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Dmitriev AA, Odden J, Mora-Boellstorff D, Kinchington PR, Sheridan K, Viehman JA, Price D, Koscumb S, Marroquin O, Sahel JA, Kowalski RP, Jhanji V, Errera MH. Herpes zoster ophthalmicus: frequency and risk factors for developing uncommon ocular manifestations. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:201-207. [PMID: 37192736 DOI: 10.1016/j.jcjo.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/12/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To determine the frequency of herpes zoster ophthalmicus (HZO) and assess risk factors for developing uncommon ocular manifestations of laboratory-verified HZO. DESIGN Retrospective cohort study. METHODS The frequency of HZO out of all herpes zoster cases was calculated using International Classification of Diseases codes for patients seen at the University of Pittsburgh Medical Center from January 1, 2004 to October 31, 2021. We also collected demographic and clinical data of patients with HZO identified by polymerase chain reaction (PCR) detection of varicella zoster virus from January 1, 2011 to December 31, 2020. RESULTS The frequency of HZO from 2004 to 2021 in all ages was 4.2% and ranged from 2.7% to 6.7% annually, with a consistent increase of 2.9% from 2012 to 2021. After the live zoster vaccine became available in 2008, the frequency of HZO decreased by 5.1% from 2008 to 2012 in patients aged 60 and older. Among 50 cases of PCR-verified HZO, 62% represented clinically-common ocular manifestations, mostly comprised of 13 cases of keratitis and 10 cases of anterior uveitis. Fifteen cases of acute retinal necrosis (ARN) represented the majority of uncommon HZO manifestations (38%), which were significantly more likely to occur in immunosuppressed patients (unadjusted odds ratio 4.55, 95% confidence interval 1.29-13.83). CONCLUSIONS The overall frequency of HZO from 2004 to 2021 was 4.2% and has increased annually since 2012. Uncommon ocular manifestations of PCR-verified HZO, mostly comprised of ARN, were more likely to occur in immunosuppressed patients.
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MESH Headings
- Humans
- Herpes Zoster Ophthalmicus/epidemiology
- Herpes Zoster Ophthalmicus/diagnosis
- Herpes Zoster Ophthalmicus/virology
- Retrospective Studies
- Male
- Female
- Risk Factors
- Middle Aged
- Aged
- Eye Infections, Viral/epidemiology
- Eye Infections, Viral/virology
- Eye Infections, Viral/diagnosis
- Adult
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/isolation & purification
- Incidence
- Aged, 80 and over
- Adolescent
- Child
- Young Adult
- Keratitis/epidemiology
- Keratitis/virology
- Keratitis/diagnosis
- Child, Preschool
- Uveitis, Anterior/virology
- Uveitis, Anterior/diagnosis
- Uveitis, Anterior/epidemiology
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/virology
- Retinal Necrosis Syndrome, Acute/epidemiology
- Polymerase Chain Reaction
- DNA, Viral/analysis
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Affiliation(s)
- Aidan A Dmitriev
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Kathleen Sheridan
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - John A Viehman
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh Medical Center Health Services Division, Pittsburgh, PA
| | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh Medical Center Health Services Division, Pittsburgh, PA
| | - Oscar Marroquin
- Clinical Analytics, University of Pittsburgh Medical Center Health Services Division, Pittsburgh, PA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
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Pietrzak MK, Pokorska-Śpiewak M. Shingles in Children. Pediatr Infect Dis J 2024:00006454-990000000-00877. [PMID: 38808995 DOI: 10.1097/inf.0000000000004404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Maja K Pietrzak
- From the Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases in Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- From the Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases in Warsaw, Poland
- Department of Children's Infectious Diseases, Medical University of Warsaw, Poland
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3
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Kain A, Tizek L, Wecker H, Wallnöfer F, Biedermann T, Zink A. Evaluating public interest in herpes zoster in Germany by leveraging the internet: a retrospective search data analysis. BMC Public Health 2023; 23:1546. [PMID: 37580664 PMCID: PMC10426197 DOI: 10.1186/s12889-023-16463-4] [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: 10/09/2022] [Accepted: 08/06/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ) and its complication postherpetic neuralgia (PHN), whose incidence are both expected to increase with an ageing population, have demonstrated high costs on healthcare systems and burden on individual quality of life. Previous studies have shown the possibility of assessing public interest in a disease and factors that influence search behaviour using internet search data. The aim of this study was to analyze internet search data for HZ in Germany to evaluate public interest in the disease and relevant influential temporal and geographic factors that modify search behavior. METHODS Google Ads Keyword Planner was used to generate a list of HZ-related keywords including their search volume for Germany as a whole and its sixteen federal states from October 2016 to September 2020. All keywords were qualitatively categorized, and changes over time and correlations with population density, physician density, and vaccination rates were assessed using Welch's ANOVA, Bonferroni correction for post-hoc analyses, and Pearson's correlation. RESULTS A total of 1,651 relevant keywords with a search volume of 20,816,210 searches were identified. Overall, national search volume increased each year of the study period with a peak in August 2020. More than half of the total search volume related to general queries (55.1%). The highest average monthly search volumes were observed in the states of Hamburg, Saarland, and Bremen. Average monthly search volume showed strong positive correlations with population density (r = .512, p = .043) and a strong negative correlation with the number of inhabitants per working physician (r = -.689, p = .003). CONCLUSIONS The study demonstrated that evaluating internet search data is a viable method for assessing public interest in HZ, thereby identifying areas of unmet need to support targeted public health campaigns.
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Affiliation(s)
- Alphina Kain
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany
| | - Linda Tizek
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany
| | - Hannah Wecker
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany
| | - Fabian Wallnöfer
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany
| | - Tilo Biedermann
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany
| | - Alexander Zink
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany.
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Forer E, Yariv A, Ostrovsky D, Horev A. The Association between Varicella Vaccination and Herpes Zoster in Children: A Semi-National Retrospective Study. J Clin Med 2023; 12:4294. [PMID: 37445329 DOI: 10.3390/jcm12134294] [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: 05/09/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Varicella vaccination in children has been performed worldwide in recent years. Despite established effectiveness, many countries still do not routinely vaccinate children against varicella, probably due to concerns about complications, such as herpes zoster infection. We aimed to compare the herpes zoster incidence in children before and after implementing the mandatory varicella vaccine in Israel in 2008. As a secondary aim, we characterized several parameters, including age, sex, and ethnic sector among herpes zoster cases, and we evaluated the complication rate to identify data relevant to the immunization status of the pediatric population. A retrospective study was conducted between 2000 and 2021, including patients aged 0-18 years old in a large cohort in southern Israel. A time series analysis and complication rates evaluations were performed in the pre- and post-vaccination eras. A total of 109.24 herpes zoster cases per 100,000 population per year were diagnosed between 2000 and 2007 (pre-vaccination era), compared to 354.71 herpes zoster cases per 100,000 population per year diagnosed between 2008 and 2021 (post-vaccination era) (p < 0.001). No change in the complication rate was documented. Thus, we concluded that there is an association between the varicella vaccine implementation program and the increase in the rate of herpes-zoster occurrence without a concurrent negative contribution to herpes zoster-related morbidity.
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Affiliation(s)
- Ester Forer
- Pediatric Division, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Adi Yariv
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Daniel Ostrovsky
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Pediatric Dermatology Service, Soroka University Medical Center, Yitzhak Rager Ave., P.O. Box 151, Beer-Sheva 8410101, Israel
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Snyder AJ, Mousa HM, Soifer M, Jammal AA, Aggarwal S, Perez VL. Increasing Rates of Herpes Zoster Ophthalmicus and the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-2891711. [PMID: 37215036 PMCID: PMC10197788 DOI: 10.21203/rs.3.rs-2891711/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose This epidemiologic study evaluates the variance in incidence of Herpes Zoster (HZ) and Herpes Zoster Ophthalmicus (HZO) within a single healthcare system with an aim to analyze their relationship to the COVID-19 pandemic. Methods All patients attending the Duke University Health System (DUHS) from January 1, 2018, to December 31, 2021, were included. General and COVID-related trends of HZO and HZ were analyzed based on new ICD-9 or ICD-10 diagnosis codes, compared with the total number of patients seen at DUHS during this period, and the number of reported COVID-19 cases in North Carolina obtained using the CDC data tracker. Results This study included 16,287 cases of HZ of whom 1,294 (7.94%) presented with HZO. The overall incidence of HZO showed an average yearly increase of 5.6%, however HZ incidence decreased by 5.3% per year. When comparing incidence rates of HZO in the 12-months before and after the COVID-19 pandemic onset in the United States (March 2020), the average incidence from March 2020 to February 2021 was 27.6 ± 11.6 compared to 18.0 ± 2.7 from March 2019 to February 2020 (p = 0.01). Moreover, 10/12 (83.3%) of the months had a higher incidence rate of HZO in the post-COVID onset year compared to their corresponding month in the pre-COVID year. Conclusion The results show HZO incidence may be increasing, despite an overall lower HZ incidence. This could suggest a distinct mechanism for HZO appearance. The COVID pandemic, directly or indirectly, may have accelerated the already increasing HZO incidence.
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Amodio E, Marrella A, Casuccio A, Vitale F. Decline in hospitalization rates for herpes zoster in Italy (2003-2018): reduction in the burden of disease or changing of hospitalization criteria? Aging Clin Exp Res 2022; 34:881-886. [PMID: 35043279 DOI: 10.1007/s40520-021-02014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Herpes Zoster (HZ) is a very demanding disease caused by the reactivation of latent Varicella Zoster Virus. The main aim of this study was to estimate the burden of the HZ hospitalizations in Italy from 2003 to 2018 evaluating temporal trends. METHODS Retrospective population-based study analyzing Hospital Discharge Records. Hospitalization records reporting the ICD-9 CM 053.X code in the principal diagnosis or in any of the five secondary diagnoses were considered as cases. Trends of hospitalization rates have been evaluated by Joinpoint analyses. RESULTS Overall, 99,036 patients were hospitalized with HZ in the 16-year period of the study, and 83,720 (84.5%) of these patients were over 50 years. Hospitalization rate was 10.4 per 100,000 persons/year with a significant decreasing trend from 13.9 in 2003-2006 to 7.8 in 2015-2018 (p < 0.001). Hospitalization rates showed a 20-fold higher risk among subjects aged over 80 years and 11-fold higher risk among 70-79-year-old subjects with respect to those aged less than 50 years. Over time, a statistically significant increase was observed for the case fatality rate (from 1.2 to 1.7%; p < 0.001) and the median length of stay (from 7 to 8 days; p < 0.001). CONCLUSIONS Zoster is a disease that causes hospitalization as relatively frequent complication and the observed reduced trend over time could be due to a restriction in hospitalization criteria instead of a reduced burden of disease. The decreasing trend should be carefully interpreted, since it could have an impact on promoting herpes zoster vaccination.
