1
|
Oh H, Tan C, Williams C, Giannelos N, Ng C. Public health impact of herpes zoster vaccination on older adults in Singapore: a modeling study. Hum Vaccin Immunother 2024; 20:2348839. [PMID: 38804600 PMCID: PMC11135959 DOI: 10.1080/21645515.2024.2348839] [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: 11/17/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
In Singapore, population aging and rising life expectancy are increasing herpes zoster (HZ) burden, which may be reduced by vaccination. The present study modeled the public health impact of HZ vaccination in Singapore using ZOster ecoNomic Analysis (ZONA) model adapted with Singapore-specific key model inputs, where available. Base case analysis was conducted in adults ≥ 50 years of age (YOA), exploring three vaccination strategies (no vaccination, recombinant zoster vaccine [RZV], zoster vaccine live [ZVL]) under mass vaccination setting (30% coverage). Scenario and sensitivity analyses were performed. Out of 1.51 million adults in 2021 (base case population), 406,513 (27.0%) cases of HZ, 68,264 (4.5%) cases of post-herpetic neuralgia (PHN), and 54,949 (3.6%) cases of other complications were projected without vaccination. RZV was estimated to avoid 73,129 cases of HZ, 11,094 cases of PHN, and 9,205 cases of other complications over the subjects' remaining lifetime; ZVL would avoid 17,565 cases of HZ, 2,781 cases of PHN, and 1,834 cases of other complications. The number needed to vaccinate to prevent one case of HZ/PHN was lower for RZV (7/41) than ZVL (26/163). Among all five age-stratified cohorts (50-59/60-64/65-69/70-79/≥80 YOA), RZV (versus no vaccination/ZVL) avoided the largest number of cases in the youngest cohort, 50-59 YOA. Results were robust under scenario and sensitivity analyses. Mass vaccination with RZV is expected to greatly reduce the public health burden of HZ among Singapore individuals ≥ 50 YOA. Findings support value assessment and decision-making regarding public health vaccination strategies for HZ prevention in Singapore.
Collapse
Affiliation(s)
- Helen Oh
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | - Carol Tan
- The Good Life Medical Centre, Geriatric Medicine, Mount Alvernia Hospital, Singapore, Singapore
| | | | | | - Cheryl Ng
- VEO Greater China and Intercontinental, GSK, Singapore, Singapore
| |
Collapse
|
2
|
Steinmann M, Lampe D, Grosser J, Schmidt J, Hohoff ML, Fischer A, Greiner W. Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns. Infection 2024; 52:1009-1026. [PMID: 38236326 PMCID: PMC11142967 DOI: 10.1007/s15010-023-02156-y] [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: 10/24/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE The burden of herpes zoster (HZ) is substantial and numerous chronic underlying conditions are known as predisposing risk factors for HZ onset. Thus, a comprehensive study is needed to synthesize existing evidence. This study aims to comprehensively identify these risk factors. METHODS A systematic literature search was done using MEDLINE via PubMed, EMBASE and Web of Science for studies published from January 1, 2003 to January 1, 2023. A random-effects model was used to estimate pooled Odds Ratios (OR). Heterogeneity was assessed using the I2 statistic. For sensitivity analyses basic outlier removal, leave-one-out validation and Graphic Display of Heterogeneity (GOSH) plots with different algorithms were employed to further analyze heterogeneity patterns. Finally, a multiple meta-regression was conducted. RESULTS Of 6392 considered records, 80 were included in the meta-analysis. 21 different conditions were identified as potential risk factors for HZ: asthma, autoimmune disorders, cancer, cardiovascular disorders, chronic heart failure (CHF), chronic obstructive pulmonary disorder (COPD), depression, diabetes, digestive disorders, endocrine and metabolic disorders, hematological disorders, HIV, inflammatory bowel disease (IBD), mental health conditions, musculoskeletal disorders, neurological disorders, psoriasis, renal disorders, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and transplantation. Transplantation was associated with the highest risk of HZ (OR = 4.51 (95% CI [1.9-10.7])). Other risk factors ranged from OR = 1.17-2.87, indicating an increased risk for all underlying conditions. Heterogeneity was substantial in all provided analyses. Sensitivity analyses showed comparable results regarding the pooled effects and heterogeneity. CONCLUSIONS This study showed an increased risk of HZ infections for all identified factors.
