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Kovacevic J, Samia AM, Shah A, Motaparthi K. Herpes zoster ophthalmicus. Clin Dermatol 2024:S0738-081X(24)00007-5. [PMID: 38281688 DOI: 10.1016/j.clindermatol.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.
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Affiliation(s)
- Jasmina Kovacevic
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Arthur Mark Samia
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ankit Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Yaegashi M, Matsui H, Yoshida A, Ban H, Miyazaki R, Oda N, Hattori K, Motomura Y, Usami H, Matsushita H. A retrospective cohort study evaluating the incidence of herpes zoster and postherpetic neuralgia after a live attenuated Oka-strain herpes zoster vaccine in a real-world setting in Japan. Vaccine 2024; 42:464-470. [PMID: 38172019 DOI: 10.1016/j.vaccine.2023.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND In Japan, freeze-dried live attenuated Oka-strain varicella-zoster virus vaccine, VVL (BIKEN), is available for adults aged ≥50 years to prevent herpes zoster (HZ). Although an increase in the antibody titer and cellular immune response has been demonstrated following vaccination with VVL (BIKEN), to date, no clinical studies have shown that the vaccine decreases the incidence of HZ and postherpetic neuralgia (PHN). This study investigated the incidence of HZ and PHN among adults aged ≥50 years who received a single dose of VVL (BIKEN) to prevent HZ. METHODS This retrospective cohort study investigated the incidence of HZ and PHN among adults aged ≥50 years who received a single dose of VVL (BIKEN) at a large hospital and affiliated clinics in Japan. A dispensing database and electronic medical records were used to identify vaccine recipients and cases of HZ and PHN. The end date of the follow-up period and the reason to end the follow-up were defined to avoid underestimating the incidence. The analysis was stratified according to age, sex, immunocompromising conditions, and use of immunosuppressant therapy. Vaccine effectiveness was estimated using published estimates of the incidence of HZ and PHN in the unvaccinated population in Japan. RESULTS A total of 1175 patients were enrolled in the study. During a median follow-up period of 3.36 years, HZ was diagnosed in 27 participants (15 men [2.8%] and 12 women [1.9%]). The incidence of HZ among VVL (BIKEN) recipients was 7.67/1000 person-years. The incidence of PHN was 0.82/1000 person-years. The vaccine effectiveness was estimated as 27.8% [95% confidence interval (CI), -29.8 to 63.9%] and 73.8% [95% CI, 38.6-100%] against HZ and PHN, respectively. CONCLUSIONS The VVL (BIKEN) had limited effectiveness at preventing HZ, but relatively good effectiveness at preventing PHN. VVL (BIKEN) might have a role as an affordable alternative.
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Affiliation(s)
- Makito Yaegashi
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hiroki Matsui
- Clinical Research Support Division, Kameda University of Health Science, Yokosuka 462, Kamogawa, Chiba 296-0001, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Akihito Yoshida
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hirokazu Ban
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Reina Miyazaki
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Nobuhiro Oda
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Kazunaga Hattori
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Yoshikazu Motomura
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hayato Usami
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hiroki Matsushita
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
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Chen JK, Shen SC, Chang YC. Trigeminal herpes zoster with multi-dermatome and temporomandibular joint involvement. J Dent Sci 2024; 19:659-660. [PMID: 38303884 PMCID: PMC10829704 DOI: 10.1016/j.jds.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 02/03/2024] Open
Affiliation(s)
- Jyh-Kwei Chen
- Division of Oral and Maxillofacial Surgery, Department of Dentistry at Taipei Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Su-Chin Shen
- Department of Ophthalmology at Chang Gung Memorial Hospital, School of Medicine at Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ching Chang
- Department of Dermatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Getzler IE, Vered S, Gavze RP, Adler L, Oved M. Unraveling the debate: Can the skin manifestations of SARS-CoV-2 infection and vaccination be explained by the reactivation of herpes virus? J Dermatol 2023; 50:1594-1602. [PMID: 37830227 DOI: 10.1111/1346-8138.16984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
Since the COVID-19 outbreak, there have been numerous reports concerning COVID-19 skin manifestations. Debate has ensued as to whether these lesions are unique or represent a form of viral reactivation. The aim of this research was to compare the incidence of herpetic skin lesions between a COVID-19 group, a Sars-CoV-2 mRNA vaccination group, and their respective controls, taking into account their Herpesviridae carrier status. To achieve this goal, the Maccabi Healthcare Services' database was scanned and cohorts of both verified COVID-19 and mRNA vaccinated patients were extracted and matched to random control groups. Patients with a documented occurrence of any Herpesviridae infection that occurred prior to the studied 'event' (i.e., COVID-19 or mRNA vaccination) were regarded as carriers of Herpesviridae. A COVID-19-related or vaccination-related lesion was defined as a clinically diagnosed herpetic lesion appearing 1 month after the index date. In the COVID-19 cohort, there was an insignificant difference in herpetic lesion incidence between the groups. However, logistic regression demonstrated that the interaction of COVID-19 with the Herpesviridae carrier status was statistically significant. For the vaccination cohort, the data showed statistically significant differences between groups in herpetic frequencies, which manifested as an almost 2-fold odds of developing a herpetic lesion. In conclusion, following the analysis of two large cohorts, there is evidence to support the contribution of both COVID-19 and the mRNA vaccine to the reactivation of Herpesviridae. Our results diminish the idea that COVID-19 has unique, herpetic-like lesions.