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Incidence of complications of herpes zoster in individuals on immunosuppressive therapy: A register-based population study. J Infect 2022; 84:531-536. [PMID: 35016899 DOI: 10.1016/j.jinf.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Herpes zoster (HZ) exposes to alterations of the quality-of-life. HZ is more frequent in immunocompromised individuals, but whether immunosuppression is associated with a higher rate of complications is not well documented. We aimed to assess association between drug-induced immunosuppression and HZ complications. METHODS Data from a sample of the French healthcare claims from 01/01/2006 to 12/31/2018 were analyzed. Complicated zoster (CZ) was defined as a hospitalization with a code for HZ or the first-time dispensation of high-dose valacyclovir and specific neuralgia analgesics. Drug-induced immunosuppression was identified through medication dispensation. Risk ratios were calculated to compare incidences in exposed individuals (EI) and non-exposed to immunosuppressive therapy (NEI). RESULTS We identified 227 and 2838 CZ, accounting for an incidence of 178 per 100,000 person-year (95%CI[154.9-201.1]) and 51.7 per 100,000 person-year (95%CI[49.8-53.6]), in EI and NEI, respectively (risk ratio: 3.44 (95%CI[3.01-3.94]). Mean age was 66 years in both groups. CZ occurred after a median of 11.7 months (IQR[5.3-49.9]) of immunosuppressive therapy. Post-herpetic neuralgia (PHN) lasted at least 3 months in 32.6% and 22.5% of cases in EI and NEI, respectively (p=.01). CONCLUSIONS Drug-induced immunosuppression increases the risk of CZ and exposes to longer-lasting PHN. Figures provided in this study could help guide prophylaxis of HZ.
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8
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Van Oorschot D, McGirr A, Goulet P, Koochaki P, Pratiwadi R, Shah S, Curran D. A Cross-Sectional Concept Elicitation Study to Understand the Impact of Herpes Zoster on Patients' Health-Related Quality of Life. Infect Dis Ther 2022; 11:501-516. [PMID: 34994924 PMCID: PMC8847496 DOI: 10.1007/s40121-021-00581-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction After a chickenpox infection, the varicella zoster virus lies dormant in nerve cells and can be reactivated in later life to cause herpes zoster (HZ), also called shingles, a painful rash that may result in persistent postherpetic neuralgia (PHN). Treatment options are limited, and HZ/PHN may have substantial negative effects on health-related quality of life (HRQoL). This qualitative cross-sectional study explored the subjective patient experience and impact on HRQoL of HZ and PHN in adults aged ≥ 50 years in Canada. Methods Patients were eligible for the study if they were aged at least 50 years and had been diagnosed with HZ by a healthcare practitioner 7–60 days earlier for HZ patients and 90–365 days earlier for PHN patients. Eligible patients were invited to participate in concept elicitation interviews by telephone. Data from the interviews were transcribed and analyzed to identify key concepts related to symptoms and impacts on the patients’ lives. Results A total of 32 patients participated, with a mean age of 61 years. Most (72%) were female. The most common symptoms reported were rash (n = 32), pain (n = 31), fatigue (n = 26), and itchiness (n = 20). The most commonly reported HRQoL domains affected were emotional functioning (n = 31), activities of daily living (n = 31), sleep (n = 29), physical functioning (n = 25) and hobbies (n = 21). A conceptual model was developed to summarize these symptoms and impacts. Conclusion HZ negatively affected many dimensions of patients’ HRQoL, particularly during the acute phase of illness. This qualitative study helps to broaden understanding of the subjective patient experience of HZ. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00581-w.
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Affiliation(s)
| | | | | | - Patricia Koochaki
- Mapi Group, Health Research and Commercialization ICON Plc, Cincinnati, OH, USA
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Nguyen DT, Dang TC, Nguyen QA, Le TD, Hoang TD, Tran TNT, Duong THN, Nguyen VT, Le VQ, Hoang TU, Duong MT, Nhu DS, Phan VN. The effect of subcutaneous injection of methylprednisolone acetate and lidocaine for refractory postherpetic neuralgia: a prospective, observational study. Health Sci Rep 2021; 4:e271. [PMID: 33855194 PMCID: PMC8031000 DOI: 10.1002/hsr2.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common and bearable complication of herpes zoster (HZ). This pain may have negative impact on the patient's all aspects of daily life and health-related quality of life (HRQOL). Despite numerous advances in treatment, many patients remain resistant to the current therapy options. It is the first time subcutaneous injection of methylprednisolone acetate and lidocaine has been used to treat refractory PHN. We report the results of this treatment evaluating pain relief and HRQOL improvement in this disorder. METHODS A total of 43 patients with refractory PHN was enrolled in the observational study. All patients received daily subcutaneous injection of methylprednisolone acetate and lidocaine for 10 consecutive days. The severity of pain was assessed by using Visual Analog Scale (VAS), and 36-Item Short Form Survey (SF-36) was applied to evaluate HRQOL. Assessment of the pain and HRQOL was carried out at baseline and posttreatment at 4 weeks as well as 6 and 12 months. RESULTS At baseline, all patients experienced severe PHN with average VAS scores of 8.44 ± 0.85 (minimum 7; maximum 10). At 4 weeks, 6 months, and 12 months after treatment, the pain had significantly decreased (P < .001), and all subjects showed significant improvement in all eight domains of HRQOL. No major adverse events associated with the subcutaneous injection were observed. CONCLUSIONS Our results indicate that subcutaneous injection of methylprednisolone acetate and lidocaine can be an effective and safe treatment for PHN.
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Affiliation(s)
- Duc Thuan Nguyen
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Thanh Chung Dang
- Department of PathophysiologyVietnam Military Medical UniversityHanoiVietnam
| | - Quang An Nguyen
- Stroke CenterPhu Tho General HospitalViet TriPhu Tho ProvinceVietnam
| | - Trung Duc Le
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Thi Dung Hoang
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Thi Ngoc Truong Tran
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Ta Hai Ninh Duong
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Van Tuan Nguyen
- Department of RehabilitationMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Van Quan Le
- Department of Functional ExplorationMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Tien Ung Hoang
- Department of RehabilitationMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | | | - Dinh Son Nhu
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Viet Nga Phan
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
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Inan Yuksel E, Kara Polat A, Gore Karaali M, Koku Aksu AE, Gurel MS. Effect of the varicella vaccination implementation on the development of herpes zoster in children and adolescents. Dermatol Ther 2021; 34:e14995. [PMID: 34031954 DOI: 10.1111/dth.14995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
Herpes zoster (HZ) is an infectious disease caused by latent varicella-zoster virus reactivation. There are conflicting reports on the varicella vaccine's effect on the incidence of HZ in children and adolescents. This study aimed to determine the impact of the single dose of varicella vaccination on HZ prevalence during childhood and adolescence. The study included children and adolescents aged <18 years who presented to the dermatology outpatient clinic between 2005 and 2019 and were diagnosed with HZ. Considering that the universal vaccination program started to be implemented in Turkey in 2013, non-vaccinated cases in the prevaccination period, vaccinated cases in the postvaccination period, and non-vaccinated patients in the postvaccination period were compared in terms of HZ prevalence and demographic features. After the initiation of the varicella vaccination program, the prevalence of HZ was found to decrease by 24.7% in all. The HZ prevalence was significantly reduced in vaccinated children, while the rate of decrease in non-vaccinated children was low (58.6% and 16.4%, respectively). The median age of the non-vaccinated cases in the postvaccination period (10 [min 0.5-max 17] years) was significantly higher compared to the other groups (p < 0.001). The number of cases aged <2 years was the highest in the vaccinated group (p < 0.001). Administration of a single dose of varicella vaccine was insufficient to decrease the prevalence of HZ <18 years of age. In the post-vaccination period, the frequency of HZ in unvaccinated cases increased in adolescence. In vaccinated children, HZ seems to develop at an earlier age.
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Affiliation(s)
- Esma Inan Yuksel
- Department of Dermatology, Firat University Faculty of Medicine, Elazıg, Turkey
| | - Asude Kara Polat
- Department of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Muge Gore Karaali
- Department of Dermatology, Erzincan Binali Yıldırım University Faculty of Medicine, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Ayse Esra Koku Aksu
- Department of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Medeniyet University, Faculty of Medicine, Istanbul, Turkey
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11
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Vaccination for quality of life: herpes-zoster vaccines. Aging Clin Exp Res 2021; 33:1113-1122. [PMID: 31643072 DOI: 10.1007/s40520-019-01374-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022]
Abstract
Current vaccination policy in most high-income countries aims to counteract the decline in cell-mediated immunity to varicella zoster virus that occurs with advancing age or immunosuppression. The aim of this review was to describe the burden of illness associated with herpes zoster (HZ) and post-herpetic neuralgia (PHN) risks and their impact on the social and common life in infected people. The effectiveness/efficacy and cost effectiveness of the immunization strategy will be presented through the review of the literature relevant to the live attenuated HZ vaccine (ZLV) licensed in 2006 and the recombinant HZ vaccine (RZV). The latter has very recently been approved to protect aged people aged ≥ 50 years against HZ morbidity including its complications, and associated health-care costs. Finally, this review also provides data with respect of precautions of using and safety of ZVL and RVZ.