Collapse
Affiliation(s)
- Maren Steinmann
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - David Lampe
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - John Grosser
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Juliana Schmidt
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Marla Louise Hohoff
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Anita Fischer
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
3
|
Wen SY, Ou-Yang C, Chang C, Chen CC, Chang HY. Impact of Type 1 Versus Type 2 Diabetes on Developing Herpes Zoster and Post-herpetic Neuralgia: A Population-based Cohort Study. Acta Derm Venereol 2023; 103:adv9400. [PMID: 37787418 PMCID: PMC10561104 DOI: 10.2340/actadv.v103.9400] [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: 02/04/2023] [Accepted: 07/14/2023] [Indexed: 10/04/2023] Open
Abstract
Type 2 diabetes is associated with an increased risk of herpes zoster and postherpetic neuralgia. However, the association of type 1 diabetes with herpes zoster or postherpetic neuralgia remains unclear. This retrospective cohort study using Taiwan's Health Insurance Research Database included 199,566 patients with type 1 diabetes and 1,458,331 with type 2 diabetes, identified during the period 2000 to 2012. Patients with type 1 diabetes had a significantly higher risk of developing herpes zoster than those with type 2 diabetes (p < 0.001). Across all age groups, the impact of diabetes on herpes zoster was greater in type 1 than in type 2 diabetes. Patients with both type 1 and type 2 diabetes had a 1.45-fold higher risk of post-herpetic neuralgia than those without diabetes (hazard ratio 1.45, 95% confidence interval 1.28-1.65; hazard ratio 1.45, 95% confidence interval 1.37-1.52, respectively), and there was no difference between the 2 types of diabetes (hazard ratio 1.06; 95% confidence interval 0.93-1.21). The results recommend consideration of herpes zoster vaccination at an earlier age in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Su-Ying Wen
- School of Management, National Taiwan University of Science and Technology, Taipei, Taiwan; Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan; Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Health and Welfare, University of Taipei, Taipei, Taiwan,
| | - Chao Ou-Yang
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | | | - Chu-Chieh Chen
- National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Hung-Yu Chang
- Division of Endocricrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Health Care Center, Chang Gung Memorial Hospital, Taoyuan Branch, Taiwan.
| |
Collapse
|
4
|
Management of Invasive Infections in Diabetes Mellitus: A Comprehensive Review. BIOLOGICS 2023. [DOI: 10.3390/biologics3010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Patients with diabetes often have more invasive infections, which may lead to an increase in morbidity. The hyperglycaemic environment promotes immune dysfunction (such as the deterioration of neutrophil activity, antioxidant system suppression, and compromised innate immunity), micro- and microangiopathies, and neuropathy. A greater number of medical interventions leads to a higher frequency of infections in diabetic patients. Diabetic individuals are susceptible to certain conditions, such as rhino-cerebral mucormycosis or aspergillosis infection. Infections may either be the primary symptom of diabetes mellitus or act as triggers in the intrinsic effects of the disease, such as diabetic ketoacidosis and hypoglycaemia, in addition to increasing morbidity. A thorough diagnosis of the severity and origin of the infection is necessary for effective treatment, which often entails surgery and extensive antibiotic use. Examining the significant issue of infection in individuals with diabetes is crucial. Comprehensive research should examine why infections are more common amongst diabetics and what the preventive treatment strategies could be.
