Epidemiology and clinical characteristics of herpes zoster in a tertiary care hospital in Brazil

Antoniolli, Luciana Pavan; Rodrigues, C.; Borges, Rafael; Goldani, Luciano Zubaran

doi:10.1016/j.bjid.2019.03.001

Cited by 8 publications

(13 citation statements)

References 7 publications

(7 reference statements)

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“…3,4,11,16 Over 60.00% of the patients were aged ≥ 50 years, with 42.98% ≥ 60 years of age; the majority (70.00%) were women. These demographic characteristics are similar to previous reports from Brazil 9,10 and elsewhere. 3,4,11,16 Supplemental Figure 1 presents a plain-language summary of the context, outcomes, and relevance of this study for healthcare providers.…”

Section: Discussionsupporting

confidence: 90%

“…3,8 More recent data indicate that the burden of HZ and associated economic costs may be substantial. [9][10][11] The demographic shift in Brazil towards an aging population 12 suggests that the healthcare costs of HZ and associated complications may be high. Understanding the disease's epidemiology and developing control strategies to reduce the burden of both HZ and PHN may provide significant public health benefits.…”

Section: Introductionmentioning

confidence: 99%

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Burden of herpes zoster among Brazilian adults – a hospital-based study

Abreu

Venys

Jacob

et al. 2021

Geriatr Gerontol Aging

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OBJECTIVE: To describe the clinical features of herpes zoster in adult patients treated at a large tertiary care hospital in Brazil over a 5-year period. METHODS: The medical records of suspected herpes zoster cases (based on ICD-10 codes) were identified for full review. Convenience sampling was used to select the medical records from a tertiary hospital in São Paulo. We collected data about co-existing medical conditions, medication use, herpes zoster-related clinical features and outcomes, and healthcare resource utilization. RESULTS: A total of 249 individuals whose first episode of herpes zoster occurred between 2010 and 2014 were included. The mean patient age was 55 years (range 18–96), and the majority were women (63.05%) and aged ≥ 50 years (63.86%). Medical comorbidities were reported in 92.77%, including diabetes (19.68%) and HIV infection (7.63%). Current/recent use of immunosuppressive agents was reported in 31.73%. A total of 65.86% of the patients were hospitalized: 102 patients (40.96%) were admitted for herpes zoster management, while 62 (24.90%) were already receiving inpatient care. The mean hospital length of stay was 16.60 days. One-third (34.14%) were managed as outpatients. Postherpetic neuralgia was reported as a complication in 18.07%. CONCLUSIONS: This retrospective descriptive study found a high frequency of herpes zoster episodes in older adults with comorbidities who sought medical care at a tertiary hospital. These results also underscore the importance of understanding the epidemiology of this disease and developing control strategies for these at-risk populations in Brazil.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Burden of herpes zoster among Brazilian adults – a hospital-based study

Abreu

Venys

Jacob

et al. 2021

Geriatr Gerontol Aging

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“…The proportion of patients with ophthalmic herpes zoster (OHZ) oscillated between 0% and 7.6% in high-risk patients and was 2.0% in average-risk ones. The percentages of patients with Ramsay Hunt syndrome (RHS) was 1.75% in one large series from Brazil [ 45 ]. The proportion of patients with RHS was in one study and was 1.8% in high-risk patients.…”

Section: Resultsmentioning

confidence: 99%

“…There was large heterogeneity among the studies in the meta-analysis, explained by the fact that not all studies used the same criterion to define and report complications. Furthermore, the large differences in the number of patients among studies increased heterogeneity [ 42 , 45 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Herpes zoster epidemiology in Latin America: A systematic review and meta-analysis