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12
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Weinmann S, Irving SA, Koppolu P, Naleway AL, Belongia EA, Hambidge SJ, Jackson ML, Klein NP, Lewin B, Liles E, Marin M, Smith N, Weintraub E, Chun C. Incidence of herpes zoster among varicella-vaccinated children, by number of vaccine doses and simultaneous administration of measles, mumps, and rubella vaccine. Vaccine 2020; 38:5880-5884. [PMID: 32444193 DOI: 10.1016/j.vaccine.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Children may receive measles-mumps-rubella (MMR) and varicella (VAR) vaccines separately or as measles-mumps-rubella-varicella (MMRV). We examined whether pediatric herpes zoster (HZ) incidence varied by pattern of varicella vaccine administration. METHODS In six integrated health systems, we examined HZ incidence among children turning 12 months old during 2003-2008. All received varicella and MMR vaccines on recommended schedules. Cases were identified through 2014 using ICD-9 codes. Incidence was examined by number of varicella vaccine doses and same-day MMR. RESULTS Among 199,797 children, overall HZ incidence was 18.6/100,000 person-years in the first-dose MMR + VAR group, 17.9/100,000 person-years in the MMRV group, and 7.5/100,000 person-years in the VAR-alone group. HZ incidence was lower following the second dose than before the second dose in all first-dose groups. CONCLUSIONS HZ incidence was not meaningfully different between the MMRV and MMR + VAR first-dose groups. Overall and within first-dose groups, HZ incidence was lower among children receiving two varicella vaccine doses.
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Affiliation(s)
- Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA.
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Padma Koppolu
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue (ML2), Marshfield, WI 54449, USA
| | - Simon J Hambidge
- Denver Community Health Services, Denver Health, Mailcode 0278, 777 Bannock Street, Denver, CO 80204, USA; Institute for Health Research, Kaiser Permanente Colorado, 2550 South Parker Road, Suite 200, Denver, CO 80014, USA
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
| | - Nicola P Klein
- Vaccine Study Center, Division of Research, Northern California Kaiser Permanente, 1 Kaiser Plaza, 16th Floor, Oakland, CA 94612, USA
| | - Bruno Lewin
- Department of Research and Evaluation, Southern California Kaiser Permanente, 100 S Los Robles Avenue, Second Floor, Pasadena, CA 91101, USA
| | - Elizabeth Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Mona Marin
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS V18-4, Atlanta, GA 30333, USA
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Eric Weintraub
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS V18-4, Atlanta, GA 30333, USA
| | - Colleen Chun
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
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Ngo AL, Urits I, Yilmaz M, Fortier L, Anya A, Oh JH, Berger AA, Kassem H, Sanchez MG, Kaye AD, Urman RD, Herron EW, Cornett EM, Viswanath O. Postherpetic Neuralgia: Current Evidence on the Topical Film-Forming Spray with Bupivacaine Hydrochloride and a Review of Available Treatment Strategies. Adv Ther 2020; 37:2003-2016. [PMID: 32297285 PMCID: PMC7467465 DOI: 10.1007/s12325-020-01335-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This is a comprehensive review of the literature about the use of bupivacaine hydrochloride for the treatment of post-herpetic neuralgia (PHN). It briefly reviews the background, biology, diagnosis and conventional treatment for PHN, and then introduces and compares the recent evidence for the use of topical bupivacaine. RECENT FINDINGS PHN is defined by pain lasting 90 days or more after the initial presentation of herpes zoster ("Shingles", HZ) rash and is the most common complication of this disease. A product of re-activation of the Varicella-Zoster virus (VZV), HZ is diagnosed more than 1 million times annually in the United States. Approximately 20% of patients with HZ will experience PHN and will continue to suffer intermittent neuropathic symptoms, including itching and pain, that is sharp, stabbing, throbbing or burning, with the pain localized to the site of their original rash. This long-lasting pain compares with the severity of long-standing rheumatics and osteo-arthritis and is accompanied by severe allodynia causing significant suffering, and a financial burden that is manifested in both healthcare costs and loss of quality-adjusted life years. Prevention of PHN may be achieved with the Zoster vaccine, although there is still a large segment of unvaccinated population. Moreover, the Zoster vaccine is not always effective for prevention. Current treatment includes medical (systemic tricyclic antidepressants, anticonvulsants and opioids, topical lidocaine and capsaicin) and interventional (subcutaneous Botox injections, nerve blocks and nerve stimulation) therapies. These therapies are not always effective, and each carries their own profile of side effects and risks. Moreover, up to 50% of patients with PHN are refractory to management. Recent evidence is emerging to support the use of topical local anesthetics for the treatment of PHN. Two small studies recently found topical lidocaine spray to be effective in treating paroxysmal pain attacks associated with PHN. Bupivacaine is a longer-lasting local anesthetic, and a film-forming formulation allows easy and durable application to the affected skin. Recent studies show that topical film-forming bupivacaine is safe and as effective as lidocaine for the treatment of PHN. PHN is an important though common complication of HZ and can cause long-lasting pain and disability. Current treatment for PNH is limited by efficacy and safety profiles of individual therapies. Recent evidence points to topical local anesthetics as an effective and safe alternative to conventional therapy. Film-forming bupivacaine may offer a durable and safe option for this otherwise difficult to treat syndrome.
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Affiliation(s)
- Anh L Ngo
- Harvard Medical School, Boston, MA, USA
- Department of Pain Medicine, Pain Specialty Group, Newington, NH, USA
| | - Ivan Urits
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | | | - Luc Fortier
- Georgetown University School of Medicine, Washington, DC, USA
| | - Anthony Anya
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jae Hak Oh
- Georgetown University School of Medicine, Washington, DC, USA
| | - Amnon A Berger
- Department of Pain Medicine, Pain Specialty Group, Newington, NH, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Manuel G Sanchez
- Department of Pain Medicine, Pain Specialty Group, Newington, NH, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edwin W Herron
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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Saadatian-Elahi M, Bauduceau B, Del-Signore C, Vanhems P. Diabetes as a risk factor for herpes zoster in adults: A synthetic literature review. Diabetes Res Clin Pract 2020; 159:107983. [PMID: 31846665 DOI: 10.1016/j.diabres.2019.107983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 01/26/2023]
Abstract
AIM The objective of this review was to evaluate the role of diabetes as a risk factor for herpes zoster (HZ) and to discuss implications of prevention by vaccination with available HZ vaccines. METHODS We reviewed studies that investigated the incidence rates of HZ in patients with diabetes. Papers in English or French published between January 2000 and December 2018 have been selected from PubMed and Google Scholarship by using appropriate key words. RESULTS The risk of HZ was significantly higher in patients with diabetes as compared to controls in 11 studies out of 16, although the magnitude of risk associated to diabetes varied across studies from 1.06 to 2.38 (p < 0.05). The incidence of HZ in patients with diabetes increased with age and was higher in women than in men. The incidence of the most common complication of HZ, i.e. post-herpetic neuralgia was also higher in patients with diabetes. CONCLUSIONS The presence of HZ adds supplementary complications to the pre-existing comorbidity in patients with diabetes. Investigating the impact of preventive measure by HZ vaccination is therefore of paramount importance in patients with diabetes.
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Affiliation(s)
- Mitra Saadatian-Elahi
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France.
| | | | - Corinne Del-Signore
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France
| | - Philippe Vanhems
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), CIC 1417, Paris, France
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Ultrasound-guided Pulsed Radiofrequency in the Management of Thoracic Postherpetic Neuralgia: A Randomized, Double-blinded, Controlled Trial. Clin J Pain 2019; 34:1017-1024. [PMID: 29757758 DOI: 10.1097/ajp.0000000000000629] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was designed to evaluate the efficacy and safety of ultrasound-guided pulsed radiofrequency (PRF) for the intercostal nerves (ICNs) in the management of thoracic postherpetic neuralgia. METHODS After 2 weeks of treatment by pregabalin 150 mg/12 hours, patients were randomly allocated into 2 groups. The PRF group, after ultrasound-guided localization of the ICN of the affected thoracic dermatome, sensory stimulation of the ICN was tested. Thereafter, the patient received 2 cycles PRF at 42°C temperature, for 120 seconds. The sham group, after stimulation, the same time was spent to mimic PRF. The same procedures were repeated to the upper and lower adjacent ICNs. Pain intensity using Visual Analogue Scale (VAS), and total analgesics consumption were assessed at the baseline, every 2 weeks for 6 months then after 9 and 12 months. The duration of effective pain relief was recorded. Quality of life was evaluated using self-evaluation questionnaires (SF-36) at baseline then after 1, 3, 6, and 12 months. RESULTS PRF group expressed a significant decrease on the VAS throughout the study period. VAS<30 was reported in the PRF group until the 22nd week. Pregabalin and acetaminophen consumption was significantly lower in the PRF group. The 8 domains of the SF-36 revealed a significant improvement in the PRF group when compared with the sham group throughout the study period except for the physical role which displayed nonsignificant improvement. CONCLUSIONS Ultrasound-guided PRF for ICNs in combination with pharmacotherapy seems to be a safe and effective treatment modality for postherpetic neuralgia.
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Harpaz R. Do varicella vaccination programs change the epidemiology of herpes zoster? A comprehensive review, with focus on the United States. Expert Rev Vaccines 2019; 18:793-811. [PMID: 31318605 DOI: 10.1080/14760584.2019.1646129] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Policy-makers in many countries have been wary of introducing varicella vaccination programs because of concerns that reduced exposures to varicella-zoster virus could increase herpes zoster (HZ) incidence. The U.S. introduced varicella vaccination in 1996 and has empiric evidence regarding this concern. Areas covered: This comprehensive review provides background emphasizing the epidemiology of varicella and of HZ in the U.S. before and after the introduction of their respective vaccines. The epidemiology is complex, and interpretation is complicated by methodologic challenges, by unexplained increases in age-specific HZ incidence that preceded varicella vaccination, and by introduction of vaccines for prevention of HZ. Nonetheless, observations from studies using different platforms and designs have yielded consistent findings, suggesting they are robust. Expert opinion: There has been no evidence that the U.S. varicella vaccination program increased HZ incidence in the general adult population over baseline trends. Furthermore, HZ incidence in children is declining. The U.S. experience can inform the development of new generations of models to predict HZ trends. More importantly, it provides reassurance for countries considering varicella vaccination that an effective program can reduce varicella morbidity and mortality while reducing the likelihood of HZ among children, and potentially, over time, across the entire population.
