post-Herpetic Neuralgia Between Medical Chart Review and Self-Report</p>

Tanenbaum¹,

Lawless²,

Sy³

et al. 2020

JPR

Self Cite

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“…54-58 Despite this possible risk, these events are not common, and a history of HZO is not a contraindication to zoster vaccination. 12,53,59,60 Another important question is whether a longer duration of anti-viral therapy will change the course of disease. Current practice is to treat individuals with a new episode of HZ with 7-14 days of antivirals.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Herpes Zoster Ophthalmicus

et al. 2016

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Purpose A hospital-based epidemiology study to describe herpes zoster ophthalmicus (HZO) prevalence, and identify risk factors for recurrent and chronic disease. Design Retrospective, hospital-based cohort study Participants All patients evaluated in the Broward and Miami VA Healthcare System (MIAVHS) during the study period. Methods Retrospective medical record review of patients seen in the MIAVHS from January 1, 2010 and December 31, 2014 with a HZO clinical diagnosis. Assessment of the patient's clinical course was defined by the following: an acute episode of HZO was defined as quiescence of disease within 90 days of initial presentation; HZO recurrence was defined as any recurrent eye disease or rash >90 days after quiescence disease was noted off therapy; chronic HZO was defined as active disease persisting greater than 90 days from initial presentation. Main Outcome Measures 1) Frequency of HZ involving the V1 dermatome (HZO) with and without eye involvement; 2) HZO recurrence rates 3) Risk factors for recurrent or chronic HZO. Results 90 patients with HZO were included in the study. The mean age at incident episode of HZO was 68±13.8 years (range, 27-95 years). The majority of patients were white (73%), immune competent (79%), and did not receive zoster vaccination at any time point in their follow up (82%). Patients were followed for a mean of 3.9±5.9 years, (range, 0-33 years). The period prevalence of HZ in any dermatome was 1.1%, the frequency of HZ involving V1 (HZO) was 0.07% and the frequency of HZO with eye involvement was 0.05%. The overall 1, 3, and 5-year recurrence rates for either recurrent eye disease or rash were 8%, 17%, 25%, respectively. Ocular hypertension (HR 4.6, 95% Cl 1.3-16.5; OR 6.7, 95% Cl 1.5-31.2) and uveitis (HR 5.7, 95%CI 1.7-19.0; OR 6.7, 95% C1 1.5-31.2) increased the risk of recurrent and chronic disease. Conclusion This study supports newer data that a significant proportion of patients experience recurrent and chronic HZO. Further study is needed to guide preventative and therapeutic approaches to recurrent and chronic HZO.

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“…The risk of recurrent HZ did not significantly differ between vaccinated and unvaccinated individuals in a matched cohort study among elderly individuals aged ≥60 years who had had a recent episode of HZ [ 38 ]. Another study reported that the overall risk of PHN was significantly reduced in immunocompetent individuals aged ≥60 years who had developed HZ, after having received the HZ vaccine (VE: 41%; 95% CI 15%; 59%) [ 39 ]. Gender-specific analysis revealed that the risk reduction for PHN was predominately observed for women with no significant difference for men.…”

Section: Hz Vaccine Effectiveness In Immunocompetent Subjectsmentioning

confidence: 99%

Real-World Effectiveness and Safety of a Live-Attenuated Herpes Zoster Vaccine: A Comprehensive Review

et al. 2016

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Herpes zoster (HZ) is a common, painful and debilitating disease caused by the reactivation of latent varicella-zoster virus in ganglia. This clinical event occurs more frequently in the elderly and those who are immunocompromised. The most common complication of HZ is post-herpetic neuralgia (PHN) which is responsible for the highest HZ-related burden of illness and is challenging to treat. Due to the important clinical and economic impact of HZ and PHN, and the suboptimal treatments that are currently available, HZ vaccination is an important approach to reduce the burden of illness. Currently, one-dose, live-attenuated vaccine is licensed in the United States and Europe to prevent HZ and it is included in some national immunization programs. The clinical efficacy, safety and tolerability of the vaccine has been demonstrated in two large phase III clinical trials, involving more than 38,000 and 22,000 individuals aged ≥60 and 50–59 years, respectively. This comprehensive review summarizes the extensive “real-world” effectiveness and safety data from both immunocompetent and immunocompromised individuals. These data confirm those from the clinical trials, supporting the use of HZ vaccine in clinical practice and provide evidence that the current recommendations for immunocompromised individuals should be revised.Funding: Funding for the editorial assistance, article processing charges, and open access fee for this publication was provided by Sanofi Pasteur MSD.

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Zoster Vaccine and the Risk of Postherpetic Neuralgia in Patients Who Developed Herpes Zoster Despite Having Received the Zoster Vaccine

Cited by 26 publications

References 16 publications

<p>Differences in Estimates of Post-Herpetic Neuralgia Between Medical Chart Review and Self-Report</p>

<p>Differences in Estimates of Post-Herpetic Neuralgia Between Medical Chart Review and Self-Report</p>

Epidemiology of Herpes Zoster Ophthalmicus

Real-World Effectiveness and Safety of a Live-Attenuated Herpes Zoster Vaccine: A Comprehensive Review

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