A clinico-epidemiological multicenter study of herpes zoster in immunocompetent and immunocompromised hospitalized children

Abstract

Purpose There are limited population-based data regarding herpes zoster in children. Thus we conducted a multi-institutional epidemiological analysis of herpes zoster in children and comparative analysis according to their immune status. Materials and Methods The study included 126 children under the age of 18 years who were hospitalized for herpes zoster at 8 hospitals in South Korea, between July 2009 and June 2015. The subjects were divided into 2 groups according to their immune status, and medical records were reviewed. Results There were 61 cases (48.4%) in the immunocompetent group and 65 cases (51.6%) in the immunocompromised group. Median age was older in immunocompromised group (11.4 vs. 8.6) (p<0.001). The mean duration of hospitalization was longer in immunocompromised group (11.0 vs. 6.6) (p<0.001). Patients were treated with oral or intravenous antiviral agents. A total of 12 in immunocompetent group were cured only by oral acyclovir. No treatment failure was found in both groups. Six immunocompromised patients had postherpetic neuralgia and 1 case was in immunocompetent group. In immunocompetent children, herpes zoster was likely caused by early varicella infection. There was no increase in progression of severity in both groups due to appropriate treatment. Conclusion Early initiation of therapy is necessary for those in immunocompromised conditions. And inactivated herpes zoster vaccination may be considered in immunocompromised adolescents in the future.

Multidermatomal herpes zoster triggered by psychological stress in an immunocompetent young adult: a rare case report and clinical insights

“…In the immunocompetent cohort, zoster occurrences were most frequent in trigeminal dermatomes and subsequently in thoracic dermatomes with associated symptoms like fever, vomiting, and headache with fever being the most prevalent symptom. Unlikely our cases showed the involvement of cervical and thoracic dermatomes with no other associated symptoms except for pain 11 .…”

“…While HZV infection is commonly linked to prior exposure to VZV during childhood, there remains a dearth of comprehensive elucidation concerning the precise factors that prompt VZV reactivation in immunocompetent individuals as they advance in age 11 . Consequently, our presented case underscores a clinical perspective wherein psychological stress is identified as a potential trigger instigating VZV reactivation, consequently resulting in the manifestation of multidermatomal HZ infection.…”

“…HZV can be associated with several complications like meningitis, cellulitis, postherpetic neuralgia, etc. among which postherpetic neuralgia severely compromises the quality of life which is a common clinical sequale 11 . Individuals with multidermatomal involvement may present with skin rashes, itching, painful vesicular eruptions, headache, and fever and with several remarkable clinical spectrums, timely identification, and early management of which put a significant impact on their physical and mental health.…”

Trigeminal Sinir Dermatomu Yerleşimli Pediatrik Herpes Zoster

“…Herpes zoster, virüse özgü hücresel bağışıklığın azalmasıyla latent VZV'nin yeniden aktive olmasından kaynaklanır. Genellikle ileri yaşlı veya immunsüpresif bireylerde görülsede tüm yaş gruplarında ve immünkompetan bireylerde de görülebilir (6). Yirmi altı ülkeden 130 çalışmanın dahil edildiği meta-analizde herpes zoster görülme sıklığı yılda 3-5/1000 kişi arasında saptanmıştır (7).…”

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

“…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 .…”