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Affiliation(s)
- Itamar E Getzler
- Department of Family Medicine, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Shiraz Vered
- School of Public Health, University of Haifa, Haifa, Israel
| | - Revital Perlove Gavze
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel-Aviv, Israel
- Department of family medicine, faculty of medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Michal Oved
- Department of Family Medicine, Maccabi Healthcare Services, Tel-Aviv, Israel
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Aljohani AG, Abduljabbar MH, Hariri J, Zimmo BS, Magboul MA, Aleissa SM, Baabdullah A, Alqutub A, Alafif K, Faidah H. Assessing the Ability of Non-dermatology Physicians to Recognize Urgent Skin Diseases. Cureus 2023; 15:e37823. [PMID: 37214029 PMCID: PMC10197985 DOI: 10.7759/cureus.37823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Many patients present to the emergency department with skin conditions that are not true dermatologic emergencies. Urgent skin conditions are uncommon. Because these conditions are rare, they can be sometimes challenging to diagnose. Few works of literature discussed the accuracy of non-dermatologists' initial judgment on dermatologic conditions concluding that non-dermatologists misdiagnose many common and uncommon skin conditions. Because the study was never done in our region, we aim to conduct an online assessment using a questionnaire assessing the ability of non-dermatologists to recognize urgent skin diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Methods A cross-sectional study was conducted. Non-dermatologist physicians were contacted through their verified emails, provided by the secretaries of each department and the academic affairs unit. The questionnaire consisted of two main sections, the first section covered demographics, specialty, and academic level. The second part had eight questions, each containing a brief case scenario about an urgent dermatological condition with a picture of the condition attached. Participants were required to answer the questions and assess on a scale from one to 10 how confident they were about their answers. The responses were collected and analyzed. Results Out of all 161 responses, this study included 93 male physicians (57.8%) and 68 female physicians (42.2%). The mean age in the study was approximately 45 ± 3 years. This study showed that the percentage of accuracy by non-dermatologists in diagnosing urgent skin diseases given the typical presentation of the condition was (61.33%); nevertheless, the percentage decreased when it was recalculated in relation to the full level of confidence to (25.3%). Herpes zoster appeared to be the most recognizable urgent skin disease, and Pemphigus vulgaris was the least recognizable one. Conclusion This study shows that it is difficult for physicians to recognize some urgent skin diseases, which affects offering the optimum health care for the patients. Moreover, more dermatology-focused courses are needed to strengthen the knowledge about dermatological diseases.
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Affiliation(s)
| | | | - Jehad Hariri
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Bader S Zimmo
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Maan A Magboul
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Saud M Aleissa
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
| | | | | | - Khalid Alafif
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Hassan Faidah
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Holroyd TA, Schiaffino F, Chang RH, Wanyiri JW, Saldanha IJ, Gross M, Moss WJ, Hayford K. Diagnostic accuracy of dried blood spots for serology of vaccine-preventable diseases: a systematic review. Expert Rev Vaccines 2021; 21:185-200. [PMID: 34852211 DOI: 10.1080/14760584.2022.2013821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Venous serum and plasma are optimal specimens for serological testing but may be logistically infeasible. Dried blood spots (DBS) are a feasible alternative, provided results are adequately sensitive and specific. We aimed to assess the diagnostic accuracy of DBS to measure IgG and IgM antibodies for vaccine-preventable diseases and compare test validity of DBS with venous blood. AREAS COVERED In October 2020, we searched seven databases for peer-reviewed studies assessing the diagnostic accuracy of DBS specimens compared with serum in detecting antibodies to VPDs in humans. We extracted data and assessed risk of bias in all included studies. We calculated sensitivity and specificity with 95% confidence intervals for each index-reference test comparison. We narratively synthesized the identified evidence on diagnostic accuracy and blood collection and processing methods for DBS. Studies on measles and rubella IgG and IgM were the most frequently identified and reported generally high sensitivity and specificity. EXPERT OPINION Lack of standardization in collection, storage, and testing methods limited systematic comparison across studies. Our findings indicate a need for additional validation studies on the diagnostic accuracy of DBS to expand their use in serological surveillance. We recommend practical considerations to improve standardized reporting for DBS validation studies.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Francesca Schiaffino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel H Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jane W Wanyiri
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Margaret Gross
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Fukuoka H, Fukuoka N, Kibe T, Tubbs RS, Iwanaga J. Oral Herpes Zoster Infection Following COVID-19 Vaccination: A Report of Five Cases. Cureus 2021; 13:e19433. [PMID: 34909338 PMCID: PMC8663753 DOI: 10.7759/cureus.19433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 02/01/2023] Open
Abstract
Recently, two cases of oral herpes zoster (HZ) following COVID-19 vaccines were reported. It was suggested that COVID-19 vaccine-related oral HZ cases might be missed or misdiagnosed as stomatitis or isolated oral herpes. In this report, five cases of oral HZ following COVID-19 vaccinations are presented. Four cases were observed on the hard palate (V2), and one case was found on the mandible (V3). Four patients did not receive any treatment for their oral HZ, but one patient also had skin reactions on her right orbit and ear and was thus treated with an antiviral drug. As these cases were seen during such a short period of time and in one practice, the relationship with the COVID-19 vaccination appears to be related.