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Affiliation(s)
- Rafael Harpaz
- a Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Weinmann S, Naleway AL, Koppolu P, Baxter R, Belongia EA, Hambidge SJ, Irving SA, Jackson ML, Klein NP, Lewin B, Liles E, Marin M, Smith N, Weintraub E, Chun C. Incidence of Herpes Zoster Among Children: 2003-2014. Pediatrics 2019; 144:peds.2018-2917. [PMID: 31182552 PMCID: PMC7748320 DOI: 10.1542/peds.2018-2917] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES After the 1996 introduction of routine varicella vaccination in the United States, most studies evaluating pediatric herpes zoster (HZ) incidence reported lower incidence over time, with varying degrees of decline. Using the combined databases of 6 integrated health care organizations, we examined HZ incidence in children over a 12-year period in the varicella vaccine era. METHODS This study included children aged 0 through 17 years from 2003 through 2014. Using electronic medical records, we identified HZ cases through International Classification of Diseases, Ninth Revision diagnosis code 053. We calculated HZ incidence rates per 100 000 person years of health plan membership for all children and among children who were vaccinated versus unvaccinated. We calculated rates for the 12-year period and examined temporal trends. Among children who were vaccinated, we compared HZ rates by month and year of age at vaccination. RESULTS The study included 6 372 067 children with ≥1 month of health plan membership. For the 12-year period, the crude HZ incidence rate for all subjects was 74 per 100 000 person years, and the rate among children who were vaccinated was 38 per 100 000 person years, which was 78% lower than that among children who were unvaccinated (170 per 100 000 person years; P < .0001). Overall HZ incidence declined by 72% (P < .0001) from 2003 through 2014. Annual rates in children who were vaccinated were consistently lower than in children who were unvaccinated. CONCLUSIONS With this population-based study, we confirm the decline in pediatric HZ incidence and the significantly lower incidence among children who are vaccinated, reinforcing the benefit of routine varicella vaccination to prevent pediatric HZ.
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Affiliation(s)
- Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon;
| | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Padma Koppolu
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Roger Baxter
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | - Nicola P. Klein
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - Bruno Lewin
- Kaiser Permanente Southern California, Pasadena, California
| | - Elizabeth Liles
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Chun
- Division of Pediatric Infectious Diseases (Emeritus), Department of Pediatrics, Northwest Permanente, Portland, Oregon
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Ghanavatian S, Wie CS, Low RS, Butterfield RJ, Zhang N, Dhaliwal GS, Montoya JM, Swanson DL. Parameters associated with efficacy of epidural steroid injections in the management of postherpetic neuralgia: the Mayo Clinic experience. J Pain Res 2019; 12:1279-1286. [PMID: 31118750 PMCID: PMC6503501 DOI: 10.2147/jpr.s190646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/18/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose: Thirty percent of patients with postherpetic neuralgia (PHN) receiving conservative treatment report unsatisfactory pain relief. Epidural steroid injections (ESIs) are commonly used as a therapeutic intervention in these patients. In this study, we aimed to determine if there are variables that predict the efficacy of ESI in patients with PHN. Patients and methods: We retrospectively identified patients seen at Mayo Clinic who had PHN and received ESI. From their medical records, we abstracted the demographic variables, concurrent medication use, anatomic approach and medication for ESI, and degree of pain relief at 2 and 12 weeks' postintervention. Results: None of the studied variables were significantly associated with efficacy of ESI in patients with PHN. PHN that began <11 months before treatment was predictive of a response to ESI at 12 weeks postintervention (positive predictive value, 55%). Patients who reported poor ESI efficacy 2 weeks after the intervention had a 94% chance of still having pain at 12 weeks. Conclusion: For this cohort of patients with PHN being treated with ESI, no demographic characteristics, concurrently used medications, or type of ESI were associated with ESI treatment efficacy at 2 or 12 weeks after the intervention.
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Affiliation(s)
| | - Christopher S Wie
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Rhonda S Low
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Nan Zhang
- Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
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Koshy E, Mengting L, Kumar H, Jianbo W. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol 2018. [PMID: 29516900 DOI: 10.4103/ijdvl.ijdvl_1021_16] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Herpes zoster is a major health burden that can affect individuals of any age. It is seen more commonly among individuals aged ≥50 years, those with immunocompromised status, and those on immunosuppressant drugs. It is caused by a reactivation of varicella zoster virus infection. Cell-mediated immunity plays a role in this reactivation. Fever, pain, and itch are common symptoms before the onset of rash. Post-herpetic neuralgia is the most common complication associated with herpes zoster. Risk factors and complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. Treatment with antiviral drugs and analgesics within 72 hours of rash onset has been shown to reduce severity and complications associated with herpes zoster and post-herpetic neuralgia. This study mainly focuses on herpes zoster using articles and reviews from PubMed, Embase, Cochrane library, and a manual search from Google Scholar. We cover the incidence of herpes zoster, gender distribution, seasonal and regional distribution of herpes zoster, incidence of herpes zoster among immunocompromised individuals, incidence of post-herpetic neuralgia following a zoster infection, complications, management, and prevention of herpes zoster and post-herpetic neuralgia.
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Affiliation(s)
- Elsam Koshy
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lu Mengting
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hanasha Kumar
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wu Jianbo
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Zheng C, Luo Y, Mercado C, Sy L, Jacobsen SJ, Ackerson B, Lewin B, Tseng HF. Using natural language processing for identification of herpes zoster ophthalmicus cases to support population-based study. Clin Exp Ophthalmol 2018; 47:7-14. [DOI: 10.1111/ceo.13340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/13/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Chengyi Zheng
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Yi Luo
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Cheryl Mercado
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Lina Sy
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Steven J Jacobsen
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Brad Ackerson
- South Bay Medical Center; Kaiser Permanente Southern California; Harbor City California USA
| | - Bruno Lewin
- Los Angeles Medical Center; Kaiser Permanente Southern California; Los Angeles California USA
| | - Hung Fu Tseng
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
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Shiraki K, Toyama N, Shiraki A, Yajima M. Age-dependent trigeminal and female-specific lumbosacral increase in herpes zoster distribution in the elderly. J Dermatol Sci 2018; 90:166-171. [DOI: 10.1016/j.jdermsci.2018.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
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Hecht J, Siedler A. [The epidemiology of varicella disease in Germany after introduction of a vaccination recommendation : Analysis of mandatory and sentinel data between 2002 and 2014]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:118-126. [PMID: 27878603 DOI: 10.1007/s00103-016-2475-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since 2004 a single varicella vaccination for all infants aged 11-14 months has been recommended in Germany and since 2009 a second dose at the age of 15-23 months is recommended. Vaccination coverage after 24 months rose from 43% in 2006 to 87.5% in 2012. A mandatory notification system was introduced in the New Federal States (NFS) between 2002 and 2009 and nationwide in 2013. A national sentinel system has been in place since 2005. OBJECTIVE AND METHOD We analyzed both data sources to describe the varicella epidemiology related to vaccination coverage after initiation of routine childhood varicella vaccination and to evaluate both notification systems regarding informative value and data quality. We looked at trends, age distribution and incidences using Microsoft Excel and Stata12. Vaccination coverage data were available from health insurance claims data. RESULTS By 2013 a decrease of cases/medical practice/month from 3.47 to 0.43 was observed. The incidence in the NFS declined from 32 to 12 out of 100,000. Sentinel and mandatory notification data showed the largest decrease among the 1-4 year-olds (-94 and -90% resp.). In 2014, varicella incidences increased in all age groups, but not the cases/medical-practice/month by age in the sentinel. DISCUSSION Increasing vaccination coverage and decreasing varicella cases demonstrate the success of routine childhood varicella vaccination. Mandatory notification data allow incidence calculation; The sentinel system has been providing more detailed information about vaccination status, better data quality and continuous national data since 2005, irrespective of the Infectious disease protection act. Trends and age distribution can be continuously calculated, whereas the nationwide mandatory data collected in the short period since April 2013 can only be evaluated to a limited extent.
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Affiliation(s)
- Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet für Impfprävention, Robert Koch-Institut Berlin, Seestr. 10, 13353, Berlin, Deutschland.
| | - Anette Siedler
- Abteilung für Infektionsepidemiologie, Fachgebiet für Impfprävention, Robert Koch-Institut Berlin, Seestr. 10, 13353, Berlin, Deutschland
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Economic Burden of Herpes Zoster (“culebrilla”) in Latin America. Int J Infect Dis 2017; 58:22-26. [DOI: 10.1016/j.ijid.2017.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 12/21/2022] Open
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Marra F, Chong M, Najafzadeh M. Increasing incidence associated with herpes zoster infection in British Columbia, Canada. BMC Infect Dis 2016; 16:589. [PMID: 27765026 PMCID: PMC5073843 DOI: 10.1186/s12879-016-1898-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies have shown an increasing incidence of herpes zoster (HZ) infection, which may be related to the introduction of varicella vaccination programs in children. We examined the epidemiology and treatment costs of HZ and post-herpetic neuralgia (PHN) over time in British Columbia, Canada. METHODS The cohort consisted of all cases with HZ infection from January 1, 1997 and December 31, 2012. Incident zoster was defined as a case (ICD-9 053 or ICD-10 B02) without a previous episode of HZ or PHN in the previous 12 months. We determined the incidence for HZ and PHN and the age-sex standardized rate for the overall population. We determined the association between the varicella vaccination program and increased HZ rates by evaluating the rate ratios in the publicly-funded varicella vaccine period compared to the non-publicly funded period in a regression model. We evaluated the hospitalization rates, treatment by GPs and their associated yearly costs for HZ and PHN. RESULTS HZ incidence increased for the entire study period from 3.2 per 1000 population in 1997 to 4.5 in 2012. HZ rates were higher for females than males and all age groups had an increased incidence rate, except the 0-9 year olds, where the rate decreased. Crude and age-sex standardized incidence rates of PHN demonstrated very similar patterns to HZ incidence. Based on the regression model, rates of HZ were higher in the older individuals. No significant increase with HZ incidence was seen during the publically funded varicella vaccination program compared to the non-publicly funded period. From 1997 to 2012, the annual HZ-related costs associated with hospitalizations and GP visits were over $CDN4.9 million and $CDN537,286, respectively; treatment costs for hospitalizations have increased significantly over time. Majority of PHN-related cases are managed by GPs, with a steady increase over time in number of cases and associated annual costs. CONCLUSIONS The incidence of zoster and PHN is increasing with time, particularly in the elderly population and the risk is greater in the over 65 year olds. Treatment costs for both HZ and PHN represent a significant burden on the Canadian healthcare system.
