Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective

Abstract

Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed.

Varicella and herpes zoster vaccine development: lessons learned

“…Clinical VZV reactivation, or zoster, is experienced by around 25–35% of people over their lifetime [26]. In many developed countries, there has been a gradual increase in zoster incidence over time that predates the introduction of varicella vaccine and may relate to changing social or environmental conditions.…”

Impfen ist nicht nur Kindersache!

“…Über 95 % der Menschen >50 Jahre haben eine Immunität gegen Varizellen und tragen somit ein Risiko der Reaktivierung des Virus mit der Manifestation als Herpes Zostererkrankung [38]. Etwa 20-35 % der Bevölkerung in den Industrienationen werden einmal im Leben einen HZ entwickeln und dieses Risiko steigt mit zunehmendem Alter an (bis zu 50 % bei >80-Jährigen).…”

Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience

“…40 However, it is possible to have more than one episode of HZ but the recurrence rate is low and accordingly to the literature ranges between 1.5 and 12.5%; the most likely rate is in the range of 4-5%. 41 The most important factor for recurrence is the duration of the pain during the acute episode. Individuals who experience pain for more than 30 d after the onset of the disease have an increased risk of recurrence, especially in the first 3-4 y after the HZ occurrence.…”