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Affiliation(s)
| | | | - Toshiro Kibe
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Surgery, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, USA
- Department of Anatomy, Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, JPN
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Forbes H, Bhaskaran K, Grint D, Hu V, Langan S, McDonald H, Morton C, Smeeth L, Walker J, Warren‐Gash C. Incidence of acute complications of herpes zoster among immunocompetent adults in England: a matched cohort study using routine health data. Br J Dermatol 2021; 184:1077-1084. [PMID: 33216946 PMCID: PMC8607468 DOI: 10.1111/bjd.19687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Herpes zoster can cause rare but serious complications; the frequency of these complications has not been well described. OBJECTIVES To quantify the risks of acute non-postherpetic neuralgia (PHN) zoster complications, to inform vaccination policy. METHODS We conducted a cohort study among unvaccinated immunocompetent adults with incident zoster, and age-, sex- and practice-matched control adults without zoster, using routinely collected health data from the UK Clinical Practice Research Datalink (years 2001 to 2018). Crude attributable risks of complications were estimated as the difference between Kaplan-Meier-estimated 3-month cumulative incidences in patients with zoster vs. controls. We used Cox models to obtain hazard ratios for our primary outcomes in patients with and without zoster. Primary outcomes were ocular, neurological, cutaneous, visceral and zoster-specific complications. We also assessed whether antivirals during acute zoster protected against the complications. RESULTS In total 178 964 incident cases of zoster and 1 799 380 controls were included. The absolute risks of zoster-specific complications within 3 months of zoster diagnosis were 0·37% [95% confidence interval (CI) 0·34-0·39] for Ramsay Hunt syndrome, 0·01% (95% CI 0·0-0·01) for disseminated zoster, 0·04% (95% CI 0·03-0·05) for zoster death and 0·97% (95% CI 0·92-1·00) for zoster hospitalization. For other complications, attributable risks were 0·48% (95% CI 0·44-0·51) for neurological complications, 1·33% (95% CI 1·28-1·39) for ocular complications, 0·29% (95% CI 0·26-0·32) for cutaneous complications and 0·78% (95% CI 0·73-0·84) for visceral complications. Attributable risks were higher among patients > 50 years old. Patients with zoster had raised risks of all primary outcomes relative to controls. Antiviral prescription was associated with reduced risk of neurological complications (hazard ratio 0·61, 95% CI 0·53-0·70). CONCLUSIONS Non-PHN complications of zoster were relatively common, which may affect cost-effectiveness calculations for zoster vaccination. Clinicians should be aware that zoster can lead to various complications, besides PHN.
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Affiliation(s)
- H.J. Forbes
- London School of Hygiene & Tropical MedicineLondonUK
| | - K. Bhaskaran
- London School of Hygiene & Tropical MedicineLondonUK
| | - D. Grint
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
| | - V.H. Hu
- London School of Hygiene & Tropical MedicineLondonUK
| | - S.M. Langan
- London School of Hygiene & Tropical MedicineLondonUK
| | - H.I. McDonald
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
| | - C. Morton
- London School of Hygiene & Tropical MedicineLondonUK
| | - L. Smeeth
- London School of Hygiene & Tropical MedicineLondonUK
| | - J.L. Walker
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
- Statistics, Modelling and Economics DepartmentPublic Health EnglandLondonUK
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9
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Maire B. Test Is Also Helpful in Clinically Unclear Cases of Varicella Zoster. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:175. [PMID: 32295697 PMCID: PMC7171474 DOI: 10.3238/arztebl.2020.0175a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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10
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Jain A, van Hoek A, Walker J, Forbes H, Langan S, Root A, Smeeth L, Thomas S. Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. Clinical Practice Research Datalink. Br J Dermatol 2018; 178:1324-1330. [PMID: 29388189 PMCID: PMC6033149 DOI: 10.1111/bjd.16399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Zoster vaccination was introduced in England in 2013, where tackling health inequalities is a statutory requirement. However, specific population groups with higher zoster burden remain largely unidentified. OBJECTIVES To evaluate health inequalities in zoster disease burden prior to zoster vaccine introduction in England. METHODS This population-based cohort study used anonymized U.K. primary care data linked to hospitalization and deprivation data. Individuals aged ≥ 65 years without prior zoster history (N = 862 470) were followed from 1 September 2003 to 31 August 2013. Poisson regression was used to obtain adjusted rate ratios (ARRs) for the association of sociodemographic factors (ethnicity, immigration status, individuals' area-level deprivation, care home residence, living arrangements) with first zoster episode. Possible mediation by comorbidities and immunosuppressive medications was also assessed. RESULTS There were 37 014 first zoster episodes, with an incidence of 8·79 [95% confidence interval (CI) 8·70-8·88] per 1000 person-years at risk. In multivariable analyses, factors associated with higher zoster rates included care home residence (10% higher vs. those not in care homes), being a woman (16% higher vs. men), nonimmigrants (~30% higher than immigrants) and white ethnicity (for example, twice the rate compared with those of black ethnicity). Zoster incidence decreased slightly with increasing deprivation (ARR most vs. least deprived 0·96 (95% CI 0·92-0·99) and among those living alone (ARR 0·96, 95% CI 0·94-0·98). Mediating variables made little difference to the ARR of social factors but were themselves associated with increased zoster burden (ARR varied from 1·11 to 3·84). CONCLUSIONS The burden of zoster was higher in specific sociodemographic groups. Further study is needed to ascertain whether these individuals are attending for zoster vaccination.