Collapse
|
5
|
Huang CT, Lee CY, Sung HY, Liu SJ, Liang PC, Tsai MC. Association Between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2022; 107:586-597. [PMID: 34536279 DOI: 10.1210/clinem/dgab675] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT Individuals with diabetes mellitus (DM) are susceptible to various infections. OBJECTIVE We estimated the risk of herpes zoster (HZ) among individuals with DM compared with individuals in the general population. METHODS We searched the PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and PerioPath databases from their inception to January 30, 2021, for studies on the risk of HZ in individuals with DM. Two authors independently screened all articles identified. The same 2 authors independently extracted the data. Four case-control studies and 12 cohort studies were included. RESULTS Meta-analyses were performed using fixed and mixed-effects models. In the pooled analysis, individuals with DM had a higher risk of developing HZ (pooled relative risk [RR]: 1.38; 95% CI, 1.21-1.57) than individuals in the general population. The results were consistent in subgroup analyses stratified by type of diabetes, age, and study design. In individuals with DM, cardiovascular disease had an additive effect on increasing the risk of HZ (pooled RR: 1.19; 95% CI, 1.11-1.28). There was a linear dose-response association between age and the risk of HZ in individuals with DM. CONCLUSION Individuals with DM have an increased risk of HZ compared with the general population. Varicella vaccination should be provided to individuals with DM regardless of their age, prioritizing older adults and those with cardiovascular disease. Varicella vaccination policies for individuals with DM should be updated based on the evidence.
Collapse
Affiliation(s)
- Chun-Ta Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Chi-Yu Lee
- Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Heng-You Sung
- Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Shu-Jung Liu
- Department of Medical Library, Mackay Memorial Hospital, Tamsui Branch, New Taipei City 25160, Taiwan
| | | | - Ming-Chieh Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
| |
Collapse
|
6
|
Hegazy WAH, Rajab AAH, Abu Lila AS, Abbas HA. Anti-diabetics and antimicrobials: Harmony of mutual interplay. World J Diabetes 2021; 12:1832-1855. [PMID: 34888011 PMCID: PMC8613656 DOI: 10.4239/wjd.v12.i11.1832] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/26/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes is one of the four major non-communicable diseases, and appointed by the world health organization as the seventh leading cause of death worldwide. The scientists have turned over every rock in the corners of medical sciences in order to come up with better understanding and hence more effective treatments of diabetes. The continuous research on the subject has elucidated the role of immune disorders and inflammation as definitive factors in the trajectory of diabetes, assuring that blood glucose adjustments would result in a relief in the systemic stress leading to minimizing inflammation. On a parallel basis, microbial infections usually take advantage of immunity disorders and propagate creating a pro-inflammatory environment, all of which can be reversed by antimicrobial treatment. Standing at the crossroads between diabetes, immunity and infection, we aim in this review at projecting the interplay between immunity and diabetes, shedding the light on the overlapping playgrounds for the activity of some antimicrobial and anti-diabetic agents. Furthermore, we focused on the anti-diabetic drugs that can confer antimicrobial or anti-virulence activities.
Collapse
Affiliation(s)
- Wael A H Hegazy
- Department of Microbiology and Immunology, Zagazig University, Zagzig 44519, Egypt
| | - Azza A H Rajab
- Department of Microbiology and Immunology, Zagazig University, Zagzig 44519, Egypt
| | - Amr S Abu Lila
- Department of Pharmaceutics, Zagazig University, Faculty of Pharmacy, Zagzig 44519, Egypt
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 81442, Saudi Arabia
| | - Hisham A Abbas
- Department of Microbiology and Immunology, Zagazig University, Zagzig 44519, Egypt
| |
Collapse
|
7
|
Batram M, Witte J, Schwarz M, Hain J, Ultsch B, Steinmann M, Bhavsar A, Wutzler P, Criée CP, Hermann C, Wahle K, Füchtenbusch M, Greiner W. Burden of Herpes Zoster in Adult Patients with Underlying Conditions: Analysis of German Claims Data, 2007-2018. Dermatol Ther (Heidelb) 2021; 11:1009-1026. [PMID: 33959878 PMCID: PMC8163947 DOI: 10.1007/s13555-021-00535-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Several chronic underlying conditions (UCs) are known to be risk factors for developing herpes zoster (HZ) and to increase the severity of HZ and its risk of recurrence. The aim of this study was to investigate the incidence and recurrence of HZ in adult patients with one or multiple UCs. METHODS A retrospective cohort study based on claims data representing 13% of the statutory health insurance population from 2007 to 2018 in Germany was performed. Patients aged ≥ 18 years were included when at least one of the following UCs was diagnosed: asthma, chronic heart failure, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), depression, diabetes mellitus type 1 or 2, and rheumatoid arthritis (RA). Exact matching was used to account for differences in the distribution of age and sex between the case and matched control cohorts. Multi-morbidity was considered in sensitivity analyses by analyzing patients with only one UC. RESULTS Patients with asthma, CHD, COPD, depression, and RA had, on average, a 30% increased risk of developing acute HZ compared to patients without any UC. RA was found to have the highest odds ratio among these conditions, varying from 1.37 to 1.57 for all age groups. Patients with depression also showed a high risk of developing HZ. Analysis of recurrence indicated that patients with at least one UC in the age groups 18-49 years and 50-59 years had the highest risk for a recurrent HZ. After experiencing a first recurrence, patients, regardless of age group, had a two- to threefold higher risk for a second recurrence. CONCLUSION This study of representative claims data shows a higher HZ incidence and recurrence frequency in patients with UCs. These results provide relevant information for national health care guidelines and disease management programs.
