Trends in herpes zoster epidemiology in Germany based on primary care sentinel surveillance data, 2005–2016

Abstract

Herpes zoster (HZ) is caused by reactivation of the varicella-zoster-virus (VZV). Childhood varicella vaccination, as recommended in Germany in 2004, may reduce the risk of HZ in vaccinated children but also virus circulation and thus the booster possibility of latent infected persons. In this context we analyzed age-specific trends in HZ epidemiology in Germany using data on HZ-associated outpatient consultations in participating sentinel sites and HZ-associated cases in all hospitals since 2005. We analyzed two separate time periods that differed in sentinel management and data integrity. For the period 2005–2010, we found a decrease in HZ-associated outpatient consultations in 1- to 4-year-olds (IRR = 0.72, 95%CI 0.63-0.81, p<0.001). For the period 2013–2016, we observed a decrease in HZ-associated outpatient consultations in 10- to 14-year-olds (IRR = 0.85, 95%CI 0.78-0.93, p<0.01). Moreover, we detected an increase in the age groups 20 years and older except for the group 30–39 years. HZ-associated hospitalizations showed similar trends for the second time period (here 2012–2015). The decrease in HZ-associated outpatient consultations and hospitalizations in children started and continued over cohorts eligible for varicella vaccination and could be a result of their reduced HZ-risk. Whether the observed steady increasing HZ incidences for adults are associated with the varicella vaccination in children remains unclear and could not be investigated with our data.

Herpes Zoster Onset 9 Years After First Varicella Zoster Vaccination in an 11-year-old Child - A Case Report

“…When it comes to patients between 10 and 19 years of age, while there was an increased risk observed in the period 2000-2006, in the following years, the increase in the HZ incidence not only seemed to reach a plateau, but also lower rates were observed in 2010 compared to 2006 in the United States [2]. Epidemiologic data from other countries, such as Germany, seem to be in accordance with the latter, demonstrating a decreasing trend in the incidence of HZ in 5 to 9 year olds from 2010 and onwards and in the 10 to 14 year olds after 2013 [5].…”

Epidemiology of skin diseases in Germany: systematic review of the current state of research – part 3: infectious skin diseases

“…Herpes zoster (shingles): All reports agreed that the rate of herpes zoster markedly increases with age, and women were affected more frequently than men [6, 8, 13].…”

“…Herpes zoster (shingles): All reports agreed that the rate of herpes zoster markedly increases with age, and women were affected more frequently than men [6,8,13]. Age-standardized incidence, which was 166-600/100,000 and thus lower than the raw incidence rate, was calculated in two studies [6,8]. One study also reported mortality rates, which were 0.21/100,000 and increased with age to a value of 3.86/100,000 in persons aged over 90 [13].…”

“…Herpes zoster (shingles): All reports agreed that the rate of herpes zoster markedly increases with age, and women were affected more frequently than men [6,8,13]. Age-standardized incidence, which was 166-600/100,000 and thus lower than the raw incidence rate, was calculated in two studies [6,8].…”

A Case of Herpes Zoster Due to Varicella-Zoster Virus Vaccines in a 14-Month-old Girl

“…In addition, although the cases of HZ in children decreased significantly from 2010 to 2015 in Germany after the implementation of the same 2-dose schedule of VZV vaccines as in Japan in 2009, the incidence of HZ in adults dramatically increased in the same period. 7 …”