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Affiliation(s)
- A. Jain
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - A.J. van Hoek
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - J.L. Walker
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
- Statistics, Modelling and Economics DepartmentPublic Health England61 Colindale AvenueLondonNW9 5EQU.K.
| | - H.J. Forbes
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - S.M. Langan
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - A. Root
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - L. Smeeth
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - S.L. Thomas
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
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11
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Walker JL, Andrews NJ, Amirthalingam G, Forbes H, Langan SM, Thomas SL. Effectiveness of herpes zoster vaccination in an older United Kingdom population. Vaccine 2018; 36:2371-2377. [PMID: 29555217 PMCID: PMC5899761 DOI: 10.1016/j.vaccine.2018.02.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vaccination against herpes zoster was introduced in the United Kingdom in 2013 for individuals aged 70 years, with a phased catch-up campaign for 71-79 year olds. Vaccine introduction has resulted in a marked fall in incident herpes zoster and in post-herpetic neuralgia (PHN), but formal evaluation of vaccine effectiveness is needed. METHODS In a population-based cohort study of older individuals born between 1933 and 1946, we used linked UK anonymised primary care health records for the first three years of the vaccination programme (01/09/2013-31/08/2016) and multivariable Poisson regression to obtain incidence rates and vaccine effectiveness (VE) against zoster and PHN. RESULTS Among 516,547 individuals, 21% were vaccinated. Incidence of zoster was 3.15/1000 person-years in vaccinees and 8.80/1000 person-years in unvaccinated individuals. After adjustment, VE was 64% (95%CI = 60-68%) against incident zoster and 81% (95%CI = 61-91%) against PHN, with very similar VE estimates in the routine and catch-up cohorts. VE against zoster was lower in those with a previous history of zoster: 47% (95%CI = 31-58%) versus 64% (95%CI = 60-68%) in those without previous zoster. There was evidence of waning VE over time, from 69% (95%CI = 65-74%) in the first year after vaccination to 45% (95%CI = 29-57%) by the third year. CONCLUSION This first formal assessment of VE in the UK zoster vaccination programme demonstrates good effectiveness of zoster vaccine, and very good protection against PHN. The findings provide evidence that VE is similar across the age groups targeted for vaccination in the UK, and on duration of protection of the vaccine in public health use. The study provides key information for decision-makers about the future direction of UK zoster vaccination programme, indicating that the live zoster vaccine may be more cost-effective than estimated previously. It also supports efforts to communicate the benefits of zoster vaccination to address the declining coverage observed across the UK.
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Affiliation(s)
- Jemma L Walker
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Nick J Andrews
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London, UK
| | - Harriet Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sinead M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Queenan JA, Farahani P, Ehsani-Moghadam B, Birtwhistle RV. The Prevalence and Risk for Herpes Zoster Infection in Adult Patients With Diabetes Mellitus in the Canadian Primary Care Sentinel Surveillance Network. Can J Diabetes 2017; 42:465-469. [PMID: 29395844 DOI: 10.1016/j.jcjd.2017.10.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/23/2017] [Accepted: 10/30/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Herpes zoster (HZ) is a common infection in Canada that can result in serious and long-term complications. People with diabetes may be at an increased risk for HZ. The objectives of this study were to develop and validate a case definition of HZ diagnosis based on electronic medical records; determine a prevalence estimate for HZ in adult patients in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) and assess the association between HZ and diabetes. METHODS This was a retrospective cross-sectional study. Patients 18 years of age or older who had made at least 1 visit to their primary health-care providers within the past 2 years in the CPCSSN were included. These data came from a 2015 extract of CPCSSN data, and a subsample of 289 patients was used to validate our case definition. Prevalences were estimated for the overall population and for people with diabetes, chronic obstructive pulmonary disease, cancer or HIV. Risk ratios were modelled for these conditions. RESULTS The sensitivity, specificity, positive predictive value and negative predictive values for HZ were 100%, 73.8%, 83.9% and 100%, respectively. The 1-year prevalence of HZ in the CPCSSN data was 0.32%. The prevalence of HZ was higher in females (0.35%) than in males (0.28%). People with diabetes have an increased risk for HZ infection (RR 2.64, 95% CI 2.34, 2.99). CONCLUSIONS People with diabetes have an increased risk for the diagnosis of HZ infection in the primary care setting in Canada. Women over the age of 65 years with diabetes and/or other chronic conditions are at greatest risk for developing HZ.
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Affiliation(s)
- John A Queenan
- Department of Family Medicine, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada.
| | - Pendar Farahani
- Programs for Assessment of Technology in Health (PATH), McMaster University, Hamilton, Ontario, Canada
| | - Behrouz Ehsani-Moghadam
- Department of Family Medicine, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
| | - Richard V Birtwhistle
- Department of Family Medicine, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
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Marinelli I, van Lier A, de Melker H, Pugliese A, van Boven M. Estimation of age-specific rates of reactivation and immune boosting of the varicella zoster virus. Epidemics 2017; 19:1-12. [DOI: 10.1016/j.epidem.2016.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
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Herpes zoster risk after 21 specific cancers: population-based case-control study. Br J Cancer 2017; 116:1643-1651. [PMID: 28463961 PMCID: PMC5518853 DOI: 10.1038/bjc.2017.124] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/22/2017] [Accepted: 04/10/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Some malignancies are known to be associated with increased risk of herpes zoster, but little is known about how associations between cancer and subsequent zoster risk vary by cancer site, by time since cancer diagnosis, and by age. METHODS An age-, sex-, calendar time-, and practice-matched case-control study, nested in the broadly UK representative Clinical Practice Research Datalink (CPRD) primary care database, was analysed using conditional logistic regression to estimate the association between 21 of the most common specific malignancies and subsequent zoster risk. We adjusted for comorbid conditions and other potential confounders, and investigated effect modification by age and time since malignancy diagnosis. RESULTS A total of 192 081 adult zoster patients and 732 035 controls were included. Malignancy overall was positively associated with zoster risk (adjusted OR 1.29, 95% CI 1.27-1.32), and the association was especially strong for haematological malignancies (OR 2.46, 2.33-2.60). Among specific malignancies, there was evidence that oral, oesophageal, stomach, colorectal, lung, breast, ovarian, prostate, kidney, bladder, and CNS cancers, as well as lymphoma, myeloma, and leukaemia were associated with increased zoster odds (P⩽0.05 in each case), but the magnitude of associations varied widely. The association was typically strongest within 2 years of malignancy diagnosis and decreased with older age for both haematological and solid malignancies. CONCLUSIONS Several cancers were associated with an increased risk of zoster, particularly within the first 2 years after diagnosis and among younger individuals. Knowledge that patients with a recent diagnosis of cancer are at high risk of zoster may encourage initiation of antiviral therapy earlier in the course of zoster when the benefits are greater. Evaluation of whether patients diagnosed with cancer would benefit from early zoster vaccination is warranted.