Collapse
Affiliation(s)
- Manuel Batram
- Department for Economics, Bielefeld University, P.O. Box 100131, 33501 Bielefeld, Germany
| | - Julian Witte
- Department for Health Economics and Health Care Management, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | | | | | | | - Maren Steinmann
- Department for Health Economics and Health Care Management, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | | | - Peter Wutzler
- Section of Experimental Virology, Institute of Medical Microbiology, University-Hospital Jena, 07740 Jena, Germany
| | - Carl-Peter Criée
- Department of Sleep and Respiratory Medicine, Evangelical Hospital Goettingen-Weende, 37120 Bovenden, Germany
| | - Christiane Hermann
- Department of Clinical Psychology, Justus-Liebig University Giessen, Otto-Behaghel-Strasse 10F, 35394 Giessen, Germany
| | - Klaus Wahle
- Department of General Medicine, University of Muenster, Domagkstr. 3, 48129 Muenster, Germany
| | - Martin Füchtenbusch
- Diabeteszentrum am Marienplatz, Rindermarkt 3, 80331 Munich, Germany
- Forschergruppe Diabetes E.V. am Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Munich-Neuherberg, Germany
| | - Wolfgang Greiner
- Department for Health Economics and Health Care Management, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| |
Collapse
|
8
|
Lai SW, Liu CS, Kuo YH, Lin CL, Hwang BF, Liao KF. The incidence of herpes zoster in patients with diabetes mellitus: A meta-analysis of cohort studies. Medicine (Baltimore) 2021; 100:e25292. [PMID: 33879659 PMCID: PMC8078473 DOI: 10.1097/md.0000000000025292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/05/2021] [Indexed: 01/04/2023] Open
Abstract
The research has correlated the risk factors of herpes zoster with some chronic diseases. This meta-analysis aimed to assess the incidence of herpes zoster in patients with diabetes mellitus.We conducted a literature search using Web of Science and PubMed for articles published from January 1, 2000 to December 31, 2019. The incidence rate ratio and 95% confidence interval for herpes zoster associated with diabetes mellitus was calculated.We included 5 cohort studies for a meta-analysis. The pooled incidences of herpes zoster in patients with diabetes mellitus and in patients without diabetes mellitus were 7.22 and 4.12 per 1000 person-years. The overall risk of developing herpes zoster was significantly higher in patients with diabetes mellitus when compared to those with no diabetes mellitus (incidence rate ratio = 1.60, 95% confidence interval = 1.33-1.93).Patients with diabetes mellitus are substantially at increased risk for the development of herpes zoster. Patients with diabetes mellitus should take into consideration the vaccination to prevent herpes zoster.
