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Giannelos N, Curran D, Nguyen C, Kagia C, Vroom N, Vroling H. The Incidence of Herpes Zoster Complications: A Systematic Literature Review. Infect Dis Ther 2024; 13:1461-1486. [PMID: 38896390 PMCID: PMC11219681 DOI: 10.1007/s40121-024-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION The objective of this work was to summarize the incidence of herpes zoster (HZ) complications in different populations. METHODS Systematic literature review of PubMed, Embase, and Virtual Health Library records between January 1, 2002 and October 20, 2022 using search strings for HZ, complications, and frequency measurements. RESULTS The review included 124 studies, most conducted in the general population (n = 93) and on individuals with comorbidities (n = 41) ≥ 18 years of age. Most studies were conducted in Europe (n = 44), Asia (n = 40), and North America (n = 36). Postherpetic neuralgia (PHN) was the most studied neurological complication. Variable relative PHN incidence was found in the general population (2.6-46.7%) or based on diagnosis: immunocompromised (3.9-33.8%), depression (0-50%), and human immunodeficiency virus (HIV) (6.1-40.2%). High incidence rates were observed in hematological malignancies (HM) and solid organ malignancies (132.5 and 93.7 per 1000 person-years, respectively). Ocular complications were frequently reported with herpes zoster ophthalmicus (HZO). The relative incidence (incidence rate) of HZO in the general population was reported as 1.4-15.9% (0.31-0.35 per 1000 person-years). High relative incidence was observed in HIV (up to 10.1%) and HM (3.2-11.3%). Disseminated HZ was the most frequently reported cutaneous complication. The relative incidence of disseminated HZ was 0.3-8.2% in the general population, 0-0.5% in the immunocompetent, and 0-20.6% in patients with comorbidities. High relative incidence was reported in HM and solid organ transplant (up to 19.3% and 14.8%, respectively). DISCUSSION Most reported complications were neurological (n = 110), ocular (n = 48), and cutaneous (n = 38). Few studies stratified complications by age or gender (or both). Incidence appeared higher in select immunocompromised populations. Higher incidence was associated with older age in several studies; the general association with gender was unclear. CONCLUSIONS Variable incidence of HZ complications was reported by population subgroup. Further research is required to quantitatively analyze incidence by age, gender, and location.
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Affiliation(s)
| | | | - Chi Nguyen
- Pallas Health Research & Consultancy, a P95 Company, Leuven, Belgium
| | - Carol Kagia
- Pallas Health Research & Consultancy, a P95 Company, Leuven, Belgium
| | - Nikki Vroom
- Pallas Health Research & Consultancy, a P95 Company, Rotterdam, Netherlands
| | - Hilde Vroling
- Pallas Health Research & Consultancy, a P95 Company, Rotterdam, Netherlands
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Zhao C, Zhang T, Zhu Q, Chen Z, Ren H, Shrestha N, Meng L, Shen Y, Luo F. PROCESS Trial: Effect of Duloxetine Premedication for Postherpetic Neuralgia Within 72 Hours of Herpes Zoster Reactivation-A Randomized Controlled Trial. Clin Infect Dis 2024; 78:880-888. [PMID: 38015658 DOI: 10.1093/cid/ciad714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster (HZ) and results in severe refractory neuropathic pain. This study aimed at evaluating the efficacy of premedication with duloxetine in the prevention of PHN. METHODS The PROCESS trial is a multicenter, randomized, open-label, blinded-endpoint trial used a 1:1 duloxetine:control ratio. Adults 50 years or older with HZ who presented with vesicles within 72 hours were recruited. The primary outcome was the incidence of PHN at 12 weeks. PHN was defined as any pain intensity score other than 0 mm on the visual analog scale (VAS) at week 12 after the onset of the rash. The secondary outcomes were the number of participants with VAS >0 and VAS ≥3. The modified intention-to-treat (mITT) principle and per-protocol (PP) principle were used for the primary outcome analysis. RESULTS A total of 375 participants were randomly assigned to the duloxetine group and 375 were assigned to the control group. There was no significant difference in the incidence of PHN in the duloxetine group compared with the control group in the mITT analysis (86 [22.9%] of 375 vs 108 [28.8%] of 375; P = .067). PP analysis produced similar results. However, there were significant differences between the 2 groups in the number of participants with VAS >0 and VAS ≥3 (P < .05 for all comparisons). CONCLUSIONS Although absolute prevention of PHN does not occur, this trial found that premedication with duloxetine can reduce pain associated with HZ, and therefore can have clinically relevant benefits. Clinical Trials Registration. Clinicaltrials.gov, NCT04313335. Registered on 18 March 2020.
