Incidence of herpes zoster and associated events including stroke—a population-based cohort study

Abstract

BackgroundMore detailed understanding of herpes zoster (HZ) is called for in the context of an increasing observed frequency of disease, and ongoing discussions regarding potential consequences of the disease. Thus, population-based data on incidence and complications of HZ are needed.MethodsWe conducted a register-based cohort study in Västra Götaland County (population 1.5 million) in Sweden. We collected data on all patients diagnosed with HZ during the years 2008 to 2010 from population-based registers. Incidence rates (IR) of HZ and related complications were calculated and stratified by age and sex.ResultsThere were 13 269 new HZ cases during the study period. Overall, the IR of herpes zoster in both genders was 3.25 (95 % CI: 3.16–3.34) per 1000 person years in 2010. The incidence was consistently higher in women than in men and in older than in young. A history of immunosuppression was more common than in the general population. The incidence was highest in individuals over 80 years of age (IR 9.2 per 1000 person years, 95 % CI: 8.8–9.6) during 2008–2010. The most common complications to HZ were ocular engagement and postherpetic neuralgia; risks for stroke and sepsis were significantly elevated during the one year following diagnosis, especially in the youngest age group of patients 0–39 years.ConclusionsHerpes zoster is more common in women, the elderly and immunosuppressed individuals. We verify a population-based association between herpes zoster and risk for stroke and sepsis, which may merit concern.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1170-y) contains supplementary material, which is available to authorized users.

Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults

“…More recently, a register-based cohort study in Sweden showed a 1.34-fold increased risk of stroke within 1 year after zoster in all age groups (7). As in the U.K. study, the risk of stroke in patients 39 years and younger was increased 10.3-fold within 1 year after zoster.…”

Varicella-zoster-virus – behov for bedre smittevern

“…A Swedish study indicates an elevated risk of stroke in the first year after herpes zoster, especially in younger patients (26). In these patients, arteritis is found with accompanying stenosis or occlusion as solitary or multiple lesions in large as well as small cerebral arteries.…”

Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study

“…[2–9] Two cohort studies from Taiwan and Sweden observed a 1.3 fold increased risk of any (ischemic or hemorrhagic) stroke within 12 months after HZ. [3, 8] Another cohort study based on the Danish national registers in adults reported a 2.3-fold increased risk in the first two weeks, a 1.2-fold increased risk between two weeks and one year and a 1.1-fold increased risk after the first year following HZ as compared to the baseline period. [7] A similar temporal pattern was observed by Langan et al in a study based on the UK Clinical Practice Research Datalink (CPRD) database in adults: the risk of stroke was 1.6-fold increased in the first month, 1.4-fold increased between one and three months, 1.2-fold increased between four and six months and not increased between seven and twelve months after HZ.…”

“…after one year. [3, 5, 8] The Danish cohort study identified HZ patients based on acyclovir prescriptions which could give rise to misclassification of herpes simplex virus infection as HZ infections. [7] All six studies had the potential for residual confounding [2, 3, 5, 7–9] due to missing information on important risk factors of stroke.…”