Collapse
Affiliation(s)
- Shih-Wei Lai
- Department of Public Health, College of Public Health and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital
| | - Cheng-Li Lin
- School of Medicine, College of Medicine, China Medical University
- Management Office for Health Data, China Medical University Hospital
| | - Bing-Fang Hwang
- Department of Occupational Safety and Health, College of Public Health, China Medical University
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien
| |
Collapse
|
9
|
Yin D, Van Oorschot D, Jiang N, Marijam A, Saha D, Wu Z, Tang H, Diaz-Decaro J, Watson P, Xie X, Ren Y, He Y, Feng Y. A systematic literature review to assess the burden of herpes zoster disease in China. Expert Rev Anti Infect Ther 2020; 19:165-179. [PMID: 32997550 DOI: 10.1080/14787210.2020.1792290] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Herpes zoster (HZ) or shingles occurs as a result of reactivation after a primary infection with varicella zoster virus (chickenpox). The burden of HZ in older adults in China is not well understood. We conducted a systematic literature review to understand the burden of disease related to HZ, its complications, and associated costs in China. AREAS COVERED Using publications retrieved from Chinese and English literature databases, we described incidence and prevalence of HZ, occurrence of HZ-related complications, and costs associated with HZ in mainland China, Taiwan, and Hong Kong. EXPERT OPINION The data, although limited, indicate that the burden of disease due to HZ is substantial in China, with incidence rates that are comparable to the rest of the world. Recently, an adjuvanted recombinant HZ vaccine was approved for use in China. Disease prevention is likely to reduce the burden of disease, with potentially significant economic benefits. However, understanding the public health impact of vaccination in China will require extensive baseline information about incidence, complication rates, and associated costs. This review gives an overview of available research, but also reveals existing gaps. Well-designed observational studies are needed to quantify the total burden of disease and potential impact of prevention through vaccination.
Collapse
Affiliation(s)
- Dapeng Yin
- Epidemiology Office, Chinese Center for Disease Control and Prevention , Beijing, China
| | | | - Ning Jiang
- Vaccines Medical/Clinical, GSK China , Beijing, China
| | - Alen Marijam
- Value Evidence and Outcomes, GSK Upper Providence , PA, USA
| | - Debasish Saha
- Epidemiology & Health Economics, GSK , Wavre, Belgium
| | - Zhenhua Wu
- Vaccines Medical/Clinical, GSK China Al , Beijing, China
| | - Haiwen Tang
- China/Hong Kong Vaccines Research & Development, GSK , Shanghai, China
| | | | - Phil Watson
- Medical Affairs Lead, Zoster, New Wave Countries, GSK , Leeds, UK
| | - Xueqiong Xie
- R&D, Xiamen Chazen Biomedical Technology Co. Ltd , Xiamen, China
| | - Yifan Ren
- R&D, Xiamen Chazen Biomedical Technology Co. Ltd , Xiamen, China
| | - Yu He
- Vaccines Medical, GSK China , Shanghai, China
| | - Yang Feng
- R&D, Xiamen Chazen Biomedical Technology Co. Ltd , Xiamen, China
| |
Collapse
|
10
|
Marra F, Parhar K, Huang B, Vadlamudi N. Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect Dis 2020; 7:ofaa005. [PMID: 32010734 PMCID: PMC6984676 DOI: 10.1093/ofid/ofaa005] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background The burden of herpes zoster (HZ) is significant worldwide, with millions affected and the incidence rising. Current literature has identified some risk factors for this disease; however, there is yet to be a comprehensive study that pools all evidence to provide estimates of risk. Therefore, the purpose of this study is to identify various risk factors, excluding immunosuppressive medication, that may predispose an individual to developing HZ. Methods The literature search was conducted in MEDLINE, EMBASE, and Cochrane Central, yielding case control, cohort, and cross-sectional studies that were pooled from January 1966 to September 2017. Search terms included the following: zoster OR herpe* OR postherpe* OR shingle* AND risk OR immunosupp* OR stress OR trauma OR gender OR ethnicity OR race OR age OR diabetes OR asthma OR chronic obstructive pulmonary disease OR diabetes. Risk ratios (RRs) for key risk factors were calculated via natural logarithms and pooled using random-effects modeling. Results From a total of 4417 identified studies, 88 were included in analysis (N = 3, 768 691 HZ cases). Immunosuppression through human immunodeficiency virus/acquired immune deficiency syndrome (RR = 3.22; 95% confidence interval [CI], 2.40–4.33) or malignancy (RR = 2.17; 95% CI, 1.86–2.53) significantly increased the risk of HZ compared with controls. Family history was also associated with a greater risk (RR = 2.48; 95% CI, 1.70–3.60), followed by physical trauma (RR = 2.01; 95% CI, 1.39–2.91) and older age (RR = 1.65; 95% CI, 1.37–1.97). A slightly smaller risk was seen those with psychological stress, females, and comorbidities such as diabetes, rheumatoid arthritis, cardiovascular diseases, renal disease, systemic lupus erythematosus, and inflammatory bowel disease compared with controls (RR range, 2.08–1.23). We found that black race had lower rates of HZ development (RR = 0.69; 95% CI, 0.56–0.85). Conclusions This study demonstrated a number of risk factors for development of HZ infection. However, many of these characteristics are known well in advance by the patient and clinician and may be used to guide discussions with patients for prevention by vaccination.
