Risk Factors for Herpes Zoster Infection: A Meta-Analysis

Abstract

Background The burden of herpes zoster (HZ) is significant worldwide, with millions affected and the incidence rising. Current literature has identified some risk factors for this disease; however, there is yet to be a comprehensive study that pools all evidence to provide estimates of risk. Therefore, the purpose of this study is to identify various risk factors, excluding immunosuppressive medication, that may predispose an individual to developing HZ. Methods The literature search was conducted in MEDLINE, EMBASE, and Cochrane Central, yielding case control, cohort, and cross-sectional studies that were pooled from January 1966 to September 2017. Search terms included the following: zoster OR herpe* OR postherpe* OR shingle* AND risk OR immunosupp* OR stress OR trauma OR gender OR ethnicity OR race OR age OR diabetes OR asthma OR chronic obstructive pulmonary disease OR diabetes. Risk ratios (RRs) for key risk factors were calculated via natural logarithms and pooled using random-effects modeling. Results From a total of 4417 identified studies, 88 were included in analysis (N = 3, 768 691 HZ cases). Immunosuppression through human immunodeficiency virus/acquired immune deficiency syndrome (RR = 3.22; 95% confidence interval [CI], 2.40–4.33) or malignancy (RR = 2.17; 95% CI, 1.86–2.53) significantly increased the risk of HZ compared with controls. Family history was also associated with a greater risk (RR = 2.48; 95% CI, 1.70–3.60), followed by physical trauma (RR = 2.01; 95% CI, 1.39–2.91) and older age (RR = 1.65; 95% CI, 1.37–1.97). A slightly smaller risk was seen those with psychological stress, females, and comorbidities such as diabetes, rheumatoid arthritis, cardiovascular diseases, renal disease, systemic lupus erythematosus, and inflammatory bowel disease compared with controls (RR range, 2.08–1.23). We found that black race had lower rates of HZ development (RR = 0.69; 95% CI, 0.56–0.85). Conclusions This study demonstrated a number of risk factors for development of HZ infection. However, many of these characteristics are known well in advance by the patient and clinician and may be used to guide discussions with patients for prevention by vaccination.

Systematic Review and Meta-analysis of Herpes Zoster Vaccine in Patients With CKD

“…The result of the sensitivity analysis showed that no individual study removal significantly affected the results of the HR and the 95% CI (Fig 5). The incidence of HZ in the general population is estimated to be 3.9 per 1000 person-years (5), increasing almost 20 fold to 70 per 1000 person-years in the CKD population (16,43,44). It is estimated that 3-6% of the CKD population will suffer a HZ infection (17,(43)(44)(45) with the risk increasing from CKD to ESKD, and is highest in PD and renal transplant populations (44).…”

Text-Based Identification of Herpes Zoster Ophthalmicus With Ocular Involvement in the Electronic Health Record: A Population-Based Study

“…It is worth noting that we examined the risk factors of ocular HZO among HZ patients, not risk factors for HZ. In our study, we found that older age and white versus Hispanic or black race/ethnicity was associated with higher risk of ocular HZO among HZ patients, similar to the risk factors for HZ [ 29 ]. However, we found that male sex was associated with higher risk of ocular HZO among HZ patients, in contrast to previous reports of women being at increased risk of HZ compared with men [ 22 ].…”

Comparisons of Staphylococcus aureus infection and other outcomes between users of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers: lessons for COVID-19 from a nationwide cohort study

“…Confounder adjustment moved the hazard ratio closer to the null but residual confounding remained. This may be because strong risk factors for infection such as conditions associated with immunosuppression were not included in our analysis, as well as family history which is hard to define in routine data sources 24 . Hip fracture was more common in ACEI users but confounder adjustment moved the hazard ratio away from the null suggesting negative (1997-2001, 2002-2006, 2007-2011, 2012-2016), kidney function (eGFR ≥60 mL/min/1.73m 2 or unmeasured, eGFR 45-59 mL/min/1.73m 2 , eGFR 30-44 mL/min/1.73m 2 , eGFR <30 mL/min/1.73m 2 , or renal replacement therapy), diagnoses of hypertension, diabetes, myocardial infarction, heart failure, and proteinuria (all covariates were time-updated).…”