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Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingjie Zhang
- Department of Pain Management, Peking University People's Hospital, Beijing, China
| | - Qian Zhu
- Department of Pain Management, China-Japan Friendships Hospital, Beijing, China
| | - Zheng Chen
- Emergency Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lan Meng
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Bauer S, Díez-Domingo J, Vallejo L. [Vaccines to protect our older adults: Efficiency, responsibility and ethics]. Aten Primaria 2024; 56:102796. [PMID: 37950979 PMCID: PMC10682519 DOI: 10.1016/j.aprim.2023.102796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/13/2023] Open
Affiliation(s)
- Sofía Bauer
- Medicina Familiar y Comunitaria, Centro de Salud de Malvarrosa; Miembro del grupo de investigación en Atención Primaria en INCLIVA, Valencia, España.
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Chen P, Chen Z, Xiao Y, Chen X, Li J, Tang Y, Shen M. Characteristics and economic burden of hospitalized patients with herpes zoster in China, before vaccination. Hum Vaccin Immunother 2023; 19:2268990. [PMID: 37899682 PMCID: PMC10760360 DOI: 10.1080/21645515.2023.2268990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023] Open
Abstract
Herpes zoster (HZ) brings a significant economic burden. The HZ vaccine was introduced in China for the first time in 2020, and there is a lack of up-to-date information on the hospitalization costs and characteristics prior to vaccination. This study aimed to describe the characteristics and economic burden of HZ inpatients in Hunan Province, China, and analyze the factors influencing the length of stay (LOS) and costs. This was a retrospective study and we extracted information from the Chinese National Health Statistics Network Reporting System on HZ inpatients in Hunan Province, China from 2017 to 2019. Spatial join tools and Global or Local Moran's Index were used for the geographic analysis of hospitalized HZ incidence. Multivariate linear regression models were used to analyze the factors influencing LOS and costs. There were 44,311 HZ inpatients included in this study, incurring a total of $31,857,734 medical costs. These patients had a median LOS of 8 days and a median expenditure of $573.47. Older age, more comorbidities, and the presence of complications with nervous system involved were all significantly associated with longer LOS and higher costs. HZ infection resulted in a large direct medical cost and heavy disease burden, especially in patients with advanced age or underlying medical conditions. The HZ vaccine has the potential to effectively reduce the disease burden and should be widely popularized especially among high-risk groups.
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Affiliation(s)
- Peng Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zheng Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Curran D, Doherty TM, Lecrenier N, Breuer T. Healthy ageing: Herpes zoster infection and the role of zoster vaccination. NPJ Vaccines 2023; 8:184. [PMID: 38017011 PMCID: PMC10684688 DOI: 10.1038/s41541-023-00757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/12/2023] [Indexed: 11/30/2023] Open
Abstract
Populations are ageing worldwide, with considerable time lived in ill-health, putting upwards pressure on healthcare budgets. Healthy ageing is defined as maintaining functional ability, including the ability to: meet basic needs; learn, grow and make decisions; be mobile; build and maintain relationships; and contribute to society. The risk and impact of infectious diseases increase with age due to immunosenescence. Vaccination can help to prevent disease in older adults, promoting healthy ageing and active lives. Herpes zoster (HZ) occurs when the varicella zoster virus is reactivated due to declining immunity. HZ is common, with a lifetime risk of one-third, and increases in incidence with age. HZ is associated with severe and intense pain, substantially affecting the functional status of patients as well as their overall health-related quality of life. HZ and its complications may result in prolonged morbidity, including persistent pain (post-herpetic neuralgia, PHN), hearing impairment, vision loss and increased risk of stroke and myocardial infarction. HZ and PHN are difficult to treat, substantiating the benefits of prevention. Vaccines to prevent HZ include a recombinant zoster vaccine (RZV). RZV has shown efficacy against the HZ burden of disease and HZ burden of interference on activities of daily living of over 90% in immunocompetent adults aged ≥50 years. Vaccine efficacy against HZ was maintained at over 70% at 10 years post-vaccination. Adult vaccination, including against HZ, has the potential to reduce burden of disease, thus helping to maintain functioning and quality of life to support healthy ageing in older adults.
