1887
  1. Home
  2. Eurosurveillance
  3. Volume 28, Issue 8, 23/Feb/2023
  4. Article
Research Open Access
Like 0
Download

Abstract

Background

Herpes zoster (HZ) affects 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age and the presence of immunocompromising conditions. In Spain, vaccination guidelines were recently updated to include the recommendation of the new recombinant zoster vaccine (RZV) for certain risk groups.

Aim

To describe the epidemiology of HZ-related hospitalisations in Spain in order to prioritise vaccination recommendations and define a baseline to monitor the effectiveness of vaccination policies.

Methods

Retrospective study using the National Health System’s Hospital Discharge Records Database, including all HZ-related hospitalisations from 1998 to 2018.

Results

The 65,401 HZ-related hospitalisations, corresponded to an annual mean hospitalisation rate of 6.75 per 100,000 population. There was an increasing trend of HZ hospitalisations over the study period. This rate was higher in males and older age groups, particularly over 65 years. Comorbidities with higher risk of readmission were leukaemia/lymphoma (RR 2.4; 95% CI: 2.3–2.6) and solid malignant neoplasm (RR 2.2; 95% CI: 2.1–2.4). Comorbidities associated with higher risk of mortality were leukaemia/lymphoma (RR 2.9; 95% CI: 2.7–3.2), solid malignant neoplasm (RR 2.9; 95% CI: 2.7–3.1) and HIV infection (RR 2.2; 95% CI: 1.8–2.7).

Conclusion

Of all patients hospitalised with HZ, those with greater risk of mortality or readmission belonged to the groups prioritised by the current vaccination recommendations of the Spanish Ministry of Health. Our study provided relevant information on clinical aspects of HZ and established the base for future assessments of vaccination policies.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Closure
A corrected article has been published for this content:
Authors’ correction for Euro Surveill. 2023;28(8)
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.8.2200390
2023-02-23
2024-04-18
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.8.2200390
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/8/eurosurv-28-8-4.html?itemId=/content/10.2807/1560-7917.ES.2023.28.8.2200390&mimeType=html&fmt=ahah

