The Epidemiology of Herpes Zoster in Patients with Newly Diagnosed Cancer

Abstract

Background: Given the limited literature, we conducted a study to examine the epidemiology of herpes zoster (HZ) among newly diagnosed cancer patients.Methods: We identified adult health plan members of Kaiser Permanente Northern California diagnosed with invasive cancer from 2001 to 2005. Electronic health records with inpatient and outpatient diagnoses, laboratory tests, and antiviral medications were used to identify HZ diagnoses from 2001 to 2006. HZ diagnoses and associated complications were confirmed by medical chart review. Treatment with chemotherapy and corticosteroids was used to classify patients by immunosuppression level.Results: Among 14,670 cancer patients, 424 were diagnosed with HZ during follow-up (median 22 months). The incidence of HZ was 31/1,000 person-year (PY) in patients with hematologic malignancies and 12/1,000 PY in patients with solid tumors. The corresponding 2-year cumulative incidence of HZ was approximately 6% and 2%, respectively. Compared with incidence rates of HZ reported in a general US population, the age-and sex-standardized rates of HZ were 4.8 times higher [95% confidence interval (CI), 4.0-5.6] in patients with hematologic malignancies and 1.9 times higher (95% CI, 1.7-2.1) in those with solid tumors. HZ risk increased with increasing level of immunosuppression. Among HZ cases, 19% with hematologic malignancies and 14% with solid tumors had HZ-associated pain for at least 30 days. The corresponding numbers for nonpain-related complications were 30% and 18%, respectively.Conclusions: Cancer patients are at substantially increased risk of HZ and among those with HZ, complications are relatively common.Impact: Better HZ prevention and treatment options for cancer patients are needed. Cancer Epidemiol Biomarkers Prev; 22(1); 82-90. Ó2012 AACR.

Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster

“…26 The incidence of HZ in a cohort of adults diagnosed with invasive cancer from 2001 to 2005 in the US was estimated at 12 per 1000 person-years in patients with solid tumors. 48 That rate is higher than ours (10.15 per 1000 personyears), although these differences could be explained at least partially by differences in the criteria for selection and grouping of tumors.…”

Lesion on the Plantar Foot

“…1 Following primary infection, the varicella zoster virus (VZV) establishes latency within sensory dorsal root ganglia; reactivation manifests as herpes zoster and is typically heralded by a painful, unilateral vesicular eruption in a dermatomal distribution. According to Centers for Disease Control and Prevention estimates, 32% of Americans will experience herpes zoster during their lifetimes.…”

“…Patients with hematologic malignantneoplasmsweretwiceaslikelytodevelopherpeszosterasthose with solid tumors and 5 times more likely than the general population. 1 Zostavax is a live, attenuated zoster vaccine, and administration may result in disseminated disease in the immunosuppressed. It is therefore contraindicated in patients with primary or acquired immunodeficiencystates,includingleukemia,lymphoma,orothermalignant neoplasms affecting the bone marrow or lymphatic system.…”

Herpes zoster in the radial nerve distribution in an 8 years old healthy child-a case report

“…1 Risk factors for developing Herpes zoster include old age, decreased immunity and hematologic malignancy documented by population-based, systematic review and retrospective cohort studies. [2][3][4][5] Herpes zoster in children is rare and more frequently seen in immunocompromized ones.…”