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Jiang M, Yao X, Peng J, Feng L, Ma Y, Shi X, Fang Y, Fang H. Cost-Effectiveness of Recombinant Zoster Vaccine for Adults Aged ≥50 Years in China. Am J Prev Med 2023; 65:818-826. [PMID: 37182556 DOI: 10.1016/j.amepre.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/06/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Adjuvanted recombinant zoster vaccine (RZV) was the first vaccine made available for herpes zoster in China. Authors aimed to evaluate its economic and health impacts on Chinese adults aged ≥50 years. METHODS A lifetime Markov model was developed to compare the cost-effectiveness of RZV with that of no vaccination from a societal perspective. Model inputs were derived from published literature and analyzed in 2022. Outcomes included total costs, quality-adjusted life-years, incremental cost-effectiveness ratio, and number of herpes zoster and herpes zoster-related cases. Sensitivity analyses were performed to examine the robustness of the model results. RESULTS RZV was more costly than no vaccination by $2.78 billion with an additional 65,008 quality-adjusted life-years gained and could avoid 1,893,530 herpes zoster cases, 295,761 postherpetic neuralgia cases, 51,734 other complications, and 229 herpes zoster-related deaths. Incremental cost-effectiveness ratios of RZV varied in a range of $34,465.5-$51,002.7 per quality-adjusted life-year. RZV for the entire cohort would be cost-effective when discount rate was <2.4%, a waning rate of 2-dose RZV efficacy decreased to <0.8%, the utility of postherpetic neuralgia was <0.496, duration of postherpetic neuralgia was >12.86 months, or the cost of RZV per dose decreased to <$229.6. In a probabilistic sensitivity analysis, the probability of RZV being cost-effective was 43.95%, 59.32%, 45.27%, and 39.50% for people aged 50-59, 60-69, 70-79, and ≥80 years, respectively, with threefold gross domestic product per capita (37,654.5 per quality-adjusted life-year) as the willingness-to-pay threshold. CONCLUSIONS RZV was most likely to be cost-effective in people aged 60-69 years. A slight decrease in vaccine cost would result in RZV being cost-effective in all people aged ≥50 years.
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Affiliation(s)
- Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Xuelin Yao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China
| | - Jin Peng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China
| | - Liuxin Feng
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue Ma
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China
| | - Xinke Shi
- Health Sciences Center, Xi'an Jiaotong University, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China; Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China.
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Fan HR, Zhang EM, Fei Y, Huang B, Yao M. Early Diagnosis of Herpes Zoster Neuralgia: A Narrative Review. Pain Ther 2023; 12:893-901. [PMID: 37129752 PMCID: PMC10289968 DOI: 10.1007/s40122-023-00510-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/30/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Early intervention reduces the incidence of postherpetic neuralgia (PHN). Typical shingles are easy to diagnose; however, there is no clear diagnostic method for neuralgia symptoms manifested before the onset of the rash, which can easily cause misdiagnosis. This not only increases the patient's pain, medical expenses, and mental burden, but more importantly, delays the valuable time for early treatment of shingles, and increases the probability of complications and PHN. OBJECTIVE In this paper, the diagnostic methods of preherpetic neuralgia were summarized and analyzed, and the current challenges were put forward to provide directions for the early diagnosis of herpes zoster (HZ) in the future. METHODS PubMed, and China National Knowledge Infrastructure (CNKI) libraries were searched using the terms "herpes zoster," "before the blistering," "diagnosis," and "neuralgia." Clinical trials, reviews, and case reports were collected and reviewed. The period of literature search is from 1 January 1980 to 1 October 2022. RESULTS The early diagnosis of herpes zoster neuralgia can reduce misdiagnosis and mistreatment, and timely and effective intervention can significantly reduce the incidence of PHN. The body may possess a mechanism that limits the local breakthrough of the virus in the skin, causing blistering later than the onset of pain. Changes in the plasma proteins of patients with varicella-zoster virus shingles neuralgia may be used as an early diagnostic indicator in patients with HZ neuralgia before eruption. CONCLUSION Early diagnosis of HZ neuralgia before eruption can facilitate timely targeted treatment, thereby reducing the incidence of PHN. Proteomic quantitative analysis and validation results can serve as a simple, micro, rapid, and accurate diagnostic method.