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Affiliation(s)
- Fawziah Marra
- University of British Columbia, Vancouver, BC Canada
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | | | - Mehdi Najafzadeh
- Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Lopez-Belmonte JL, Cisterna R, Gil de Miguel A, Guilmet C, Bianic F, Uhart M. The use of Zostavax in Spain: the economic case for vaccination of individuals aged 50 years and older. J Med Econ 2016; 19:576-86. [PMID: 26808422 DOI: 10.3111/13696998.2016.1146726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Population aging brings up a number of health issues, one of which is an increased incidence of herpes zoster (HZ) and its complication, post-herpetic neuralgia (PHN). Zostavax vaccine has recently become available to prevent HZ and PHN. This study evaluates the cost-effectiveness of vaccination against HZ in Spain considering a vaccination of the population aged 50 years and older and comparing this to the current situation where no vaccination is being administered. Methods An existing, validated, and published economic model was adapted to Spain using relevant local input parameters and costs from 2013. Results Vaccinating 30% of the Spanish population aged 50 years and older resulted in €16,577/QALY gained, €2025/HZ case avoided, and €5594/PHN case avoided under the third-party payer perspective. From a societal perspective, the ICERs increased by 6%, due to the higher price of the vaccine. The number needed to vaccinate to prevent one case was 20 for HZ, and 63 for PHN3. Sensitivity analyses showed that the model was most sensitive to the HZ and PHN epidemiological data, the health state utilities values, and vaccine price used. Conclusion Considering an acceptable range of cost-effectiveness of €30,000-€50,000 per QALY gained, vaccination of the 50+ population in Spain against HZ with a new vaccine, Zostavax, is cost-effective and makes good use of the valuable healthcare budget.
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Affiliation(s)
| | - Ramón Cisterna
- b Clinical Microbiology and Infection Control OSI Bilbao Basurto , UPV/EHU Bilbao , Spain
| | - Angel Gil de Miguel
- c Health Sciences and Public Healthcare Department , Universidad Rey Juan Carlos , Madrid , Spain
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Chen HH, Lin IC, Chen HJ, Yeh SY, Kao CH. Association of Herpes Zoster and Type 1 Diabetes Mellitus. PLoS One 2016; 11:e0155175. [PMID: 27171477 PMCID: PMC4865148 DOI: 10.1371/journal.pone.0155175] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/04/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of our study was to determine the association of type 1 diabetes mellitus (T1DM) and the risk of herpes zoster (HZ). METHODS In this cohort study, we selected 4736 patients with T1DM registered in the Catastrophic Illness Patient Database who received insulin therapy before 2003 and 18944 participants without DM who were selected by frequency matched based on sex and age. Cox proportional hazard regression analysis was used to measure the hazard ratios (HRs) of HZ in the T1DM group compared with that in the non-T1DM group. RESULTS Cox proportional hazard regression analysis showed that the adjusted HR of HZ was 2.38 times higher for patients in the T1DM group (95% CI = 1.77-3.19) than for those in the non-T1DM group. According to diabetes severity, mild and serious T1DM patients were associated with a higher risk of HZ (adjusted HR = 2.26, 95% CI = 1.67-3.05; and adjusted HR = 5.08, 95% CI = 2.66-9.71, respectively) than subjects without T1DM. CONCLUSION Patients with T1DM are at a higher risk of HZ than those without T1DM.
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Affiliation(s)
- Hsin-Hung Chen
- School of Medicine and Public Health, Chung Shan Medical University, Taichung, Taiwan
- Division of Metabolism & Endocrinology, Changhua Christian Hospital, Changhua, Taiwan
- Nantou Christian Hospital, Nantou, Taiwan
| | - I-Ching Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | | | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Zhu Q, Zheng H, Qu H, Deng H, Zhang J, Ma W, Lin Y, Xie X, Qiu Q, Huang Z. Epidemiology of herpes zoster among adults aged 50 and above in Guangdong, China. Hum Vaccin Immunother 2016; 11:2113-8. [PMID: 26020733 PMCID: PMC4635933 DOI: 10.1080/21645515.2015.1016672] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Herpes zoster (HZ) exists widely in China and most cases occur among old people, but no epidemiology information of HZ was available. We aimed to investigate the epidemiology characteristics of HZ among adults aged 50 and over in Guangdong, China. A total of 34 counties/districts were randomly selected in Guangdong, and 7149 residents aged 50 and over were investigated by local CDC professionals using accidental sampling method. There were 247 respondents having had HZ before; the lifetime prevalence of HZ among people aged 50 and above in study area was 3.46%. The prevalence in females was higher than that in males. Pearl River Delta had the highest prevalence (5.29%), while Northern Guangdong had the lowest (1.87%). The annual incidence in the year 2013, 2012 and 2011 was 5.8, 3.4 and 4.1 per 1000 person-years, respectively. Detailed investigation of HZ cases showed that all cases meted the definition of HZ and had at least 1 typical symptom. 40% cases had suffered post-herpetic neuralgia. 75.9% cases had sought aid from hospital and 9.1% of them had been hospitalized. People who sought aid from hospital had more serious level of neuralgia. The epidemiology features of HZ in Guangdong were consistent with the current findings in other countries. The results of this study can provide baseline epidemiology information of HZ for further studies.
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Affiliation(s)
- Qi Zhu
- a Guangdong Provincial Center for Disease Control and Prevention ; Guangzhou , China
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Erlenwein J, Thoms KM, Brandebusemeyer F, Pfingsten M, Mansur A, Quintel M, Schön MP, Petzke F. Pre-Existing Chronic Pain Influences the Severity of Acute Herpes Zoster Pain—A Prospective Observational Cohort Study. PAIN MEDICINE 2016; 17:1317-1328. [DOI: 10.1093/pm/pnv116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Chen HH, Lin CL, Yeh SY, Kao CH. Short-term dipeptidyl peptidase-4 inhibitor use increases the risk of herpes zoster infection in Asian patients with diabetes. QJM 2016; 109:91-5. [PMID: 25991869 DOI: 10.1093/qjmed/hcv096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We aimed to evaluate whether patients with diabetes who use dipeptidyl peptidase (DPP)-4 inhibitors are at a higher risk of developing a herpes zoster (HZ) infection. METHODS We used a subset of the Longitudinal Health Insurance Database 2000 containing all inpatient and outpatient medical claims of ∼1 million people who were randomly sampled from the National Health Insurance Research Database. Patients who were newly diagnosed with Type 2 diabetes International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM 250.x0 and 250.x2) who used antidiabetic medications were divided into two cohorts based on their use of DPP-4 inhibitors between 2009 and 2011. Cox proportion hazard regression models were used to assess the effects of DPP-4 inhibitors on the incidence of HZ compared with the non-DPP-4-inhibitor-exposed cohort. RESULTS Patients in DPP-4-inhibitor-exposed cohort with diabetes and HZ infections revealed an incidence density of 4.20 per 1000 person-years compared with 3.50 per 1000 person-years for the non-DPP-4-inhibitor-exposed cohort (adjusted hazard ratio [HR] = 1.19, 95% confidence interval [CI] = 0.70-1.99). Furthermore, high-dose DPP-4-inhibitor treatment was associated with a significantly higher risk of HZ (adjusted HR = 2.46, 95% CI = 1.16-5.19 for a defined daily dose [DDD] ≥ 360). In addition, short-term DPP-4-inhibitor treatment was associated with a significantly higher risk of HZ (adjusted HR = 2.04, 95% CI = 1.03-4.04 for a DDD ≥ 360 days). CONCLUSION These results suggest that Asian patients with diabetes who use short-term DPP-4 inhibitors might be at a higher risk of developing HZ.
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Affiliation(s)
- H-H Chen
- From the Institute of Public Health and Medicine, Chung Shan Medical University, Taichung, Taiwan, Division of Metabolism & Endocrinology, Changhua Christian Hospital, Changhua, Taiwan, Division of Metabolism & Endocrinology, Nantou Christian Hospital, Nantou, Taiwan
| | - C-L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, College of Medicine, China Medical University, Taichung, Taiwan
| | - S-Y Yeh
- Division of Metabolism & Endocrinology, Nantou Christian Hospital, Nantou, Taiwan, Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - C-H Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan and Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Yang TU, Cheong HJ, Song JY, Noh JY, Kim WJ. Survey on public awareness, attitudes, and barriers for herpes zoster vaccination in South Korea. Hum Vaccin Immunother 2015; 11:719-26. [PMID: 25785481 DOI: 10.1080/21645515.2015.1008885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A cross-sectional study was performed to assess current public awareness of herpes zoster (HZ) and its vaccine, determine the factors that influence people's intention regarding HZ vaccination, and investigate the barriers for vaccination by changing decisions with sequential questions regarding knowledge, cost, and physician's recommendation in the Department of Infectious Diseases, Korea University Guro Hospital, in South Korea, between August 23 and September 15 of 2013. Among 603 subjects who completed the survey, 85.7% and 43.6% subjects were aware of HZ and HZ vaccination, respectively. Women, younger age group, those with higher income or higher education levels were more likely to be aware of HZ. Overall, 85.8% of subjects aware of HZ were willing to be vaccinated or vaccinate their parents. The main obstacles for the increased acceptance toward vaccination were the high cost and low perceived risk, which decreased acceptance to 60.2%. However, physician's recommendation reversed 69.5% of the refusal to accept HZ vaccine. These results indicate that expanding public education and physician's recommendations are important factors aimed at increasing HZ vaccine coverage rate.