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Matthews A, Turkson M, Forbes H, Langan SM, Smeeth L, Bhaskaran K. Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the U.K. Clinical Research Practice Datalink. Br J Dermatol 2016; 175:1183-1194. [PMID: 27292233 PMCID: PMC5215701 DOI: 10.1111/bjd.14815] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 02/06/2023]
Abstract
Background Statins are commonly prescribed worldwide and recent evidence suggests that they may increase the risk of herpes zoster (HZ). Objectives To quantify the effect of statin exposure on the risk of HZ in the U.K. Methods A matched case–control study was conducted using data from U.K. primary care and hospital records. Patients > 18 years with an incident diagnosis of HZ were matched to up to four controls for age, sex and general practice. Patients were included in the statin exposure group if they had ever used a statin, and the daily dosage of the most recent statin prescription and the time since the most recent statin prescription were also recorded. The primary outcome was an incident diagnosis of HZ. Odds ratios (ORs) were estimated from conditional logistic regression and adjusted for potential confounders. Results A total of 144 959 incident cases of HZ were matched to 549 336 controls. Adjusted analysis suggested strong evidence for an increase in the risk of HZ related to statin exposure (OR 1·13, 95% confidence interval 1·11–1·15). There was also an increased risk when dosages were increased for patients who were currently or had recently been receiving statin treatment (Ptrend < 0·001), and we found an attenuation of the increased risk of HZ in previous statin users as the time since last statin exposure increased (Ptrend < 0·001). Conclusions These findings are consistent with the hypothesis that statin therapy leads to an increase in the risk of HZ. What's already known about this topic? Studies in both Canada and Taiwan have recently reported a small but significantly increased risk of herpes zoster (HZ) in patients receiving statin treatment. As statins are one of the most widely prescribed drugs in the U.K., with around 45 million prescriptions every year, any adverse effects will have substantial public health implications.
What does this study add? In this large matched case–control study, statin exposure was associated with a modest increase in the risk of HZ. A dose–response relationship was observed, and there was an attenuation of the increased risk over time among people who stopped statin therapy, indicating that the increased risk is consistent with a causal effect. There may be extra motivation to maximize HZ vaccine uptake among eligible patients receiving a statin.
Linked Comment:Shalom and Cohen. Br J Dermatol 2016; 175:1137–1138.
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Affiliation(s)
- A Matthews
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - M Turkson
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - H Forbes
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - S M Langan
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - L Smeeth
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - K Bhaskaran
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
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Abstract
Supplemental Digital Content is Available in the Text. Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. By preventing zoster through vaccination, the risk of this common complication is reduced. We searched MEDLINE and Embase for studies assessing risk factors for postherpetic neuralgia, with a view to informing vaccination policy. Nineteen prospective studies were identified. Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. Evidence for differences by gender was conflicting, with considerable between-study heterogeneity. A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4). Systemic lupus erythematosus, recent trauma, and personality disorder symptoms were associated with postherpetic neuralgia in single studies. No evidence of higher postherpetic neuralgia risk was found with depression (n = 4) or cancer (n = 5). Our review confirms a number of clinical features of acute zoster are risk factors for postherpetic neuralgia. It has also identified a range of possible vaccine-targetable risk factors for postherpetic neuralgia; yet aside from age-associated risks, evidence regarding risk factors to inform zoster vaccination policy is currently limited.
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Abstract
Herpes zoster or shingles is reactivation of the varicella zoster virus that had entered the cutaneous nerve endings during an earlier episode of chicken pox traveled to the dorsal root ganglia and remained in a latent form. This condition is characterized by occurrence of multiple, painful, unilateral vesicles and ulceration which shows a typical single dermatome involvement. In this case report, we present a patient with herpes zoster involving the mandibular division of the trigeminal nerve, with unilateral vesicles over the right side of lower third of face along the trigeminal nerve tract, with intraoral involvement of buccal mucosa, labial mucosa and the tongue of the same side. Cytopathology revealed classic features of herpes infection including inclusion bodies, perinuclear halo and multinucleated cells.
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Affiliation(s)
- Snehal Shah
- Department of Oral Pathology and Microbiology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Sasidhar Singaraju
- Department of Oral Pathology and Microbiology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - A Einstein
- Department of Oral Pathology and Microbiology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Ashish Sharma
- Department of Oral Pathology and Microbiology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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Abstract
Varicella zoster virus (VZV) causes chickenpox and herpes zoster. Herpes zoster is a common infection in older adults and can lead to potentially debilitating postherpetic neuralgia. This article reviews the diagnosis and management of herpes zoster, including strategies to reduce disease frequency and severity with the herpes zoster vaccine.