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Affiliation(s)
- Han-Rui Fan
- Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - En-Ming Zhang
- Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Yong Fei
- Department of Anesthesiology and Pain, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, People's Republic of China.
| | - Bing Huang
- Department of Anesthesiology and Pain, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, People's Republic of China
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Hornung RS, Kinchington PR, Umorin M, Kramer PR. PAQR8 and PAQR9 expression is altered in the ventral tegmental area of aged rats infected with varicella zoster virus. Mol Pain 2023; 19:17448069231202598. [PMID: 37699860 PMCID: PMC10515525 DOI: 10.1177/17448069231202598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
Infection with varicella zoster virus (VZV) results in chicken pox and reactivation of VZV results in herpes zoster (HZ) or what is often referred to as shingles. Patients with HZ experience decreased motivation and increased emotional distress consistent with functions of the ventral tegmental area (VTA) of the brain. In addition, activity within the ventral tegmental area is altered in patients with HZ. HZ primarily affects individuals that are older and the VTA changes with age. To begin to determine if the VTA has a role in HZ symptoms, a screen of 10,000 genes within the VTA in young and old male rats was completed after injecting the whisker pad with VZV. The two genes that had maximal change were membrane progesterone receptors PAQR8 (mPRβ) and PAQR9 (mPRε). Neurons and non-neuronal cells expressed both PAQR8 and PAQR9. PAQR8 and PAQR9 protein expression was significantly reduced after VZV injection of young males. In old rats PAQR9 protein expression was significantly increased after VZV injection and PAQR9 protein expression was reduced in aged male rats versus young rats. Consistent with previous results, pain significantly increased after VZV injection of the whisker pad and aged animals showed significantly more pain than young animals. Our data suggests that PAQR8 and PAQR9 expression is altered by VZV injection and that these changes are affected by age.
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Affiliation(s)
- Rebecca S Hornung
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX, USA
| | - Paul R Kinchington
- Department of Ophthalmology and of Molecular Microbiology and Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mikhail Umorin
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX, USA
| | - Phillip R Kramer
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX, USA
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Lin W, Tsai C, Yeh C, Chian T, Liu Y, Wang H, Ko P, Lin T, Hsiao L, Chen P, Gau J, Liu C. Herpes zoster prophylaxis: Essential for treating newly diagnosed multiple myeloma patients. Cancer Med 2022; 12:3013-3026. [PMID: 36127838 PMCID: PMC9939124 DOI: 10.1002/cam4.5215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is known for its immune disturbance and patients suffering from MM are thus vulnerable to opportunistic infections, including herpes zoster (HZ). As HZ infection remarkably affects patients' quality of life and poses huge economic burdens on the health system, we aim to identify the risk factors of HZ infection and evaluate the effects of different dosages, types, and durations of anti-HZ prophylaxis drugs to prevent HZ infection. METHODS 551 MM patients at Taipei Veterans General Hospital in Taiwan between January 1, 2009 and August 31, 2021 were restrospectively analyzed. The patients' baseline characteristics were recorded. The primary endpoint of the study was the incidence of HZ infection among the studied patient population. Due to the lack of cost coverage from Taiwanese public health insurance on HZ prophylaxis drugs, the use of anti-HZ drugs mainly depends on physicians' preferences and patients' choices. RESULTS In our study, prophylaxis was given to 283 of the patients. In the multivariate analysis, we included non-prophylaxis, age ≥ 60, corrected serum calcium ≥12 mg/dl, serum creatinine ≥2 mg/dl, serum β2-microglobulin ≥5500 mg/L, autologous stem cell transplant (SCT), and allogeneic SCT for analysis. Our results demonstrated that the non-prophylaxis group (HR: 2.37, 95% CI 1.57-3.57) and patients receiving autologous SCT (HR: 2.22, 95% CI 1.28-3.86) and allogeneic SCT (HR: 5.12, 95% CI 1.13-23.22) had higher risk of HZ infection. The difference in dosage and types of anti-HZ drugs showed similar protective effects. In patients who stopped anti-HZ prophylaxis before active cancer-related treatment, a higher risk of getting HZ infection compared to the corresponding group was also observed (adjusted HR 3.09, 95% CI 1.35-7.07, p = 0.008). CONCLUSIONS We concluded that MM patients should receive HZ prophylaxis drugs while receiving active cancer-related treatment. Patients receiving SCT are also at high risk of getting HZ infection, even under prophylaxis.