References

  1. Heyman D. Control of communicable diseases. Manual. 20th edition. American Public Health Association. Washington. 2015.
  2. Bricout H, Haugh M, Olatunde O, Prieto RG. Herpes zoster-associated mortality in Europe: a systematic review. BMC Public Health. 2015;15(1):466-466.  https://doi.org/10.1186/s12889-015-1753-y  PMID: 25940080 
  3. Nagel MA, Niemeyer CS, Bubak AN. Central nervous system infections produced by varicella zoster virus. Curr Opin Infect Dis. 2020;33(3):273-8.  https://doi.org/10.1097/QCO.0000000000000647  PMID: 32332223 
  4. van Oorschot D, Vroling H, Bunge E, Diaz-Decaro J, Curran D, Yawn B. A systematic literature review of herpes zoster incidence worldwide. Hum Vaccin Immunother. 2021;17(6):1714-32.  https://doi.org/10.1080/21645515.2020.1847582  PMID: 33651654 
  5. Yawn BP, Gilden D. The global epidemiology of herpes zoster. Neurology. 2013;81(10):928-30.  https://doi.org/10.1212/WNL.0b013e3182a3516e  PMID: 23999562 
  6. Pinchinat S, Cebrián-Cuenca AM, Bricout H, Johnson RW. Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis. 2013;13(1):170.  https://doi.org/10.1186/1471-2334-13-170  PMID: 23574765 
  7. Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ. 2014;348:g2911.  https://doi.org/10.1136/bmj.g2911  PMID: 25134101 
  8. Yanni EA, Ferreira G, Guennec M, El Hahi Y, El Ghachi A, Haguinet F, et al. Burden of herpes zoster in 16 selected immunocompromised populations in England: a cohort study in the Clinical Practice Research Datalink 2000-2012. BMJ Open. 2018;8(6):e020528.  https://doi.org/10.1136/bmjopen-2017-020528  PMID: 29880565 
  9. Esposito S, Principi N. Herpes zoster prevention: A difficult problem to solve. Vaccine. 2018;36(36):5442-8.  https://doi.org/10.1016/j.vaccine.2017.07.099  PMID: 28784283 
  10. Harbecke R, Cohen JI, Oxman MN. Herpes zoster vaccines. J Infect Dis. 2021;224(12) Suppl 2;S429-42.  https://doi.org/10.1093/infdis/jiab387  PMID: 34590136 
  11. Oxman MN. Advances and controversies in our understanding of herpes zoster-introduction. J Infect Dis. 2018;218(suppl_2):S55-6.  https://doi.org/10.1093/infdis/jiy156  PMID: 30247594 
  12. Working Group on Vaccination Against Herpes Zoster. Public Health Commission of the Interterritorial Council of the National Health System. Recomendaciones de vacunación frente a herpes zóster. [Vaccination recommendations against shingles]. Madrid: Ministry of Health; 25 Mar 2021. Spanish. Available from: https://www.mscbs.gob.es/fr/profesionales/saludPublica/prevPromocion/vacunaciones/programasDeVacunacion/docs/HerpesZoster_RecomendacionesVacunacion.pdf
  13. Ministry of Health. Registro de Actividad de Atención Especializada – RAE-CMBD. [Health Care Specialized Care Activity Registry – RAE-CMBD]. Madrid: Ministry of Health. [Accessed: 15 Feb 2022]. Spanish. Available from: https://pestadistico.inteligenciadegestion.sanidad.gob.es/publicoSNS/Comun/DefaultPublico
  14. Instituto Nacional de Estadistica (INE). Resident population by date, sex and age. Madrid: INE; 1 Jul 2022. Available from: https://www.ine.es/jaxiT3/Tabla.htm?t=9681&L=1
  15. QGIS. A free and open geographic information system. [Accessed 10 Feb 2023]. Available from: https://qgis.org/en/site/
  16. Cunningham AL, Levin MJ. Herpes zoster vaccines. J Infect Dis. 2018;218(suppl_2):S127-33.  https://doi.org/10.1093/infdis/jiy382  PMID: 30247592 
  17. Masa-Calles J, López-Perea N, Vila Cordero B, Carmona R. [Surveillance and epidemiology of Herpes Zoster in Spain.]. Rev Esp Salud Publica. 2021;95:e202106088. PMID: 34168107 
  18. Koshy E, Mengting L, Kumar H, Jianbo W. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol. 2018;84(3):251-62.  https://doi.org/10.4103/ijdvl.IJDVL_1021_16  PMID: 29516900 
