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Growing international and national focus on quantitatively measuring and improving ocean health has increased the need for comprehensive, scientific, and repeated indicators to track progress towards achieving policy and societal goals. The Ocean Health Index (OHI) is one of the few indicators available for this purpose. Here we present results from five years of annual global assessment for 220 countries and territories, evaluating potential drivers and consequences of changes and presenting lessons learned about the challenges of using composite indicators to measure sustainability goals. Globally scores have shown little change, as would be expected. However, individual countries have seen notable increases or declines due in particular to improvements in the harvest and management of wild-caught fisheries, the creation of marine protected areas (MPAs), and decreases in natural product harvest. Rapid loss of sea ice and the consequent reduction of coastal protection from that sea ice was also responsible for declines in overall ocean health in many Arctic and sub-Arctic countries. The OHI performed reasonably well at predicting near-term future scores for many of the ten goals measured, but data gaps and limitations hindered these predictions for many other goals. Ultimately, all indicators face the substantial challenge of informing policy for progress toward broad goals and objectives with insufficient monitoring and assessment data. If countries and the global community hope to achieve and maintain healthy oceans, we will need to dedicate significant resources to measuring what we are trying to manage.

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.