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Affiliation(s)
- Wen‐Ying Lin
- Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Chun‐Kuang Tsai
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chiu‐Mei Yeh
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Institute of Public HealthNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Tin Chian
- Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yao‐Chung Liu
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Hao‐Yuan Wang
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Po‐Shen Ko
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ting‐An Lin
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Liang‐Tsai Hsiao
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Po‐Min Chen
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jyh‐Pyng Gau
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chia‐Jen Liu
- Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Institute of Emergency and Critical Care MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Sun R, Wang N, Mou H, Gao C, Yu L, Li W, Li T, Huang P, Gong W. Risk Factors for Poor Pain Control in Zoster-Associated Pain: A Retrospective Study. Pain Ther 2022; 11:1471-1481. [PMID: 36030333 PMCID: PMC9633892 DOI: 10.1007/s40122-022-00426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION The objective was to investigate the risk factors for poor pain control in patients with herpes zoster (HZ)-associated neuropathic pain treated with drugs combined with nerve block therapy. Neuropathic pain commonly follows HZ. Nerve block therapy is the most commonly used clinical treatment for such pain, combining anti-inflammation and analgesia to prevent peripheral sensitization of nerve. METHODS Using clinical practice data from a cohort study at our research center, we established a multivariate logistic regression model to investigate potential risk factors for poor control of zoster-associated pain (ZAP) treated with drugs plus nerve block therapy, including demographic characteristics, complications, laboratory tests, and characteristics of HZ attacks. RESULTS Of the 429 patients with ZAP who received drugs plus nerve block therapy, 95 (22.14%) had poor pain control after treatment. The risk of poor pain control was closely related to presence of cancer (odds ratio (OR) 4.173, 95% confidence interval (CI) 1.342-12.970), numerical rating scale score on admission (OR 1.929, 95% CI 1.528-2.434), and red blood cell count (OR 0.560, 95% CI 0.328-0.954). Area under the receiver operator characteristic curve was 0.730. Goodness of fit (Hosmer-Lemeshow) was 0.874. CONCLUSIONS The risk of poor pain control in patients with ZAP increased as a result of certain patient characteristics and complications, especially severe pain before treatment and cancer.
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Affiliation(s)
- Ruifeng Sun
- Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China.,Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ning Wang
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hai Mou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Can Gao
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lv Yu
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Wenshan Li
- Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Tiancong Li
- Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Peiling Huang
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Weijun Gong
- Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China. .,Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China.
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11
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Sollie M, Jepsen P, Sørensen JA. Patient-reported quality of life in patients suffering from acute herpes zoster-a systematic review with meta-analysis. Br J Pain 2022; 16:404-419. [PMID: 36032345 PMCID: PMC9411760 DOI: 10.1177/20494637211073050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Objectives Herpes Zoster (HZ) is a common painful, debilitating condition caused by reactivation of the varicella-zoster virus. It is characterized by a painful skin eruption which is very complex to treat. Studies have reported that HZ negatively affects Quality of Life (QoL), but no large systematic review on this topic has been published to date. This systematic review aims to summarize the current data on patient-reported QoL amongst patients diagnosed with HZ. Methods We searched Medline, Embase, Cochrane Library, CINAHL, and PsycINFO. The primary outcome was the change in percent impairment of QoL compared to normative data. Secondary outcomes were meta-analyses comparing reported QoL to a control group or normative data. Results We assessed a total of 536 studies for inclusion. Thirteen studies were included in the systematic review and five studies in the meta-analyses. The total number of patients was 5472. Conclusions This systematic review and meta-analysis found lower reported QoL amongst patients diagnosed with acute herpes zoster compared to normative values. Our data show that acute herpes zoster significantly reduces the quality of life of the patients affected.