Collapse
Affiliation(s)
- Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamalpreet Parhar
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bill Huang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nirma Vadlamudi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
11
|
The diabetes pandemic and associated infections: suggestions for clinical microbiology. ACTA ACUST UNITED AC 2018; 30:1-17. [PMID: 30662163 PMCID: PMC6319590 DOI: 10.1097/mrm.0000000000000155] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/08/2017] [Indexed: 12/15/2022]
Abstract
There are 425 million people with diabetes mellitus in the world. By 2045, this figure will grow to over 600 million. Diabetes mellitus is classified among noncommunicable diseases. Evidence points to a key role of microbes in diabetes mellitus, both as infectious agents associated with the diabetic status and as possible causative factors of diabetes mellitus. This review takes into account the different forms of diabetes mellitus, the genetic determinants that predispose to type 1 and type 2 diabetes mellitus (especially those with possible immunologic impact), the immune dysfunctions that have been documented in diabetes mellitus. Common infections occurring more frequently in diabetic vs. nondiabetic individuals are reviewed. Infectious agents that are suspected of playing an etiologic/triggering role in diabetes mellitus are presented, with emphasis on enteroviruses, the hygiene hypothesis, and the environment. Among biological agents possibly linked to diabetes mellitus, the gut microbiome, hepatitis C virus, and prion-like protein aggregates are discussed. Finally, preventive vaccines recommended in the management of diabetic patients are considered, including the bacillus calmette-Guerin vaccine that is being tested for type 1 diabetes mellitus. Evidence supports the notion that attenuation of immune defenses (both congenital and secondary to metabolic disturbances as well as to microangiopathy and neuropathy) makes diabetic people more prone to certain infections. Attentive microbiologic monitoring of diabetic patients is thus recommendable. As genetic predisposition cannot be changed, research needs to identify the biological agents that may have an etiologic role in diabetes mellitus, and to envisage curative and preventive ways to limit the diabetes pandemic.
Collapse
|
12
|
Lin SY, Zhang SZ, An JX, Qian XY, Gao XY, Wang Y, Zhao WX, Eastwood D, Cope DK, Williams JP. The effect of ultrasound-guided percutaneous ozone injection around cervical dorsal root ganglion in zoster-associated pain: a retrospective study. J Pain Res 2018; 11:2179-2188. [PMID: 30323652 PMCID: PMC6174887 DOI: 10.2147/jpr.s163340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective This study was to evaluate the effectiveness of ultrasound-guided percutaneous ozone injections around the cervical dorsal root ganglions of zoster-associated pain (ZAP) patients. Study design Retrospective comparative study. Settings The study was conducted at a pain center of a university hospital. Patients and methods From June 2016 to July 2017, a total number of 30 patients with ZAP were treated with ultrasound-guided percutaneous ozone injection around the cervical dorsal root ganglion (DRG) at the injured nerve level (C2-C8). A volume of 3 mL ozone-oxygen mixture at a concentration of 30 µg/mL was injected into the area around the DRG. Patients were divided into two groups according to their disease duration: group A (at or <3 months) and group B (>3 months). The pain severity was assessed according to a visual analog scale, and imaging changes were evaluated by ultrasound. Patient improvements in pain and neurologic function were evaluated during a follow-up period from 1 to 3 months. Results The data showed that ozone injections reduced pain in patients with ZAP. However, the success rate of group A was higher than group B. After the injection, the von Frey data demonstrated decreases in both groups, but, there were no significant differences between the groups. Moreover, univariate logistic regression analysis and multivariate regression analysis showed a history of diabetes mellitus had a significant effect on the treatment results. Conclusions Percutaneous ozone injection around the DRG might be a useful method for treatment-resistant cases of ZAP at the cervical level. Institutional Review Board (IRB) approval number: HK2017-1130.
