Herpes zoster-associated mortality in Europe: a systematic review

Abstract

BackgroundReactivation of latent varicella zoster virus, partly due to age-related immunosenescence and immunosuppressive conditions, results in herpes zoster (HZ) and its associated complications. The management of the most important complication, post-herpetic neuralgia (PHN), is challenging, particularly in the elderly, and is generally unsatisfactory. No previous reviews have reported the incidence of HZ-associated mortality.MethodsWe carried out a systematic literature review to identify studies and databases providing data for HZ-associated mortality in adults aged ≥50 years in Europe.ResultsWe identified 12 studies: Belgium (1); France (1); Germany (1); the Netherlands (2); Portugal (1); Spain (4) and England/Wales (2) and 4 databases from Europe: France; Germany and England/Wales. The incidence was available from eight studies; it was highest in those aged ≥95 in France (19.48/100,000). In the European (WHO) database, the overall mortality ranged from 0 to >0.07/100,000. The age- and gender-specific HZ mortality rates from the other databases showed that while in younger age groups the HZ mortality rate was higher in males, in older patients the rate was much higher in women. The case fatality rate was 2 and 61/100 000 in those 45–65 and ≥65 years, respectively. A similar increase with age was seen for the hospital fatality rate; 0.6% in those 45–65 years in the UK and 7.1% in those ≥80 in Spain.ConclusionsAlthough the data were sparse and heterogeneous, HZ-associated mortality clearly increases with age. In addition, the elderly who develop HZ often have underlying diseases and are at increased risk of functional decline and loss of independence. Mortality should be taken into account in health-economics models.

Risk of herpes zoster after exposure to varicella to explore the exogenous boosting hypothesis: self controlled case series study using UK electronic healthcare data

“…Thirdly, the event of interest must not censor the observation period—for example, if the zoster event increases the likelihood of death. This assumption is fulfilled, as zoster is rarely associated with increased mortality 35. Supplementary box e-1 provides a detailed discussion of these fundamental assumptions.…”

Cost-effectiveness of the recombinant zoster vaccine in the German population aged ≥60 years old

“…38,39 HZ fatality figures were calculated from Ultsch et al (2011), using the same approach as applied in a previous review; mortality rates reported per 100,000 person-years were calculated as the HZ case fatality rate. 10,40 Costs Direct medical and indirect costs related to HZ were taken from Ultsch et al (2013), who used a retrospective database combining both patient-related billing data from a SHI and patient-related treatment documentation from a regional Association of SHI-Accredited Physicians. Individuals of all ages with a HZ diagnosis in 2005-2008 were included and observed for two years (one HZ diagnosis-free year before diagnosis and one year after HZ diagnosis).…”

Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis

“…Herpes zoster, or shingles, is a neurocutaneous disease that occurs through reactivation of latent varicella zoster virus (the virus that causes chicken pox). 1 A quarter of the population is at risk of developing herpes zoster during their lifetime, 2 3 4 5 6 and two thirds of people with the disease are aged 50 years or older. 7 The morbidity from herpes zoster increases with age.…”