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Langan SM, Minassian C, Smeeth L, Thomas SL. Risk of stroke following herpes zoster: a self-controlled case-series study. Clin Infect Dis 2014; 58:1497-503. [PMID: 24700656 PMCID: PMC4017889 DOI: 10.1093/cid/ciu098] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/23/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Herpes zoster is common and vaccine preventable. Stroke risk may be increased following zoster, but evidence is sparse and could be explained by differences between people with and without zoster. Our objective was to determine if stroke risk is increased following zoster. METHODS Within-person comparisons were undertaken using the self-controlled case-series method and data from the UK Clinical Practice Research Datalink (1987-2012). Participants had a first-ever diagnosis of zoster and stroke within the study period. Stroke incidence in periods following zoster was compared with incidence in other time periods. Age-adjusted incidence ratios (IRs) and 95% confidence intervals (CIs) were calculated. RESULTS A total of 6584 individuals were included. Stroke rate was increased following zoster compared with the baseline unexposed period, then gradually reduced over 6 months: weeks 1-4 (age-adjusted IR, 1.63; 95% CI, 1.32-2.02), weeks 5-12 (IR, 1.42; 95% CI, 1.21-1.68), and weeks 13-26 (IR, 1.23; 95% CI, 1.07-1.42), with no increase thereafter. A stronger effect was observed for individuals with zoster ophthalmicus, rising to a >3-fold rate 5-12 weeks after zoster. Oral antivirals were given to 55% of individuals: IRs for stroke were lower among those receiving antivirals compared with those not treated, suggesting a protective effect. CONCLUSIONS We have established an increased stroke rate within 6 months following zoster. Findings have implications for zoster vaccination programs, which may reduce stroke risk following zoster. The low antiviral prescribing rate needs to be improved; our data suggest that antiviral therapy may lead to a reduced stroke risk following zoster.
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Affiliation(s)
| | | | - Liam Smeeth
- Faculty of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine,
United Kingdom
| | - Sara L. Thomas
- Faculty of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine,
United Kingdom
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Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014; 348:g2911. [PMID: 25134101 PMCID: PMC4019782 DOI: 10.1136/bmj.g2911] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To quantify the effects of possible risk factors for herpes zoster at different ages. DESIGN Case-control study. SETTING UK Clinical Practice Research Datalink primary care data. PARTICIPANTS 144 959 adults diagnosed with zoster between 2000 and 2011; 549,336 age, sex, and practice matched controls. MAIN OUTCOME MEASURES Conditional logistic regression was used to generate adjusted odds ratios to estimate the strength of association of each potential risk factor with zoster and assess effect modification by age. RESULTS The median age of the cases and controls was 62 years. Factors associated with increased risk of zoster included rheumatoid arthritis (3111 (2.1%) v 8029 (1.5%); adjusted odds ratio 1.46, 99% confidence interval 1.38 to 1.55), inflammatory bowel disease (1851 (1.3%) v 5118 (0.9%); 1.36, 1.26 to 1.46), chronic obstructive pulmonary disease (6815 (4.7%) v 20 201 (3.7%); 1.32, 1.27 to 1.37), asthma (10 243 (7.1%) v 31 865 (5.8%); 1.21, 1.17 to 1.25), chronic kidney disease (8724 (6.0%) v 29 437 (5.4%); 1.14, 1.09 to 1.18), and depression (6830 (4.7%) v 22 052 (4.0%); 1.15, 1.10 to 1.20). Type 1, but not type 2, diabetes showed some association with zoster (adjusted odds ratio 1.27, 1.07 to 1.50). The relative effects of many assessed risk factors were larger in younger patients. Patients with severely immunosuppressive conditions were at greatest risk of zoster-for example, patients with lymphoma (adjusted odds ratio 3.90, 3.21 to 4.74) and myeloma (2.16, 1.84 to 2.53), who are not eligible for zoster vaccination. CONCLUSIONS A range of conditions were associated with increased risk of zoster. In general, the increased risk was proportionally greater in younger age groups. Current vaccines are contraindicated in people at the greatest risk of zoster, highlighting the need for alternative risk reduction strategies in these groups.
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Affiliation(s)
- Harriet J Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Tim Clayton
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Esteban-Vasallo MD, Domínguez-Berjón MF, Gil-Prieto R, Astray-Mochales J, Gil de Miguel A. Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster: a population-based study from primary care in Madrid (Spain). Hum Vaccin Immunother 2014; 10:1650-60. [PMID: 24805130 DOI: 10.4161/hv.28620] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The objectives of this study were to estimate incidence density rates (IDR) of herpes zoster (HZ) and to analyze the association with sociodemographic characteristics and selected chronic medical conditions. The study cohort consisted of the adult population included in the Public Health System of the Autonomous Community of Madrid, Spain on 1/10/2009 (5 244 402 persons). Data source were electronic medical records from primary care between 1/10/2009-31/12/2012. Individual socioeconomic status (SES) was inferred by geocoding. Poisson regression analyses were stratified by sex, to identify factors associated with HZ. We identified 81 541 incident cases of HZ (61.7% in women and 46.5% in the group aged 60 and over). IDR was 4.11 per 1000 person-years in men and 5.95 in women. IDR were higher with age, in autochthonous population, those with lower SES and in patients with immunodeficiencies. After adjustment, higher incidence rate ratios were found with age, autochthonous origin, lower SES, and in patients with HIV-infection/AIDS (3.20, CI95% 2.90-3.53 in men and 2.98, CI95% 2.58-3.45 in women), and other immunodeficiencies (1.57, CI95% 1.41-1.75 and 1.65, CI95% 1.50-1.80). COPD, asthma, DM, ischemic heart disease, other cardiovascular diseases, and cancer were also associated with an increased incidence of HZ. We conclude that older, autochthonous patients with lower SES and with certain underlying medical conditions had a higher probability of suffering HZ. Electronic databases are useful for estimating the incidence of HZ, and for finding associations with sociodemographic and clinical characteristics. Identifying unrecognized risk factors for HZ, such as asthma or cardiovascular diseases, is crucial to interpret the epidemiology of HZ, to target vaccination programs and to monitor their effect.