  19. Centro Nacional de Epidemiología. CIBERESP. Instituto de Salud Carlos III. Informe epidemiológico sobre la situación del Herpes Zóster en España, 1998-2018. [Epidemiology of Herpes Zoster, Spain 1998-2018]. Madrid: CIBERESP; 2020. Spanish. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/archivos%20A-Z/HERPES%20ZOSTER/Informe_HZ_España_1998-2018.pdf
  20. Esteban-Vasallo MD, Domínguez-Berjón MF, Gil-Prieto R, Astray-Mochales J, Gil de Miguel A. Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster: a population-based study from primary care in Madrid (Spain). Hum Vaccin Immunother. 2014;10(6):1650-60.  https://doi.org/10.4161/hv.28620  PMID: 24805130 
  21. Kawai K, Yawn BP, Wollan P, Harpaz R. Increasing Incidence of Herpes Zoster Over a 60-year Period From a Population-based Study. Clin Infect Dis. 2016;63(2):221-6.  https://doi.org/10.1093/cid/ciw296  PMID: 27161774 
  22. Kovac M, Lal H, Cunningham AL, Levin MJ, Johnson RW, Campora L, et al. Complications of herpes zoster in immunocompetent older adults: Incidence in vaccine and placebo groups in two large phase 3 trials. Vaccine. 2018;36(12):1537-41.  https://doi.org/10.1016/j.vaccine.2018.02.029  PMID: 29463421 
  23. Tseng HF, Bruxvoort K, Ackerson B, Luo Y, Tanenbaum H, Tian Y, et al. The Epidemiology of Herpes Zoster in Immunocompetent, Unvaccinated Adults ≥50 Years Old: Incidence, Complications, Hospitalization, Mortality, and Recurrence. J Infect Dis. 2020;222(5):798-806.  https://doi.org/10.1093/infdis/jiz652  PMID: 31830250 
  24. Gans H, Chemaly RF. Varicella zoster immune globulin (human) (VARIZIG) in immunocompromised patients: a subgroup analysis for safety and outcomes from a large, expanded-access program. BMC Infect Dis. 2021;21(1):46.  https://doi.org/10.1186/s12879-020-05656-6  PMID: 33430796 
  25. Paganino C, Alicino C, Trucchi C, Albanese E, Sticchi L, Icardi G. Herpes Zoster: the rationale for the introduction of vaccination in Italy. J Prev Med Hyg. 2015;56(1):E33-6. PMID: 26789830 
  26. Pham MA, Bednarczyk RA, Becker ER, Orenstein WA, Omer SB. Trends in U.S. Community hospitalizations due to herpes zoster: 2001-2015. Vaccine. 2019;37(6):882-8.  https://doi.org/10.1016/j.vaccine.2018.12.034  PMID: 30616954 
  27. Heywood AE, Wang H, Macartney KK, McIntyre P. Varicella and herpes zoster hospitalizations before and after implementation of one-dose varicella vaccination in Australia: an ecological study. Bull World Health Organ. 2014;92(8):593-604.  https://doi.org/10.2471/BLT.13.132142  PMID: 25177074 
  28. Wolfson LJ, Daniels VJ, Altland A, Black W, Huang W, Ou W. The Impact of Varicella Vaccination on the Incidence of Varicella and Herpes Zoster in the United States: Updated Evidence From Observational Databases, 1991-2016. Clin Infect Dis. 2020;70(6):995-1002. PMID: 31147680 
  29. Wutzler P, Bonanni P, Burgess M, Gershon A, Sáfadi MA, Casabona G. Varicella vaccination - the global experience. Expert Rev Vaccines. 2017;16(8):833-43.  https://doi.org/10.1080/14760584.2017.1343669  PMID: 28644696 
  30. Harpaz R, van Hoek AJ. Point-Counterpoint: The Hope-Simpson Hypothesis and Its Implications Regarding an Effect of Routine Varicella Vaccination on Herpes Zoster Incidence. J Infect Dis. 2018;218(suppl_2):S57-62.  https://doi.org/10.1093/infdis/jiy418  PMID: 30247602 
  31. Crouch AE, Hohman MH, Andaloro C. Ramsay Hunt Syndrome. Florida: StatPearls Publishing; 2022. Available from: http://www.ncbi.nlm.nih.gov/books/NBK557409/
  32. Centers for Disease Control and Prevention (CDC). Complications of shingles. Atlanta: CDC. [Accessed: 19 Mar 2022]. Available from: https://www.cdc.gov/shingles/about/complications.html
  33. Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016;157(1):30-54.  https://doi.org/10.1097/j.pain.0000000000000307  PMID: 26218719 