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Affiliation(s)
- Martin Sollie
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pernille Jepsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jens A Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Yu Z, Zhao Y, Jin J, Zhu J, Yu L, Han G. Antiviral treatment in outpatients with herps zoster in six major areas of China, 2010–2019. Front Public Health 2022; 10:942377. [PMID: 35968424 PMCID: PMC9372588 DOI: 10.3389/fpubh.2022.942377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
Objective The objective of this study was to assess the status and trends of antiviral treatment in outpatients with herpes zoster in China. Methods Prescription data on antiviral drugs were extracted from the database of the Hospital Prescription Analysis Program of China according to the inclusion criteria. Yearly prescriptions and costs were calculated, and trends were analyzed. The trends were further stratified by age, sex, and specific drug use. The distribution of defined daily costs (DDCs) of valaciclovir and famciclovir were analyzed, and trends in the median DDCs were identified. Results A total of 132,911 prescriptions from 49 hospitals located in six major areas of China were included in the analysis. The yearly prescriptions containing antivirals increased from 8,819 in 2010 to 16,361 in 2019. The percentage of prescriptions for patients aged 65 years and above also increased (27.7% in 2010 to 31.0% in 2019), and the number of prescriptions for females was higher than those for males (P < 0.001). The average cost of antivirals per prescription decreased; thus, the yearly cost showed no increasing trend. The main prescribed antivirals were valaciclovir and famciclovir, which progressively increased in prescriptions. The use of acyclovir decreased during the study period. Prescriptions containing topical formulations, acyclovir and penciclovir, both increased. The DDCs of valaciclovir and famciclovir decreased dramatically. Conclusion The use of antivirals has increased over the decade, while the cost has not. Antiviral treatments adhere well to recent recommendations, except for the use of topical antivirals. The findings of this study may benefit the healthcare source allocation and management of herpes zoster in China.
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Affiliation(s)
- Zhenwei Yu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuhua Zhao
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiayi Jin
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianping Zhu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingyan Yu
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Lingyan Yu
| | - Gang Han
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Gang Han
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13
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Gil de Miguel Á, Eiros Bouza JM, Martínez Alcorta LI, Callejo D, Miñarro C, Vallejo-Aparicio LA, García A, Tafalla M, Cambronero MDR, Rodríguez R, Martin-Gomez L. Direct Medical Costs of Four Vaccine-Preventable Infectious Diseases in Older Adults in Spain. PHARMACOECONOMICS - OPEN 2022; 6:509-518. [PMID: 35254649 PMCID: PMC8899779 DOI: 10.1007/s41669-022-00329-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Protection against vaccine-preventable diseases is especially relevant in older adults due to age-related decline in immunity (immunosenescence). However, adult vaccination remains a challenge with overall low coverage rates, which has an impact on both the patients who have these diseases and the health care system in terms of resource use and costs derived. This study aimed to estimate the direct economic impact of herpes zoster, pneumococcal disease, influenza and pertussis in Spanish adults 45 years and older. METHODS Data from 2015 were extracted from two Spanish public databases: the Minimum Basic Data Set for Hospitalisations and the Clinical Database of Primary Care. Codes from the International Classification of Diseases and the International Classification of Primary Care were used to identify and classify the diseases analysed. The variables extracted and calculated were hospitalisation (cases, percentage, length of stay, costs, mortality), primary care (cases, percentage, costs) and referrals (cases, percentage, costs). Results were presented for the age groups 45-64 years, 65-74 years, > 74 years and all ages. RESULTS In adults 45 years and older, total costs amounted to €134.1 million in 2015 (i.e. 63.9% of the total direct costs for all age groups): 44.4% due to pneumococcal disease, 39.5% due to influenza, 16.0% due to herpes zoster and 0.1% due to pertussis. Hospitalisations represented 58.1% (€77.9 million) of the total costs, with 15,910 admissions, 144,752 days of hospitalisation and 1170 deaths. Primary care registered 566,556 visits with a cost of €35.0 million, and 269,186 referrals with a cost of €21.1 million. CONCLUSION The direct economic burden of herpes zoster, pneumococcal disease, influenza and pertussis in adults 45 years and older was high in Spain, and may be underestimated as it only considered medical assistance and not other applicable direct or indirect costs. Increasing vaccination rates in adults may potentially reduce the economic burden derived from these diseases, although future cost-effectiveness analysis including other disease-related costs, vaccination costs and vaccination effectiveness would be needed.