Collapse
Affiliation(s)
- Si-Yu Lin
- China Three Gorges, University School of Medicine, Yichang, China, .,Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China,
| | - Shi-Zhong Zhang
- China Three Gorges, University School of Medicine, Yichang, China,
| | - Jian-Xiong An
- China Three Gorges, University School of Medicine, Yichang, China, .,Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China,
| | - Xiao-Yan Qian
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China,
| | - Xin-You Gao
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China,
| | - Yong Wang
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China,
| | - Wen-Xing Zhao
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China,
| | - Derek Eastwood
- Department of Pain Services, Wirral University Teaching Hospital, Wirral, Merseyside, UK
| | - Doris K Cope
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John P Williams
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
13
|
Abstract
Accumulating evidence suggests that diabetes mellitus (DM) represents an important risk factor for both herpes zoster and post-herpetic neuralgia. Moreover, post-herpetic neuralgia appears to be more severe and persistent in diabetic patients. On the other hand, a novel vaccine against varicella-zoster virus (VZV) was recently introduced in clinical practice. Given the increased risk and severity of herpes zoster infection in patients with DM, this vaccine might be useful in this population. However, there are limited data regarding the efficacy and safety of vaccination against herpes zoster in the diabetic population. The aim of the present review is to discuss the incidence and consequences of herpes zoster infection in DM and to comment on the role of vaccination against VZV in these patients.
Collapse
Affiliation(s)
- Marianthi Papagianni
- First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Symeon Metallidis
- First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
14
|
Kawai K, Yawn BP. Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis. Mayo Clin Proc 2017; 92:1806-1821. [PMID: 29202939 DOI: 10.1016/j.mayocp.2017.10.009] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To systematically review studies examining risk factors for herpes zoster (HZ). METHODS We performed a literature search using PubMed, EMBASE, and Web of Science for articles published from January 1, 2003, to February 1, 2017. A random-effects model was used to summarize the risk ratio (RR) or odds ratio (OR) and 95% CI. RESULTS Of the 3450 studies screened, we included 84 studies in the systematic review and conducted meta-analysis in 62 studies. Women were at increased risk of HZ compared with men (pooled adjusted RR, 1.31; 95% CI, 1.27-1.34). Black individuals had almost half the risk of HZ as white individuals (pooled RR, 0.54; 95% CI, 0.47-0.63). Family history was found to be a risk factor for HZ (pooled OR, 3.59; 95% CI, 2.39-5.40). Autoimmune diseases, including rheumatoid arthritis (pooled RR, 1.67; 95% CI, 1.41-1.98) and systemic lupus erythematosus (pooled RR, 2.10; 95% CI, 1.40-3.15), were associated with an elevated risk of HZ. Other comorbidities were associated with an increased risk of HZ, with the pooled RRs ranging from 1.25 (95% CI, 1.13-1.39) for asthma to 1.30 (95% CI, 1.17-1.45) for diabetes mellitus and 1.31 (95% CI, 1.22-1.41) for chronic obstructive pulmonary disease. CONCLUSION Our review revealed that female sex, race/ethnicity, family history, and comorbidities are risk factors for HZ. Efforts are needed to increase the uptake of zoster vaccination.
Collapse
Affiliation(s)
- Kosuke Kawai
- Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA.
