Increasing Trends of Herpes Zoster in Australia

Abstract

BackgroundIncreasing trends in incidence of herpes zoster (HZ) have been reported in Australia and internationally. This may reflect the impact of childhood VZV vaccination programs introduced universally in Australia in late 2005. The objective of this study was to evaluate changes in incidence of HZ and PHN in Australia over time, and associated healthcare resource utilisation.MethodsAustralian data on general practice (GP) encounters for HZ, specific antiviral prescribing data from the pharmaceutical benefits scheme, emergency department presentations from the states of NSW and Victoria and national hospitalisation data for HZ were analysed for time trends using regression models. Two time periods (2000-2006 and 2006-2013) were compared which correspond broadly with the pre- and post- universal VZV vaccination period.ResultsAll data sources showed increasing rates of HZ with age and over time. The GP database showed a significant annual increase in encounters for HZ of 2.5 per 100,000 between 1998 and 2013, and the rates of prescriptions for HZ increased by 4.2% per year between 2002 and 2012. In the 60+ population HZ incidence was estimated to increase from 11.9 to 15.4 per 1,000 persons using GP data or from 12.8 to 14.2 per 1,000 persons using prescription data (p<0.05, between the two periods). Hospitalisation data did not show the same increasing trend over time, except for the age group ≥80 years. Most emergency visits for HZ were not admitted, and showed significant increases over time.DiscussionThe burden of HZ in Australia is substantial, and continues to increase over time. This increase is seen both pre- and post-universal VZV vaccination in 2005, and is most prominent in the older population. The substantial burden of HZ, along with ageing of the Australian population and the importance of healthy ageing, warrants consideration of HZ vaccination for the elderly.

Assessing vaccine effectiveness of publicly funded vaccination programs in Queensland

“…Unlike earlier national analyses (58,242), our hospitalisation findings suggested there is a small (in terms of absolute numbers), but significant increase in HZ admissions among 40-49 year olds, with the increase almost reaching significance among 60-69 year olds. Continued surveillance will be useful in identifying whether this trend will continue with the maturation of the VV program.…”

“…In order to prevent HZ among those at high risk, the Australian Government has recently announced public funding for a live-attenuated zoster vaccine Reassuringly, an analysis of national data from Australia found age-standardised hospitalisations rates for HZ were lower in the first 4.5 years of the VV program compared to the 1.5 years immediately preceding vaccine licensure (58). Another recent study comparing age-specific Australian HZ hospitalisation rates up to 6.5 years post VV public funding found rates remained stable in all age-groups, except aged ≥80 years, in whom there had been a significant increase compared to the pre-vaccine funded period (242). Non-admitted patient data sources in Australia (242) and other countries (243-245) provide evidence of increasing HZ incidence rates more broadly across age-groups, however, they also show that the increasing trend preceded the VV programs, complicating the assessment of what role VV may have on increases in HZ rates (246).…”

“…Another recent study comparing age-specific Australian HZ hospitalisation rates up to 6.5 years post VV public funding found rates remained stable in all age-groups, except aged ≥80 years, in whom there had been a significant increase compared to the pre-vaccine funded period (242). Non-admitted patient data sources in Australia (242) and other countries (243-245) provide evidence of increasing HZ incidence rates more broadly across age-groups, however, they also show that the increasing trend preceded the VV programs, complicating the assessment of what role VV may have on increases in HZ rates (246).…”

Adverse events following vaccination of older people may be under‐reported

“…3,4 The majority of PHN cases occur in patients over 50 years of age. [4][5][6][7] The proportion of shingles patients who develop PHN increases with age (from approximately 1 in 10 cases in those aged 50-59 years to 1 in 4 cases in those aged over 80 years). 5,6,8 Other complications of shingles include:…”

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

“…59 In conclusion, evidence of an increase of HZ in countries with a universal varicella vaccination program is not consistent; 60 many studies have shown evidence of increasing incidence trends in HZ in countries with or without a universal varicella vaccination program. 61,62,63 Besides, in some countries, HZ incidence started to increase years before the vaccine was introduced. For these reasons, continuous monitoring is needed to understand the secular trends in HZ before and after introduction of varicella vaccination programmes.…”