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Affiliation(s)
- Tae Un Yang
- a Division of Infectious Diseases; Department of Internal Medicine ; Korea University College of Medicine ; Seoul , South Korea
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Functional decline and herpes zoster in older people: an interplay of multiple factors. Aging Clin Exp Res 2015; 27:757-65. [PMID: 26440662 DOI: 10.1007/s40520-015-0450-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/09/2015] [Indexed: 12/17/2022]
Abstract
Herpes zoster is a frequent painful infectious disease whose incidence and severity increase with age. In older people, there is a strong bidirectional link between herpes zoster and functional decline, which refers to a decrement in ability to perform activities of daily living due to ageing and disabilities. However, the exact nature of such link remains poorly established. Based on the opinion from a multidisciplinary group of experts, we here propose a new model to account for the interplay between infection, somatic/psychiatric comorbidity, coping skills, polypharmacy, and age, which may account for the functional decline related to herpes zoster in older patients. This model integrates the risk of decompensation of underlying disease; the risk of pain becoming chronic (e.g. postherpetic neuralgia); the risk of herpes zoster non-pain complications; the detrimental impact of herpes zoster on quality of life, functioning, and mood; the therapeutic difficulties due to multimorbidity, polypharmacy, and ageing; and the role of stressful life events in the infection itself and comorbid depression. This model underlines the importance of early treatment, strengthening coping, and vaccine prevention.
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Roh NK, Park YM, Kang H, Choi GS, Kim BJ, Lee YW, Lew BL, Sim WY. Awareness, Knowledge, and Vaccine Acceptability of Herpes Zoster in Korea: A Multicenter Survey of 607 Patients. Ann Dermatol 2015; 27:531-8. [PMID: 26512167 PMCID: PMC4622887 DOI: 10.5021/ad.2015.27.5.531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/24/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background Herpes zoster (HZ) infection can significantly impair the quality of life of the affected individuals, and its treatment imposes a considerable cost burden on the health-care system and on society at large. However, there is little information on the perception of this disease and the acceptability of vaccines in Korea. Objective The aim of this study is to determine the awareness of HZ and its vaccine, and to identify factors associated with the acceptability of the HZ vaccine among outpatients of dermatology clinics. Methods A questionnaire-based survey was conducted on 607 outpatients who visited the dermatologic clinics. Results The responses of the patients revealed a high awareness of HZ (85.4%) but a relatively low knowledge about HZ and its vaccine (42.3%). The HZ vaccination rate among patients aged ≥50 years was 9%. A history of HZ infection, being older, and greater knowledge about HZ and its vaccine were associated with a higher HZ vaccine acceptability. Of those who had not been vaccinated, 58.3% were interested in receiving the vaccine. The most frequent reason for this interest was "severe sequelae," followed by "knowing someone who has HZ" and "recommendation from a doctor." High cost was the most common reason for unwillingness to receive the vaccination. Conclusion Despite a high awareness of HZ, vaccine acceptability was extremely low among this study cohort. Vaccination acceptability would be improved by encouraging doctors to educate elderly patients about the disease and the availability of vaccination, and by the provision of insurance coverage for HZ vaccination.
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Affiliation(s)
- Nam Kyung Roh
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hoon Kang
- Department of Dermatology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea. ; Research Institute of Medical Science, Konkuk University, Seoul, Korea
| | - Bark Lynn Lew
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Woo Young Sim
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea
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[Recommendations for treatment and prevention of herpes zoster and associated pain in aged adults]. Rev Med Interne 2015; 37:35-42. [PMID: 26383768 DOI: 10.1016/j.revmed.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/25/2015] [Accepted: 08/17/2015] [Indexed: 12/23/2022]
Abstract
Initiated within the first 72 hours of the rash, prescribing antiviral drugs reduces both acute neuralgia (AN) and later complications and especially postherpetic neuralgia (PHN). But their analgesic as well as preventative effect on AN and PHN is modest. Combination with analgesic drugs is more often needed for pain management. However, the pharmacological management of pain, in the context of old patients' frailty, co-morbidities and often polypharmacy, must be carefully considered. Based on analyses of the evidences from the literature, this review presents the therapeutic options we have at one's disposal and proposes a stepwise management for both AN and PHN specifically designed for aged population.
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Tseng HF, Lewin B, Hales CM, Sy LS, Harpaz R, Bialek S, Luo Y, Jacobsen SJ, Reddy K, Huang PY, Zhang J, Anand S, Bauer EM, Chang J, Tartof SY. Zoster Vaccine and the Risk of Postherpetic Neuralgia in Patients Who Developed Herpes Zoster Despite Having Received the Zoster Vaccine. J Infect Dis 2015; 212:1222-31. [PMID: 26038400 DOI: 10.1093/infdis/jiv244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/03/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although it is evident that zoster vaccination reduces postherpetic neuralgia (PHN) risk by reducing herpes zoster (HZ) occurrence, it is less clear whether the vaccine protects against PHN among patients who develop HZ despite previous vaccination. METHODS This cohort study included immunocompetent patients with HZ. The vaccinated cohort included 1155 individuals who were vaccinated against HZ at age ≥60 years and had an HZ episode after vaccination. Vaccinated patients were matched 1:1 by sex and age with unvaccinated patients. Trained medical residents reviewed the full medical record to determine the presence of HZ-related pain at 1, 2, 3, and 6 months after HZ diagnosis. The incidence of PHN was compared between vaccinated and unvaccinated -patients. RESULTS Thirty vaccinated women (4.2%) experienced PHN, compared with 75 unvaccinated women (10.4%), with an adjusted relative risk of 0.41 (95% confidence interval, .26-.64). PHN occurred in 26 vaccinated men (6.0%) versus 25 unvaccinated men (5.8%), with an adjusted relative risk of 1.06 (.58-1.94). These associations did not differ significantly by age. CONCLUSIONS Among persons experiencing HZ, prior HZ vaccination is associated with a lower risk of PHN in women but not in men. This sex-related difference may reflect differences in healthcare-seeking patterns and deserve further investigation.
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Affiliation(s)
- Hung Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - Craig M Hales
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Rafael Harpaz
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie Bialek
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kavya Reddy
- Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center
| | | | - Jeff Zhang
- Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center
| | - Sean Anand
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Erin Mary Bauer
- Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center
| | | | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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Abstract
The age-associated increased susceptibility to infectious disease would suggest that vaccination should be a route to promote healthy aging and keep our seniors autonomous and independent. While vaccination represents a cost-effective and efficient strategy at community level, the ability of the immune system to mount a protective immune response is still unpredictable at the level of the individual. Thus, at a similar age, some individuals, including the elderly, might still be 'good' responders while some other, even younger, would definitely fail to mount a protective response. In this review, the current burden of vaccine-preventable diseases in the aging and aged population will be detailed with the aim to identify the ideal vaccine candidates over the age of 50 years. This article will conclude with potential strategies to reduce, as best as possible, this burden and the imperative need to overcome barriers in extending current vaccine coverage towards to a lifelong vaccine schedule.
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Affiliation(s)
- Pierre-Olivier Lang
- Translational Medicine Research group, Cranfield Health, Cranfield University, Cranfield, England,
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Wen SY, Liu WL. Epidemiology of pediatric herpes zoster after varicella infection: a population-based study. Pediatrics 2015; 135:e565-71. [PMID: 25713285 DOI: 10.1542/peds.2013-4037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are limited population-based data regarding pediatric herpes zoster (HZ). METHODS Children aged <12 years with varicella infections between 2000 and 2006 were identified from a national population-based database and followed-up for a diagnosis of HZ until December 2008. Since a routine varicella vaccination program was started in 2004, vaccinated children without medically attended varicella were identified between 2004 and 2006, and followed-up for a diagnosis of HZ until December 2008. RESULTS Of 27 517 children with medically attended varicella, 428 developed HZ. The incidence of HZ was 262.1 per 100 000 person-years. Of 25 132 vaccinated children without medically attended varicella, 106 developed HZ. The incidence of HZ was 93.3 per 100 000 person-years. The mean duration from varicella to HZ was 4.12 years. Children diagnosed with varicella at aged <2 years had a higher incidence (P < .001) and shorter duration (P = .04) than those diagnosed aged ≧2 years. Children diagnosed with varicella aged ≥2 but <8 years had a significantly increased incidence of HZ after than before the vaccination program (relative risk = 1.85 at 3 years of follow-up, P = .03). Children with varicella infections had a significantly greater risk of HZ than vaccinated children without a history of varicella (relative risk = 2.31 at 4 years of follow-up, P < .001). CONCLUSIONS This study demonstrates the population-based epidemiologic characteristics of pediatric HZ among those who contracted varicella. In the early postvaricella vaccination period, an increased HZ incidence was observed among children with varicella infection aged ≥2 years.