  34. Curran D, Schmidt-Ott R, Schutter U, Simon J, Anastassopoulou A, Matthews S. Impact of herpes zoster and postherpetic neuralgia on the quality of life of Germans aged 50 or above. BMC Infect Dis. 2018;18(1):496.  https://doi.org/10.1186/s12879-018-3395-z  PMID: 30285731 
  35. Marra F, Parhar K, Huang B, Vadlamudi N. Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect Dis. 2020;7(1):ofaa005.  https://doi.org/10.1093/ofid/ofaa005  PMID: 32010734 
  36. Papagianni M, Metallidis S, Tziomalos K. Herpes Zoster and Diabetes Mellitus: A Review. Diabetes Ther. 2018;9(2):545-50.  https://doi.org/10.1007/s13300-018-0394-4  PMID: 29520743 
  37. Habel LA, Ray GT, Silverberg MJ, Horberg MA, Yawn BP, Castillo AL, et al. The epidemiology of herpes zoster in patients with newly diagnosed cancer. Cancer Epidemiol Biomarkers Prev. 2013;22(1):82-90.  https://doi.org/10.1158/1055-9965.EPI-12-0815  PMID: 23118142 
  38. Yenikomshian MA, Guignard AP, Haguinet F, LaCasce AS, Skarin AT, Trahey A, et al. The epidemiology of herpes zoster and its complications in Medicare cancer patients. BMC Infect Dis. 2015;15(1):106.  https://doi.org/10.1186/s12879-015-0810-6  PMID: 25888128 
  39. Yang YW, Chen YH, Wang KH, Wang CY, Lin HW. Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study. CMAJ. 2011;183(5):E275-80.  https://doi.org/10.1503/cmaj.101137  PMID: 21343261 
  40. Opstelten W, Van Essen GA, Schellevis F, Verheij TJM, Moons KGM. Gender as an independent risk factor for herpes zoster: a population-based prospective study. Ann Epidemiol. 2006;16(9):692-5.  https://doi.org/10.1016/j.annepidem.2005.12.002  PMID: 16516488 
  41. Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? Lancet Infect Dis. 2004;4(1):26-33.  https://doi.org/10.1016/S1473-3099(03)00857-0  PMID: 14720565 
  42. Curran D, Van Oorschot D, Varghese L, Oostvogels L, Mrkvan T, Colindres R, et al. Assessment of the potential public health impact of Herpes Zoster vaccination in Germany. Hum Vaccin Immunother. 2017;13(10):2213-21.  https://doi.org/10.1080/21645515.2017.1345399  PMID: 28708959 
  43. Rafferty E, Reifferscheid L, Russell ML, Booth S, Svenson LW, MacDonald SE. The impact of varicella vaccination on paediatric herpes zoster epidemiology: a Canadian population-based retrospective cohort study. Eur J Clin Microbiol Infect Dis. 2021;40(11):2363-70.  https://doi.org/10.1007/s10096-021-04298-z  PMID: 34175998 
Epidemiology of Herpes Zoster in the pre-vaccination era: establishing the baseline for vaccination programme’s impact in Spain
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Carlos+Risco+Risco&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Risco Risco Carlos</a>, <a href="/search?value1=Zaida+Herrador&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Herrador Zaida</a>, <a href="/search?value1=Noem%C3%AD+Lopez-Perea&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lopez-Perea Noemí</a>, <a href="/search?value1=Diego+Mart%C3%ADnez-Urbistondo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Martínez-Urbistondo Diego</a>, <a href="/search?value1=Rafael+Su%C3%A1rez+del+Villar+Carrero&option1=author&noRedirect=true" class="nonDisambigAuthorLink">del Villar Carrero Rafael Suárez</a>, <a href="/search?value1=Josefa+Masa-Calles&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Masa-Calles Josefa</a></span>. Epidemiology of Herpes Zoster in the pre-vaccination era: establishing the baseline for vaccination programme’s impact in Spain. <a href="/content/ecdc">Euro Surveill.</a> 2023;28(8):pii=2200390. <a href="https://doi.org/10.2807/1560-7917.ES.2023.28.8.2200390" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2023.28.8.2200390</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 11 May 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 06 Dec 2022 </span> </p>
/content/10.2807/1560-7917.ES.2023.28.8.2200390
/content/10.2807/1560-7917.ES.2023.28.8.2200390
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error