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Affiliation(s)
- María D Esteban-Vasallo
- Subdirectorate for Health Promotion and Prevention; Madrid Regional Health Authority; Madrid, Spain
| | | | - Ruth Gil-Prieto
- Department of Preventive Medicine and Public Health and Medical Inmunology and Microbiology; Rey Juan Carlos University; Madrid, Spain
| | - Jenaro Astray-Mochales
- Subdirectorate for Health Promotion and Prevention; Madrid Regional Health Authority; Madrid, Spain
| | - Angel Gil de Miguel
- Department of Preventive Medicine and Public Health and Medical Inmunology and Microbiology; Rey Juan Carlos University; Madrid, Spain
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Esteban-Vasallo MD, Gil-Prieto R, Domínguez-Berjón MF, Astray-Mochales J, Gil de Miguel A. Temporal trends in incidence rates of herpes zoster among patients treated in primary care centers in Madrid (Spain), 2005-2012. J Infect 2013; 68:378-86. [PMID: 24247069 DOI: 10.1016/j.jinf.2013.09.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/13/2013] [Accepted: 09/30/2013] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study aimed to estimate total and age-specific incidence rates of HZ with data from electronic clinical records in primary care (ECRPC) and to analyze trends by sex and age. METHODS Descriptive cross-sectional study covering the incident HZ episodes registered in the ECRPC of the Madrid Regional Public Health System in 2005-2012. Annual crude and age-adjusted incidence rates were calculated. Differences by sex and age were assessed by poisson regression. The annual percentage of change (APC) of incidence rates and 'breakthrough points' of the time trends were determined with the Joinpoint Regression Program. RESULTS 211,650 episodes of HZ were identified (60.6% women, 52.2% > 55 years). The incidence rate increased from 363.21 to 481.92 per 100,000 person-year in 2005-2012. Rates were higher among women and increased with age. The APC for the period was 3.59% in men and 3.67% in women (p < 0.05). Age-specific rates increased in patients over 14 years. The APC in the 25-44 age group was 7.4% since 2007. The incidence rate ratio (women/men) was highest in this group. CONCLUSIONS The incidence of HZ presents an upward trend in 2005-2012 in adults and the elderly. Monitoring the incidence and age-specific rates, will help to detect changes in trends.
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Affiliation(s)
- M D Esteban-Vasallo
- Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, C/San Martín de Porres, 6, 28035 Madrid, Spain.
| | - R Gil-Prieto
- Department of Preventive Medicine and Public Health and Medical Immunology and Microbiology, Rey Juan Carlos University, Avda. de Atenas, s/n, 28922 Alcorcón, Madrid, Spain
| | - M F Domínguez-Berjón
- Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, C/San Martín de Porres, 6, 28035 Madrid, Spain
| | - J Astray-Mochales
- Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, C/San Martín de Porres, 6, 28035 Madrid, Spain
| | - A Gil de Miguel
- Department of Preventive Medicine and Public Health and Medical Immunology and Microbiology, Rey Juan Carlos University, Avda. de Atenas, s/n, 28922 Alcorcón, Madrid, Spain
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Lionis CD, Vardavas CI, Symvoulakis EK, Papadakaki MG, Anastasiou FS, Antonopoulou MD, Apostolakis CM, Dimitrakopoulos SA, Fountakis GI, Grammatikopoulos IA, Komninos JD, Kounalakis DK, Ladoukaki ES, Makri KV, Petraki CS, Ploumis NG, Prokopiadou DP, Stefanaki IN, Tsakountakis NA, Tsiligianni IG, Tzortzis EN, Vasilaki AA, Vasilopoulos TK, Vrentzos GE. Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece. BMC FAMILY PRACTICE 2011; 12:136. [PMID: 22145678 PMCID: PMC3266196 DOI: 10.1186/1471-2296-12-136] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/06/2011] [Indexed: 11/10/2022]
Abstract
Background Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.
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Affiliation(s)
- Christos D Lionis
- Department of Social Medicine, Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, PO Box 2208, Postal Code 71003, Greece.
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Tanuseputro P, Zagorski B, Chan KJ, Kwong JC. Population-based incidence of herpes zoster after introduction of a publicly funded varicella vaccination program. Vaccine 2011; 29:8580-4. [PMID: 21939721 DOI: 10.1016/j.vaccine.2011.09.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 08/30/2011] [Accepted: 09/07/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Past varicella infection (chicken pox) may reactivate into herpes zoster (shingles). Varicella vaccination leads to a reduction in cases of varicella that may in turn increase herpes zoster rates due to reduction in the immune boosting effect of exposure to varicella zoster virus against varicella reactivation. We assessed the impact of childhood varicella vaccination in Ontario, Canada on zoster incidence and healthcare visits, and established baseline zoster rates prior to zoster vaccine introduction. METHODS We used population-based, administrative databases to identify zoster incidence and healthcare use from April 1992 to March 2010. RESULTS After routine varicella vaccination, zoster incidence rates decreased 29% for children aged 0-9 and changed minimally for other ages. Age-standardized rates of hospitalizations during the study period declined by 53%, while outpatient rates declined by 9%. The annual zoster incidence for those 60 or older was 740 per 100,000. CONCLUSIONS In the early post-varicella vaccination period, incidence rates of medically attended herpes zoster did not increase for the overall population and decreased moderately for children 9 years and younger, the age group targeted for varicella vaccination.