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Affiliation(s)
- Su-Ying Wen
- Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei, Taiwan; Center for General Education, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Wen-Liang Liu
- Institute of Clinical Research and Training, Taipei City Hospital, Taipei, Taiwan and Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Gater A, Uhart M, McCool R, Préaud E. The humanistic, economic and societal burden of herpes zoster in Europe: a critical review. BMC Public Health 2015; 15:193. [PMID: 25880058 PMCID: PMC4349710 DOI: 10.1186/s12889-015-1514-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/09/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) or "shingles" is common in persons aged 50 years or over. HZ is characterised by a painful dermatological rash which typically resolves in approximately one month. Persistent pain for months or years after rash onset, however, is a common complication of HZ; referred to as post-herpetic neuralgia (PHN). Both HZ and PHN have a significant impact on patients' lives, with considerable implications for healthcare systems and wider society. The aim of the present review is to provide comprehensive documentation and critical appraisal of published data concerning the humanistic, economic and societal burden of HZ in Europe. METHODS Systematic literature searches were conducted in Medline, EMBASE, PsycINFO, EconLit, HEED and CRD databases. Searches were conducted in July 2014 and restricted to articles published in the past 20 years. Articles were selected for full review by two independent researchers in accordance with predefined eligibility criteria. RESULTS From a review of 1619 abstracts, 53 eligible articles, were identified which reported data concerning healthcare resource use (n = 38), direct costs (n = 20), indirect costs (n = 16), total costs (n = 10) and impact on health-related quality of life (HRQoL) (n = 21). Findings highlight that PHN is associated with greater impairments in HRQoL and higher costs of management than HZ. For both HZ and PHN, pain severity is a significant predictor of impact on individuals, healthcare systems and society. While the incidence of HZ and PHN increase with age, age does not appear to be a key driver of overall costs for HZ and PHN. Specifically, while direct costs (e.g. GP, specialists, medications, hospitalisations) tend to be higher for older patients, indirect costs (e.g. work time missed) are higher for younger patients. CONCLUSIONS Available evidence highlights that HZ and PHN result in significant humanistic and economic burden for patients, healthcare systems and wider societies. A tendency to focus upon healthcare resource use and the direct costs of management at the expense of other impacts (e.g. informal caregivers and formal social care) may result in an underestimation of the true burden of HZ and PHN.
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Affiliation(s)
- Adam Gater
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK.
| | - Mathieu Uhart
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, Lyon, France.
| | - Rachael McCool
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK.
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Ouwens MJNM, Littlewood KJ, Sauboin C, Téhard B, Denis F, Boëlle PY, Alain S. The impact of 2-dose routine measles, mumps, rubella, and varicella vaccination in France on the epidemiology of varicella and zoster using a dynamic model with an empirical contact matrix. Clin Ther 2015; 37:816-829.e10. [PMID: 25726457 DOI: 10.1016/j.clinthera.2014.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/08/2014] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Varicella has a high incidence affecting the vast majority of the population in France and can lead to severe complications. Almost every individual infected by varicella becomes susceptible to herpes zoster later in life due to reactivation of the latent virus. Zoster is characterized by pain that can be long-lasting in some cases and has no satisfactory treatment. Routine varicella vaccination can prevent varicella. The vaccination strategy of replacing both doses of measles, mumps, and rubella (MMR) with a combined MMR and varicella (MMRV) vaccine is a means of reaching high vaccination coverage for varicella immunization. The objective of this analysis was to assess the impact of routine varicella vaccination, with MMRV in place of MMR, on the incidence of varicella and zoster diseases in France and to assess the impact of exogenous boosting of zoster incidence, age shift in varicella cases, and other possible indirect effects. METHODS A dynamic transmission population-based model was developed using epidemiological data for France to determine the force of infection, as well as an empirically derived contact matrix to reduce assumptions underlying these key drivers of dynamic models. Scenario analyses tested assumptions regarding exogenous boosting, vaccine waning, vaccination coverage, risk of complications, and contact matrices. FINDINGS The model provides a good estimate of the incidence before varicella vaccination implementation in France. When routine varicella vaccination is introduced with French current coverage levels, varicella incidence is predicted to decrease by 57%, and related complications are expected to decrease by 76% over time. After vaccination, it is observed that exogenous boosting is the main driver of change in zoster incidence. When exogenous boosting is assumed, there is a temporary increase in zoster incidence before it gradually decreases, whereas without exogenous boosting, varicella vaccination leads to a gradual decrease in zoster incidence. Changing vaccine efficacy waning levels and coverage assumptions are still predicted to result in overall benefits with varicella vaccination. IMPLICATIONS In conclusion, the model predicted that MMRV vaccination can significantly reduce varicella incidence. With suboptimal coverage, a limited age shift of varicella cases is predicted to occur post-vaccination with MMRV. However, it does not result in an increase in the number of complications. GSK study identifier: HO-12-6924.
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Affiliation(s)
| | | | | | - Bertrand Téhard
- Pharmaco Epidemiology Unit, GSK France, Marly-le-Roi, France
| | - François Denis
- CHU de Limoges, Service de Bactériologie Virologie-Hygiène, Limoges, France
| | - Pierre-Yves Boëlle
- Université Pierre et Marie Curie, Service de Biostatistique - INSERM U707, Paris, France
| | - Sophie Alain
- CHU de Limoges, Service de Bactériologie Virologie-Hygiène, Limoges, France; Université de Limoges, Faculté de Médecine, Service de Bactériologie, INSERM UMR 1092, Limoges, France
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Hillebrand K, Bricout H, Schulze-Rath R, Schink T, Garbe E. Incidence of herpes zoster and its complications in Germany, 2005–2009. J Infect 2015; 70:178-86. [DOI: 10.1016/j.jinf.2014.08.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/12/2014] [Accepted: 08/28/2014] [Indexed: 11/26/2022]
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Preventing and managing herpes zoster: key actions to foster healthy aging. Aging Clin Exp Res 2015; 27:5-11. [PMID: 25652328 DOI: 10.1007/s40520-015-0314-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/15/2014] [Indexed: 02/07/2023]
Abstract
Population aging is the demographic phenomenon characterizing all countries in the world, and it is challenging the national infrastructures, in particular health systems. However, aging itself is not associated with increased medical spending, but disability and comorbidity that affect older individuals are the actual drivers for health expenditures. Therefore, if people age in better health, medical spending may be significantly reduced. Preventative interventions proved to be effective in reducing/preventing disease and disability and often found to be cost effective, include diet and exercise interventions, medications, routine disease screenings, and immunizations. Vaccination can protect older citizens against life-threatening diseases, such as influenza, pneumococcal infections, tetanus, and against diseases which adversely impact their quality of life, such as herpes zoster (HZ). Including HZ vaccination in its citizens' lifetime immunization calendar can reinforce Europe's commitment toward active, healthy aging. This paper outlines the consensus statement of a group of Italian experts on HZ.
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The societal impact of herpes zoster and postherpetic neuralgia on patients, life partners, and children of patients in Germany. ScientificWorldJournal 2014; 2014:749698. [PMID: 25548792 PMCID: PMC4274846 DOI: 10.1155/2014/749698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/09/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to assess the impact of herpes zoster (HZ) and postherpetic neuralgia (PHN) on the daily activities of patients and family members who care for them. Some former patients and family members participated in face-to-face interviews or in a T-group meeting (qualitative phase) and some participated in telephone interviews (quantitative phase). They all expressed feelings of helplessness and frustration mixed with depression, sadness, or rage. Many of the former patients said their lives stopped, in contrast to family members who said that their lives were busy and stressful. Family members caring for patients with PHN were more psychologically stressed than those caring for patients with HZ. Although former patients appreciated the psychological and emotional support given by their family members, they underestimated the impact that their disease had on them. Former patients and their family never forgot this illness and its considerable impact on their lives, particularly when PHN occurred. We need to raise the awareness of the general public about the real life impact of HZ and PHN and their often severe, debilitating consequences and the potential benefits from vaccination.
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Prevalence and impact on quality of life of post-herpetic neuralgia in French medical centers specialized in chronic pain management: The ZOCAD study. Med Mal Infect 2014; 44:515-24. [DOI: 10.1016/j.medmal.2014.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/25/2014] [Accepted: 10/14/2014] [Indexed: 11/18/2022]
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Pica F, Gatti A, Divizia M, Lazzari M, Ciotti M, Sabato AF, Volpi A. One-year follow-up of patients with long-lasting post-herpetic neuralgia. BMC Infect Dis 2014; 14:556. [PMID: 25361823 PMCID: PMC4226872 DOI: 10.1186/s12879-014-0556-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 10/10/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent information on epidemiology and management of post-herpetic neuralgia (PHN), a painful complication of zoster, is scarce. METHODS This study was conducted at the Pain Clinic of the Policlinico Tor Vergata, Rome, Italy, on eighty-five immunocompetent patients with a clinical diagnosis of PHN. At enrollment (time 0, T0), the patients were interviewed by physicians to obtain demographic data and information about their zoster clinical history and underwent a blood test for VZV-DNA research. DN4 and SF-12 questionnaires were used to assess the neuropathic nature of pain and the overall health status, respectively. A one-year follow-up was planned for enrolled cases, who were visited at regular intervals of at least 3 months. RESULTS At T0 all the patients were at least 6 months from the episode of acute zoster and still presented with intense pain (mean VAS =6.7; mean DN4 = 5.7). Using antivirals within 72 hours from the rash onset was associated to a significant reduction of pain at T0 (p = 0.006 vs untreated patients). Only 2.6% of patients treated with antivirals during acute zoster but 18.6% of the untreated ones presented with neuropathic pain at T12 (p =0.007), even though the two groups were similar at T0. VZV-DNA was found in 5 out of the 50 available blood samples. At the last follow-up visit, PCS and MCS scores of the PHN patients were found to be recovered over those of the historical age-matched healthy controls. Undesirable side effects of analgesic therapies were observed in 15.3 to 28.8% of the patients. CONCLUSIONS Patients who six months after acute zoster still have significant neuropathic pain, have a high probability of suffering from chronic pain in the subsequent months/years. The initial antiviral treatment has a significant impact on the pain. Current strategies of analgesic therapy are effective to achieve relief of pain in PHN patients, but they are burdened with heavy and undesirable side effects.