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Affiliation(s)
| | | | | | | | | | | | - Andrea García
- GSK, Calle de Severo Ochoa, pq. Tecnológico de Madrid, 2, Tres Cantos, 28760, Madrid, Spain
| | | | | | - Rubén Rodríguez
- GSK, Calle de Severo Ochoa, pq. Tecnológico de Madrid, 2, Tres Cantos, 28760, Madrid, Spain
| | - Laura Martin-Gomez
- GSK, Calle de Severo Ochoa, pq. Tecnológico de Madrid, 2, Tres Cantos, 28760, Madrid, Spain
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14
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Zhang J, Han X, Su D, Gu X, Yu W. Research Trends and Hotspots on Herpes Zoster: A 10-Year Bibliometric Analysis (2012-2021). Front Med (Lausanne) 2022; 9:850762. [PMID: 35559334 PMCID: PMC9089455 DOI: 10.3389/fmed.2022.850762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose Herpes zoster infection, with its considerable burden to individuals and society, remains a challenge around the world. However, to the knowledge of the authors, little bibliometric quantitative or qualitative analysis has been carried out to evaluate herpes zoster research. This study aimed to use a bibliometric analysis to evaluate current publication trends and hotspots on herpes zoster research worldwide, in order to advance research in this field. Methods Relevant publications from January 2012 to December 2021 were collected from the Web of Science Core Collection database. Citespace (V5.8.R3) was used to analyze the research points, including publication countries, institutions and authors, cited author, cited reference and their clustering, and keyword co-occurrence, and burst keyword to acquire research trends and hotspots. Results A total of 9,259 publications were obtained, with a steady increase in the number of annual publications during the decade. Articles were the main type of publication. The United States is the leading country in this research, and the University of Colorado has the highest influence in this field. Oxman is the most representative author, with a main research interest in herpes zoster vaccines. The top five cited authors' publications focused on herpes zoster vaccines, molecular mechanisms, and postherpetic neuralgia. A co-citation map resulted 19 main clusters, and revealed that vaccines, postherpetic neuralgia, treatments, varicella zoster virus and its mechanisms, and epidemiology of herpes zoster were the current research focus after clustering co-cited publications. Human herpesviruses, antiviral prophylaxis, rheumatoid arthritis, recombinant zoster vaccine, varicella vaccination and postherpetic neuralgia were the top clusters after co-occurrence keywords analysis. Moreover, burst keywords detection showed that the subunit vaccine was the new hotspot in the field of herpes zoster. Conclusion This bibliometric study defined the overall prospects in the field of herpes zoster and provided valuable instruction for the ongoing research. The keyword "subunit vaccine" indicated that a vaccine for herpes zoster prevention was the hotspot. Efforts to prevent varicella zoster virus infection will be essential to improve herpes zoster outcomes.
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Affiliation(s)
- Jian Zhang
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Han
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diansan Su
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiyao Gu
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weifeng Yu
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Pan CX, Lee MS, Nambudiri VE. Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review. Ther Adv Vaccines Immunother 2022; 10:25151355221084535. [PMID: 35340552 PMCID: PMC8941701 DOI: 10.1177/25151355221084535] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/11/2022] [Indexed: 12/30/2022] Open
Abstract
Herpes zoster (HZ) is a neurocutaneous disease that causes significant morbidity
worldwide. The disease is caused by the reactivation of the varicella-zoster
virus (VZV), which leads to the development of a painful, vesicular rash and can
cause complications such as post-herpetic neuralgia and vision loss. Globally,
the incidence of HZ is increasing, and it incurs billions in cost annually to
the healthcare system and to society through loss of productivity. With the
advent of effective vaccines such as the live attenuated vaccine,
Zostavax®, in 2006, and more recently the adjuvant recombinant
subunit vaccine, Shingrix®, in 2017, HZ has become a preventable
disease. However, access to the vaccines remains mostly limited to countries
with developed economies, such as the United States and Canada. Even among
countries with developed economies that license the vaccine, few have
implemented HZ vaccination into their national immunization schedules due to
cost-effectiveness considerations. In this review, we discuss the currently
available HZ vaccines, landscape of HZ vaccine guidelines, and economic burden
of disease in countries with developed and developing economies, as well as
barriers and considerations in HZ vaccine access on a global scale.
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Affiliation(s)
- Catherina X. Pan
- Harvard Medical School, Boston, MA, USADepartment of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michelle S. Lee
- Harvard Medical School, Boston, MA, USADepartment of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vinod E. Nambudiri
- Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115, USA Harvard Medical School, Boston, MA, USA
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