Risk of herpes zoster in the Japanese population with immunocompromising and chronic disease conditions: Results from a claims database cohort study, from 2005 to 2014

Abstract

Older adults, women and patients with immunocompromised (IC) or chronic medical conditions have a higher incidence of herpes zoster (HZ) and are at higher risk of developing HZ‐associated complications such as postherpetic neuralgia. The incidence rates of HZ in various IC and chronic conditions have been previously reported in a retrospective cohort study using claims data from Japanese adults. Here, we report further analyses from this cohort using univariate and multivariable Cox regression to estimate crude and adjusted hazard ratios (HRs) associated with different IC and chronic conditions. After adjusting for multiple covariates (age, sex and other coexisting medical conditions), the risk of HZ was higher in women (HR, 1.14 [95% CI, 1.11–1.17]), irrespective of age and increased with increasing age, being substantially higher in patients aged 65 years or older (HR, 3.28 [95% CI, 3.07–3.49]) when compared with those aged 18–29 years. The highest HRs were observed for the following specific IC conditions; hematopoietic stem cell transplant recipients (HR, 9.85 [95% CI, 6.80–14.28]), hematological malignancy (HR, 3.22 [95% CI, 2.54–4.09]), systemic lupus erythematosus (HR, 2.46 [95% CI, 1.45–4.15]) and inflammatory bowel disease (HR, 1.59 [95% CI, 1.14–2.21]). For most other IC and chronic medical conditions, a higher risk was also apparent though of a smaller magnitude (HRs ranging from 1.2 to <1.5). These results corroborate our previous findings and demonstrate an increased risk of HZ associated with different IC and chronic conditions.

Incidence rates for hospitalized infections, herpes zoster, and malignancies in patients with ulcerative colitis in Japan: an administrative health claims database analysis

“…The incidence rate of herpes zoster in Japan has been previously estimated to be 0.49 per 100 patient-years (95% CI, 0.49-0.50) in the general population and 0.74 per 100 patientyears (95% CI, 0.52-1.02) among patients with IBD. 9 The incidence rates estimated in this analysis in all treatment groups of the MDV cohort (with the exception of the incidence rate estimated in patients receiving calcineurin inhibitors) were comparable to the previous estimate among patients with IBD. In patients with IBD, previous studies have reported an association between the use of corticosteroids, thiopurines, and TNFi and the risk of herpes zoster, 11,14 and the herpes zoster risk has been shown to increase with thiopurine and TNFi combination therapy, compared with either thiopurine or TNFi monotherapy.…”

“…4 Herpes zoster, caused by the reactivation of latent varicella zoster virus, is a major public health issue and the incidence rate of herpes zoster in Japan has been previously estimated to be 0.49 per 100 patient-years (95% confidence interval [CI], 0.49-0.50) in the general population. 9 Inflammatory bowel disease (IBD) is associated with cellular and humoral immune dysfunctions, resulting in susceptibility to viral infection and reactivation; studies in Western countries and Japan have demonstrated that patients with IBD are at an increased risk for herpes zoster. [9][10][11][12][13] The use of corticosteroids, thiopurines, TNFi, and combination therapy have been reported to increase the risk of herpes zoster.…”

“…9 Inflammatory bowel disease (IBD) is associated with cellular and humoral immune dysfunctions, resulting in susceptibility to viral infection and reactivation; studies in Western countries and Japan have demonstrated that patients with IBD are at an increased risk for herpes zoster. [9][10][11][12][13] The use of corticosteroids, thiopurines, TNFi, and combination therapy have been reported to increase the risk of herpes zoster. 11,12,14 However, the association between herpes zoster and UC therapies in patients with UC in Japan is uncertain due to a lack of data from Asian patients with UC.…”

B cell targeted therapy for immunoglobulin G4-related disease

“…In addition, rituximab therapy has been associated with the risk of generalized herpes zoster infection [48], reactivation of hepatitis B virus [49], and development of progressive multifocal leukoencephalopathy [50]. In particular, since the frequency of herpes zoster is higher in the elderly [51], in whom IgG4-RD predominate in the Japanese population. It is desirable to limit the use of rituximab in both induction and maintenance therapy for IgG4-RD, to younger patients and others who are at less risk of complications.…”

Short-Term Prognostic Factors in Hospitalized Herpes Zoster Patients and Its Associated Cerebro-Cardiovascular Events: A Nationwide Retrospective Cohort in Japan

“…Herpes zoster (HZ) is an infection caused by the varicellazoster virus (VZV). The risk of onset and severity increases in the elderly and in patients with underlying diseases that can lead to immunosuppression, such as connective tissue diseases (CTD) and malignancies (1)(2)(3)(4)(5). The incidence of HZ is increasing due to an aging society and the development of immunosuppressive therapy for autoimmune diseases, including CTD, and the occurrence of severe HZ may increase (6)(7)(8).…”