et al. 2021

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The epidemiology and burden of Herpes Zoster (HZ) are largely unknown, and there are no recent reviews summarizing the available evidence from the Latin America and Caribbean (LAC) region. We conducted a systematic review and meta-analysis to characterize the epidemiology and burden of HZ in LAC. Bibliographic databases and grey literature sources were consulted to find studies published (January 2000 –February 2020) with epidemiological endpoints: cumulative incidence and incidence density (HZ cases per 100,000 person-years), prevalence, case-fatality rates, HZ mortality, hospitalization rates, and rates of each HZ complication. Twenty-six studies were included with most studies coming from Brazil. No studies reported the incidence of HZ in the general population. In population at higher risk, the cumulative incidence ranged from 318–3,423 cases of HZ per 100,000 persons per year of follow-up. The incidence density was 6.4–36.5 cases per 1,000 person-years. Age was identified as a major risk factor towards HZ incidence which increase significantly in people >50 years of age. Hospitalization rates ranged from 3%–35.7%. The in-hospital HZ mortality rate ranged from 0%–36%. Overall, HZ mortality rates were found to be higher in females across all age groups and countries. The incidence of HZ complications (such as post-herpetic neuralgia, ophthalmic herpes zoster, and Ramsay Hunt syndrome) was higher in the immunosuppressed compared to the immunocompetent population. Acyclovir was the most frequently used therapy. Epidemiological data from Ministry of Health databases (Argentina, Brazil, Colombia, Chile y Mexico) and Institute for Health Metrics and Evaluation’s Global Burden of Disease project reported stable rates of hospitalizations and deaths over the last 10 years. High-risk groups for HZ impose a considerable burden in LAC. They could benefit from directed healthcare initiatives, including adult immunization, to prevent HZ occurrence and its complications.

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“…However, HZ remains problematic for both the unvaccinated and immunocompromised populations, with increased incidence rates up to 3–4 and 5–6 times higher, respectively 2,4,5 . Adult studies have implicated immunocompromised status as a major risk factor in development of HZ, and there is an association between both immunosuppressive medications and chronic disease with worse outcomes 4–9 . Age‐specific incidence rates are 1.5–4 times higher for the adult autoimmune/autoinflammatory (AI) population compared to healthy adults 5 .…”

Section: Introductionmentioning

confidence: 99%

Validation of coding algorithms for the identification of herpes zoster among children

Rutstein

Gmuca

Gerber

et al. 2021

Pharmacoepidemiology and Drug

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Purpose To examine the validity of International Classification of Diseases, 10th Revision, (ICD‐10) code‐based algorithms for herpes zoster (HZ) in the electronic medical record (EMR) of a large, integrated pediatric healthcare network and to examine baseline demographics and chronic comorbidities associated with HZ in a representative pediatric population. Methods We reviewed the electronic charts of all patients with a single ICD‐10 for HZ (B02.xx) as their primary or secondary diagnosis in the EMR of the Children's Hospital of Philadelphia (CHOP) healthcare network from January 2010–March 2019. The positive predictive value (PPV) for a single code for HZ was calculated and alternative algorithms were examined to determine which method resulted in the highest PPV. Results The PPV for a single ICD‐10 code was 91.7% (95% CI 80.8–95.4) for definitive and/or probable cases of HZ and 63.9% (95% CI 53.4%–75.5%) for definitive cases alone. Adding a prescription for an antiviral did not improve the PPV. However, adding a new code for rash entered within 1 week of the HZ code increased the PPV to 100% for definitive and/or probable cases but with substantial loss of sensitivity. A high proportion of children with HZ who required inpatient hospitalization had chronic disease (70%) and were on systemic immunomodulatory therapy (50%). Conclusions HZ can be identified with a high PPV in electronic medical records of children using ICD‐10 code alone. These findings lay the foundation for future pharmacoepidemiologic research to better understand risk factors for HZ infection.

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Epidemiology and clinical characteristics of herpes zoster in a tertiary care hospital in Brazil

Cited by 8 publications

References 7 publications

Burden of herpes zoster among Brazilian adults – a hospital-based study

Burden of herpes zoster among Brazilian adults – a hospital-based study

Herpes zoster epidemiology in Latin America: A systematic review and meta-analysis

Validation of coding algorithms for the identification of herpes zoster among children

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