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van Wijck AJM, Wallace M, Mekhail N, van Kleef M. 17. Herpes Zoster and Post-Herpetic Neuralgia. Pain Pract 2010; 11:88-97. [DOI: 10.1111/j.1533-2500.2010.00428.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Herpes zoster: Burden of disease in France. Vaccine 2010; 28:7933-8. [PMID: 20946861 DOI: 10.1016/j.vaccine.2010.09.074] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 07/31/2010] [Accepted: 09/23/2010] [Indexed: 11/23/2022]
Abstract
This work provides estimates of HZ incidence and HZ-related hospitalization and mortality rates in France, where no immunization programme has been implemented. Herpes zoster data was obtained from the Sentinelles surveillance general practitioners (GPs) network, the PMSI Data processing centre for hospital discharges and from the French National Mortality Database (INSERM CépiDC). The yearly HZ incidence rate averaged 382 cases per 100,000 inhabitants (95% CI 364-405) and exponentially increased with age. The annual rates of hospitalizations and mortality due to HZ varied from 4.14±0.32 to 14.42±0.39 and from 0.11±0.03 to 0.29±0.04 per 100,000 inhabitants, respectively, depending on whether HZ was coded in a 'primary' or 'primary or associated' diagnosis. One or more factors of immunodepression occurred in 43.4% of hospitalized cases and in 21.6% HZ-related deaths.
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Keah S. Painful oral ulcers. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2010; 5:107-108. [PMID: 25606199 PMCID: PMC4170394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Sh Keah
- FRACGP, AM Family Physician, Elizabeth Medical Centre
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van Hoek AJ, Gay N, Melegaro A, Opstelten W, Edmunds WJ. Estimating the cost-effectiveness of vaccination against herpes zoster in England and Wales. Vaccine 2009; 27:1454-67. [PMID: 19135492 DOI: 10.1016/j.vaccine.2008.12.024] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 12/17/2008] [Indexed: 11/29/2022]
Abstract
A live-attenuated vaccine against herpes zoster (HZ) has been approved for use, on the basis of a large-scale clinical trial that suggests that the vaccine is safe and efficacious. This study uses a Markov cohort model to estimate whether routine vaccination of the elderly (60+) would be cost-effective, when compared with other uses of health care resources. Vaccine efficacy parameters are estimated by fitting a model to clinical trial data. Estimates of QALY losses due to acute HZ and post-herpetic neuralgia were derived by fitting models to data on the duration of pain by severity and the QoL detriment associated with different severity categories, as reported in a number of different studies. Other parameters (such as cost and incidence estimates) were based on the literature, or UK data sources. The results suggest that vaccination of 65 year olds is likely to be cost-effective (base-case ICER=pound20,400 per QALY gained). If the vaccine does offer additional protection against either the severity of disease or the likelihood of developing PHN (as suggested by the clinical trial), then vaccination of all elderly age groups is highly likely to be deemed cost-effective. Vaccination at either 65 or 70 years (depending on assumptions of the vaccine action) is most cost-effective. Including a booster dose at a later age is unlikely to be cost-effective.
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Affiliation(s)
- A J van Hoek
- Modelling and Economics Unit, Health Protection Agency, Centre for Infections, London NW9 5EQ, UK.
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Stein AN, Britt H, Harrison C, Conway EL, Cunningham A, Macintyre CR. Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older. Vaccine 2008; 27:520-9. [PMID: 19027048 DOI: 10.1016/j.vaccine.2008.11.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 10/31/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022]
Abstract
Incidence of zoster and post-herpetic neuralgia (PHN) and associated health care resource utilisation were investigated in the Australian population aged > or =50 years, using general practice data from 2000 to 2006, and pharmaceutical prescribing, hospital morbidity and emergency department data from 1998 to 2005. Zoster and PHN incidence rates were estimated as approximately 10/1000 and 1.45/1000 persons, respectively, with antivirals prescribed for 73.5% of zoster cases. Estimated hospitalisation and emergency department visit rates were 0.67/1000 and 0.38/1000 persons, respectively. Management of zoster (including PHN) involved approximately 2.4 general practitioner consultations. Total costs to the health care system were estimated as approximately 32.8 million per year. The substantial burden of zoster and PHN highlights the potential benefit of zoster vaccination.
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Affiliation(s)
- Alicia N Stein
- CSL Limited, 45 Poplar Road, Parkville, Victoria 3052, Australia.
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German V, Sakagiannis G, Margaritis G, Falagas ME. Inka dinka don't. Herpes zoster. Am J Med 2008; 121:772-3. [PMID: 18724965 DOI: 10.1016/j.amjmed.2008.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 05/27/2008] [Accepted: 05/28/2008] [Indexed: 11/24/2022]
Affiliation(s)
- Vasilios German
- Second Internal Medicine and Infectious Diseases Department, 401 Army General Hospital of Athens, Greece
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