| | - Barbara P Yawn
- Department of Family Medicine and Community Health, University of Minnesota, Blaine, MN
| |
Collapse
|
15
|
Muñoz-Quiles C, López-Lacort M, Ampudia-Blasco FJ, Díez-Domingo J. Risk and impact of herpes zoster on patients with diabetes: A population-based study, 2009-2014. Hum Vaccin Immunother 2017; 13:2606-2611. [PMID: 28933622 PMCID: PMC5798425 DOI: 10.1080/21645515.2017.1368600] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/14/2017] [Accepted: 08/13/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS This study was designed to assess the impact of diabetes on the risk and severity of herpes zoster (HZ), and the impact of HZ on diabetes. It focused primarily on immunocompetent patients aged ≥ 50 years who would be eligible for preventive vaccination. METHODS Using population and healthcare databases of Valencia Region (Spain), a retrospective cohort of all subjects ≥ 50 years was followed up between 2009 and 2014. HZ and diabetes were defined using ICD-9 codes. We compared the incidence of HZ between non-diabetes and diabetes groups and healthcare resource consumption due to HZ in the 6 months following HZ diagnosis using different statistical generalized linear models (GLM). We also compared resources consumption due to diabetes treatment and haemoglobinA1c(HbA1c) levels before and after HZ. RESULTS The cohort consisted of 2,289,485 individuals ≥ 50 years old, 397,940 of whom had diabetes. HZ incidence rate was 9.3 cases/1000 persons with diabetes-year (95% CI: 9.1-9.4). Incidence increased with age in all groups. The risk of HZ increased in the diabetes group compared to the non-diabetes group (RR 1.2, 95% credibility interval [CrI] 1.17-1.22). Patients with diabetes utilized more health care resources due to their HZ episodes than patients without diabetes. In 24% of well controlled patients with diabetes (HbA1C levels ≤ 6.5%), HbA1C increased after HZ. CONCLUSIONS Diabetes increased by 20% the risk of HZ. HZ contributed to the deterioration of glycaemic control and higher healthcare resource consumption in people with diabetes, becoming a priority population for HZ immunization.
Collapse
Affiliation(s)
- Cintia Muñoz-Quiles
- Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain
| | - Mónica López-Lacort
- Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain
| | - F. Javier Ampudia-Blasco
- Diabetes Reference Unit, Endocrinology and Nutrition Dep., Clinic University Hospital of Valencia, Valencia, Spain
| | - Javier Díez-Domingo
- Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain
- Universidad Católica de Valencia San Vicente Mártir, València, Spain
| |
Collapse
|
16
|
Schmidt SAJ, Vestergaard M, Baggesen LM, Pedersen L, Schønheyder HC, Sørensen HT. Prevaccination epidemiology of herpes zoster in Denmark: Quantification of occurrence and risk factors. Vaccine 2017; 35:5589-5596. [PMID: 28874322 DOI: 10.1016/j.vaccine.2017.08.065] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/07/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Herpes zoster (HZ) is a vaccine-preventable disease caused by reactivation of the varicella-zoster virus. Unfortunately, formulation of recommendations on routine immunization is hampered by a lack of data on disease burden, since most countries do not record cases of HZ in the general population. We developed and validated an algorithm to identify HZ based on routinely collected registry data and used it to quantify HZ occurrence and risk factors in Denmark prior to marketing of the HZ vaccine. METHODS We included patients aged ≥40years with a first-time systemic Acyclovir, Valacyclovir, or Famciclovir prescription or a hospital-based HZ diagnosis in the Danish nationwide health registries during 1997-2013. In a validation substudy (n=176), we computed the proportion of persons with HZ among patients who redeemed antiviral prescriptions. In a cohort study, we computed age-specific rates of HZ (45,297,258 person-years). In a case-control study, we then computed odds ratios (ORs) for common chronic diseases and immunosuppressive factors among HZ cases (n=189,025) vs. matched population controls (n=945,111). RESULTS Medical record review confirmed HZ in 87% (95% confidence interval: 79-93%) of persons ≥40years who dispensed antivirals at doses recommended for HZ. HZ rates increased from 2.15/1000 person-years in 40-year-olds to 9.45/1000 person-years in 95-year-olds. Rates were highest in women. HZ was diagnosed during hospitalization among 3.5%. As expected, persons with severe immunosuppressive conditions had the highest ORs of HZ (between 1.82 and 4.12), but various autoimmune diseases, asthma, chronic kidney disease, and inhaled glucocorticoids were also associated with increased ORs (between 1.06 and 1.64). CONCLUSION This algorithm is a valid tool for identifying HZ in routine healthcare data. It shows that HZ is common in Denmark, especially in patients with certain chronic conditions. Prioritized vaccination of such high-risk patients might be an option in countries considering alternatives to universal vaccination.
Collapse
Affiliation(s)
- Sigrun A J Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Emergency Department, Regional Hospital of Randers, Randers, Denmark.
| | - Mogens Vestergaard
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark; Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lisbeth M Baggesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|