Herpes Zoster-Associated Mortality in Europe
Herpes Zoster-Associated Mortality in Europe
Varicella-zoster virus (VZV) is a herpes virus that infects nearly all humans and causes two distinct diseases: varicella, the primary infection which usually occurs in childhood, and herpes zoster (HZ) which is the result of the reactivation of VZV which remains latent in the sensory ganglia following primary infection. This reactivation occurs when VZV-specific cellular-mediated immunity decreases, mainly due to age-related immunosenescence and immunosuppressive conditions.
HZ is characterized by a vesicular skin rash localized in the sensory region of the affected ganglia, and is often preceded, or accompanied by acute pain or itching. The individual lifetime risk of developing HZ is between 24% and 30%, or approximately 1 in 4 people. However, for individuals aged 85 and over, this risk increases to 1 in 2. HZ incidence increases markedly after 50 years of age, with two-thirds of HZ cases occurring in individuals aged 50 years and over. Anyone who has had varicella is at risk of HZ; in Europe varicella affects over 90% of children before the age of 15.
HZ is painful during the acute phase, but pain may persist for months or even years. Post-herpetic neuralgia (PHN), defined as chronic pain persisting after rash onset, occurs in 20% to 50% of patients, and can lead to several months of treatment and loss of quality of life. After 1 year, almost 10% of patients, mainly older people, still have persistent pain.
A recent literature review showed that the annual HZ incidence is similar throughout Europe, varying from 2.0 to 4.6/1 000 person-years, with no clear geographic trend. Age-specific HZ incidence rates are around 1/1 000 children <10 years, around 2/1 000 adults aged <40 years, and around 1–4/1 000 adults aged 40–50 years, increasing to around 7–8/1 000 after age 50 years, up to 10/1 000 after 80 years of age. This review confirmed that, in Europe, HZ incidence increases with age, particularly after 50 years of age. Similarly, data on the percentage of HZ cases who develop PHN are available across EU. PHN, defined as HZ-associated pain lasting for at least three months, has been reported to occur in 10% to 20% of patients. However, the prevalence and severity of PHN increases with age, and has been reported to be as high as 60% to 70% of patients aged ≥60. In people aged over 50 years, there is a higher rate of HZ-associated hospitalization and HZ and PHN have a greater impact on the quality of life of patients and their relatives.
To date, a review of the data for HZ-associated mortality has not been published. To fill this gap and to have a complete picture of the burden of HZ and PHN, we performed a systematic literature review of data on HZ-associated mortality in people aged ≥50 years in Europe.
Background
Varicella-zoster virus (VZV) is a herpes virus that infects nearly all humans and causes two distinct diseases: varicella, the primary infection which usually occurs in childhood, and herpes zoster (HZ) which is the result of the reactivation of VZV which remains latent in the sensory ganglia following primary infection. This reactivation occurs when VZV-specific cellular-mediated immunity decreases, mainly due to age-related immunosenescence and immunosuppressive conditions.
HZ is characterized by a vesicular skin rash localized in the sensory region of the affected ganglia, and is often preceded, or accompanied by acute pain or itching. The individual lifetime risk of developing HZ is between 24% and 30%, or approximately 1 in 4 people. However, for individuals aged 85 and over, this risk increases to 1 in 2. HZ incidence increases markedly after 50 years of age, with two-thirds of HZ cases occurring in individuals aged 50 years and over. Anyone who has had varicella is at risk of HZ; in Europe varicella affects over 90% of children before the age of 15.
HZ is painful during the acute phase, but pain may persist for months or even years. Post-herpetic neuralgia (PHN), defined as chronic pain persisting after rash onset, occurs in 20% to 50% of patients, and can lead to several months of treatment and loss of quality of life. After 1 year, almost 10% of patients, mainly older people, still have persistent pain.
A recent literature review showed that the annual HZ incidence is similar throughout Europe, varying from 2.0 to 4.6/1 000 person-years, with no clear geographic trend. Age-specific HZ incidence rates are around 1/1 000 children <10 years, around 2/1 000 adults aged <40 years, and around 1–4/1 000 adults aged 40–50 years, increasing to around 7–8/1 000 after age 50 years, up to 10/1 000 after 80 years of age. This review confirmed that, in Europe, HZ incidence increases with age, particularly after 50 years of age. Similarly, data on the percentage of HZ cases who develop PHN are available across EU. PHN, defined as HZ-associated pain lasting for at least three months, has been reported to occur in 10% to 20% of patients. However, the prevalence and severity of PHN increases with age, and has been reported to be as high as 60% to 70% of patients aged ≥60. In people aged over 50 years, there is a higher rate of HZ-associated hospitalization and HZ and PHN have a greater impact on the quality of life of patients and their relatives.
To date, a review of the data for HZ-associated mortality has not been published. To fill this gap and to have a complete picture of the burden of HZ and PHN, we performed a systematic literature review of data on HZ-associated mortality in people aged ≥50 years in Europe.
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