Disease burden of herpes zoster in Sweden - predominance in the elderly and in women - a register based study

Abstract

BackgroundThe herpes zoster burden of disease in Sweden is not well investigated. There is no Swedish immunization program to prevent varicella zoster virus infections. A vaccine against herpes zoster and its complications is now available. The aim of this study was to estimate the herpes zoster burden of disease and to establish a pre-vaccination baseline of the minimum incidence of herpes zoster.MethodsData were collected from the Swedish National Health Data Registers including the Patient Register, the Pharmacy Register, and the Cause of Death Register. The herpes zoster burden of disease in Sweden was estimated by analyzing the overall, and age and gender differences in the antiviral prescriptions, hospitalizations and complications during 2006-2010 and mortality during 2006-2009.ResultsAnnually, 270 per 100,000 persons received antiviral treatment for herpes zoster, and the prescription rate increased with age. It was approximately 50% higher in females than in males in the age 50+ population (rate ratio 1.39; 95% CI, 1.22 to 1.58). The overall hospitalization rate for herpes zoster was 6.9/100,000 with an approximately three-fold increase for patients over 80 years of age compared to the age 70-79 group. A gender difference in hospitalization rates was observed: 8.1/100,000 in females and 5.6/100,000 in males. Herpes zoster, with a registered complication, was found in about one third of the hospitalized patients and the most common complications involved the peripheral and central nervous systems. Death due to herpes zoster was a rare event.ConclusionsThe results of this study demonstrate the significant burden of herpes zoster disease in the pre-zoster vaccination era. A strong correlation with age in the herpes zoster- related incidence, hospitalization, complications, and mortality rates was found. In addition, the study provides further evidence of the female predominance in herpes zoster disease.

Temporal trends in herpes zoster-related hospitalizations in Madrid (Spain), 2003–2013

“…22,35 This range appears to be wider when only hospitalizations with HZ as principal diagnosis are considered, reaching a 58.5%. 30,32 Complications stemming from the peripheral and central nervous systems dominated (including postherpetic neuralgia), quite similar to the findings at national and international levels. 12,22,32 Other common complications were herpes zoster opthalmicus, among which a study in our country detected a significant increase from 1997 to 2008.…”

“…22, 23, 30, 32, 34e36 Hospitalization rates considering only primary diagnoses of HZ are similar in our region to the average rate for Spain and slightly lower to those found in other similar regions, which ranged between 3.1 and 6.9 per 100,000 personyear. 21,22,32,34,35 This variation may reflect the differing admission criteria in the different settings, as well as …”

“…No changing trends were found in Sweden for the period 2006e2010, with no national pediatric immunization program against VZV, and in a province of Canada between 1992 and 2008, where varicella vaccine was available since 1999 and funded for children by a governmental program since 2005. 24,32 Another study performed in The Netherlands, with no routine VZV vaccination, even found lower hospitalization rates for the 4-year period 1998e2001 compared to 1994e1997. 21 In the other hand a specific study of hospital discharges with diagnoses of HZ in US found that population-adjusted rates of hospital admissions began to increase in 2001 being this trend specially marked in the group of 65 years and over.…”

Reducing the burden of Herpes Zoster in Italy

“…HZ is an extremely debilitating experience, for the affected subjects, with an impairment of physical, productive, and interpersonal abilities and with psychological effects in case of chronicization of the disease. 38 HZ and PHN negatively affect the patient quality of life (QoL); besides suffering due to the typical symptoms of skin lesions and the associated pain, subjects can also have an impaired ability to perform daily activities or maintain social and family relationships. The whole spectrum of symptoms and related functional and social symptoms can cause a chronic alteration in the psychological status of the affected subject.…”

Persistent dilemmas in zoster eye disease

“…Most studies find that women are affected significantly more frequently than men with regard to HZ incidence, hospitalisations and mortality 14 17 18. PHN persists for longer than 1 year in nearly half of the patients older than age 70 19–21.…”