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Salleras L, Salleras M, Salvador P, Soldevila N, Prat A, Garrido P, Domínguez A. Herpes zoster and postherpetic neuralgia in Catalonia (Spain). Hum Vaccin Immunother 2014; 11:178-84. [PMID: 25483532 PMCID: PMC4514275 DOI: 10.4161/hv.34421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022] Open
Abstract
The objective of the study was to analyze the descriptive epidemiology and costs of herpes zoster (HZ) and postherpetic neuralgia (PHN) in people aged ≥50 years in Catalonia (Spain). The incidence of HZ in Catalonia was estimated by extrapolating the incidence data from Navarre (Spain) to the population of Catalonia. The incidence of PHN was estimated according to the proportion of cases of HZ in the case series of the Hospital del Sagrado Corazón de Barcelona that evolved to PHN. Drug costs were obtained directly from the prescriptions included in the medical record (according to official prices published by the General Council of the College of Pharmacists). The cost of care was obtained by applying the tariffs of the Catalan Health Institute to the number of outpatient visits and the number and duration of hospital admissions. The estimated annual incidence of HZ was 31 763, of which 21 532 (67.79%) were in patients aged ≥50 years. The respective figures for PHN were 3194 and 3085 (96.59) per annum, respectively. The mean cost per patient was markedly higher in cases of PHN (916.66 euros per patient) than in cases of HZ alone (301.52 euros per patient). The cost increased with age in both groups of patients. The estimated total annual cost of HZ and its complications in Catalonia was € 9.31 million, of which 6.54 corresponded to HZ and 2.77 to PHN. This is the first Spanish study of the disease burden of HZ in which epidemiological data and costs were collected directly from medical records. The estimated incidence of HZ is probably similar to the real incidence. In contrast, the incidence of PHN may be an underestimate, as around 25% of patients in Catalonia attend private clinics financed by insurance companies. It is also probable that the costs may be an underestimate as the costs derived from the prodromal phase were not included. In Catalonia, HZ and PHN cause an important disease burden (21 532 cases of HZ and 3085 de PHN with an annual cost of € 9.31 million) in people aged ≥50 years, in whom vaccination is indicated.
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Affiliation(s)
- Luis Salleras
- Department of Public Health. School of Medicine; University of Barcelona; Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Carlos III Institute of Health; Madrid, Spain
| | - Montse Salleras
- Dermatology Service; Hospital del Sagrado Corazón; Barcelona, Spain
| | - Patricia Salvador
- Department of Public Health. School of Medicine; University of Barcelona; Barcelona, Spain
| | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP); Carlos III Institute of Health; Madrid, Spain
| | - Andreu Prat
- Department of Public Health. School of Medicine; University of Barcelona; Barcelona, Spain
| | - Patricio Garrido
- Department of Public Health. School of Medicine; University of Barcelona; Barcelona, Spain
| | - Angela Domínguez
- Department of Public Health. School of Medicine; University of Barcelona; Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Carlos III Institute of Health; Madrid, Spain
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Gabutti G, Franco E, Bonanni P, Conversano M, Ferro A, Lazzari M, Maggi S, Rossi A, Scotti S, Vitale F, Volpi A, Greco D. Reducing the burden of Herpes Zoster in Italy. Hum Vaccin Immunother 2014; 11:101-7. [PMID: 25483522 DOI: 10.4161/hv.34363] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Herpes Zoster (HZ) is a viral disease with painful neuro-dermatologic manifestations. Incidence increases with age. In Italy, the estimated incidence is 6.3 cases/1000 person/year; hospital admissions are less than 2%, 69% in patients aged over 65 years. The most frequent complication of HZ is Post-Herpetic Neuralgia (PHN) characterized by metameric pain, allodynia, and hyperalgesia. In Italy 20.6% and 9.2% of HZ patients experience PHN after 3 and 6 months, respectively. Available antiviral and analgesic treatments are relatively unsatisfactory in reducing pain and length of the disease. Prevention has recently become possible with the live attenuated vaccine Oka/Merck. Clinical studies show a reduction of 51% in the incidence of the disease, 61% of its burden and 67% of PHN in vaccinees. Protection seems to be long lasting and vaccine safety matches registration requirements. Available evidence suggests that the costs for QALY (less than € 20 000) and avoided cases is favorable. Due to the heavy burden of disease, it is time to offer this vaccination to elderly population.
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Tsai TF, Yao CA, Yu HS, Lan CC, Chao SC, Yang JH, Yang KC, Chen CY, White RR, Psaradellis E, Rampakakis E, Kawai K, Acosta CJ, Sampalis JS. Herpes zoster-associated severity and duration of pain, health-related quality of life, and healthcare utilization in Taiwan: a prospective observational study. Int J Dermatol 2014; 54:529-36. [PMID: 25209019 DOI: 10.1111/ijd.12484] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology; National Taiwan University Hospital; Taipei Taiwan
| | - Chien-An Yao
- Department of Family Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Hsin-Su Yu
- Department of Dermatology; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Cheng-Che Lan
- Department of Dermatology; Kaohsiung Medical University; Kaohsiung Taiwan
- Kaohsiung Municipal Ta-Tung Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology; National Cheng Kung University Hospital; College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - Jen-Hung Yang
- Department of Dermatology; Buddist Tzu Chi General Hospital; Tzu Chi University School of Medicine; Hualien Taiwan
- Department of Dermatology; Chung Shan Medical University Hospital; Taichung Taiwan
| | - Kuo-Chia Yang
- Department of Dermatology; Changhua Christian Hospital; Changhua Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine; National Taiwan University Hospital; Taipei Taiwan
| | | | | | | | | | | | - John S. Sampalis
- JSS Medical Research; St-Laurent QC Canada
- McGill University; Montreal QC Canada
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Gater A, Abetz-Webb L, Carroll S, Mannan A, Serpell M, Johnson R. Burden of herpes zoster in the UK: findings from the zoster quality of life (ZQOL) study. BMC Infect Dis 2014; 14:402. [PMID: 25038799 PMCID: PMC4223600 DOI: 10.1186/1471-2334-14-402] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/04/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ) is a painful condition that can have a substantial negative impact on patients' lives. However, UK-specific data on the debilitating impact of HZ, in terms of patients' experience of pain and impairments in Health-Related Quality of Life (HRQoL) are limited. The Zoster Quality of Life (ZQOL) study, a large-scale UK cross-sectional study, was conducted to quantify the burden of HZ in UK patients. METHODS A total of 229 HZ patients aged 50 years or over were recruited from primary and secondary/tertiary care centres throughout the UK. Patients completed a battery of validated questionnaires, including the Zoster Brief Pain Inventory (ZBPI), the Medical Outcomes Study Short-Form 36 (SF-36) and the EuroQol-5 Dimensions (EQ-5D) on initial presentation to the doctor and again 7-14 days later. At follow-up patients also completed the Treatment Satisfaction with Medication (TSQM) questionnaire. Where available, mean questionnaire scores in the HZ population were compared to scores for age-matched norms to investigate the burden associated with HZ. RESULTS Pain was prominent among patients, with 57.9% at the initial study visit reporting pain in the preceding 24 hours at levels typically considered to have a significant impact on HRQoL (i.e. ZBPI worst pain ≥ 5). This was reflected in SF-36 and EQ-5D scores that were significantly lower for patients when compared to age-matched norms (p < 0.05) - except for the SF-36 domain of physical functioning. HRQoL was inversely associated with levels of reported pain, with those patients in the greatest amount of pain reporting the greatest HRQoL impact. However, there was no association between pain severity and participant age. The majority of patients (69.4%) received antivirals within 72 hours of rash appearing and 69.9% of patients were also taking analgesics for the management of HZ pain. TSQM scores indicated that patients were least satisfied with the effectiveness of their prescribed treatment. CONCLUSIONS The acute presentation of HZ is a painful experience that can have a significant impact on the physical and mental wellbeing of sufferers. Findings highlight significant unmet need among patients, particularly in terms of the effectiveness of therapies for the management of HZ.
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Serpell M, Gater A, Carroll S, Abetz-Webb L, Mannan A, Johnson R. Burden of post-herpetic neuralgia in a sample of UK residents aged 50 years or older: findings from the Zoster Quality of Life (ZQOL) study. Health Qual Life Outcomes 2014; 12:92. [PMID: 24920439 PMCID: PMC4063222 DOI: 10.1186/1477-7525-12-92] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 06/03/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (shingles). As a chronic condition, PHN can have a substantial adverse impact on patients' lives. However, UK-specific data concerning the burden of PHN on individual patients, healthcare systems and wider society, are lacking. As the first UK-wide cross-sectional study of its kind, The Zoster Quality of Life (ZQOL) study was designed to address these concerns. METHODS Patients (n = 152) with a confirmed diagnosis of PHN (defined as pain persisting ≥ 3 months following rash onset) and aged ≥50 years were recruited from primary and secondary/tertiary care centres throughout the UK. All patients completed validated questionnaires, including the Zoster Brief Pain Inventory (ZBPI), the Medical Outcomes Study Short-Form 36 (SF-36), the EuroQol-5 Dimensions (EQ-5D) and the Treatment Satisfaction with Medication (TSQM) questionnaire. Where available, mean patient population scores on these questionnaires were compared to scores derived from age-matched normative samples to quantify the burden associated with PHN. RESULTS Despite numerous consultations with healthcare professionals and receiving multiple medications for the management of their PHN, the majority of patients reported being in pain 'most of the time' or 'all of the time'. A total of 59.9% (n = 91) of all PHN patients reported pain in the preceding 24 hours to assessment at levels (ZBPI worst pain ≥ 5) typically considered to have a significant impact on Health Related Quality of Life (HRQoL). Accordingly, scores for SF-36 and EQ-5D indicated significant deficits in HRQoL among PHN patients compared to age-matched norms (p < 0.05) and patients reported being dissatisfied with the perceived efficacy of therapies received for the management of PHN. Increased pain severity was observed among older participants and higher levels of pain severity were associated with greater HRQoL deficits. CONCLUSIONS The inadequate relief provided by PHN therapies available in the UK is associated with a significant burden among PHN patients in terms of pain severity and deficits in HRQoL which may persist for years. Therefore, alternative means such as prevention of shingles and PHN, are essential for reducing the impact on individual patients, healthcare systems and society as a whole.
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Abstract
OBJECTIVE The 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. DESIGN We 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. RESULTS We 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. CONCLUSIONS HZ is a significant global health burden that is expected to increase as the population ages. Future research with rigorous methods is important.
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Affiliation(s)
- Kosuke Kawai
- Global Health Outcomes, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Berhanu G Gebremeskel
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Camilo J Acosta
- Global Health Outcomes, Merck & Co., Inc., West Point, Pennsylvania, USA
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