Abstract
BackgroundThe current UK vaccination programme for herpes zoster (HZ) excludes people aged ≥80 years. This study aimed to quantify the number of individuals ≥80 years who missed HZ vaccination and the consequent epidemiological and economic burden of HZ and post-herpetic neuralgia (PHN).MethodsImmunocompetent individuals aged ≥80 years between 1st September 2013 and 31st December 2017 in the Clinical Practice Research Datalink were selected and linked to Hospital Episodes Statistics, where available. Rates of HZ and PHN and healthcare resource utilisation were investigated for the overall study population and by age group (80–84, 85–89, ≥90 years old) and the burden of HZ and PHN was projected to the UK population.Results4,858 HZ episodes and 464 PHN cases were identified in 255,165 individuals over 576,421 person-years (PY). Rates of HZ and PHN were 8.43 (95% confidence interval [CI] 8.19–8.66) and 0.80 (0.73–0.87) per 1,000 PY respectively and lowest in those aged ≥90 (HZ rate 7.37/1,000 PY; PHN rate 0.56/1,000 PY). Within HZ episodes, 10.27% of GP visits, 5.82% of prescribed medications and 21.65% of hospitalisations were related to HZ/PHN. Median length of hospitalisation increased from 7.0 days for all-cause to 10.5 days for HZ/PHN related hospitalisations. Individuals ≥90 stayed in hospital a median of 3–4 days longer than younger groups. Approximately 2.23 million individuals in the UK missed HZ vaccination since 2013 (1.86 million had never been eligible and 365,000 lost eligibility for HZ vaccination), resulting in an estimated 43,149 HZ episodes.ConclusionThis study highlights the impact of the 80-year upper age limit policy on the health system. Our study estimates that 2.23 million individuals in the UK may have lost the opportunity to be vaccinated and that their burden of HZ and PHN remains high, especially among the very elderly.
Highlights
Herpes zoster (HZ, shingles) is caused by the reactivation of the varicella zoster virus within the sensory ganglia [1, 2] and occurs most frequently in older adults. [3,4,5] The most common complication of herpes zoster (HZ) is post-herpetic neuralgia (PHN), a persistent neuropathic pain after the onset of the acute HZ episode. [6, 7] Older individuals are more likely to develop PHN and experience more severe acute pain
Rates of HZ and PHN and healthcare resource utilisation were investigated for the overall study population and by age group (80–84, 85– 89, 90 years old) and the burden of HZ and PHN was projected to the UK population
Our study estimates that 2.23 million individuals in the UK may have lost the opportunity to be vaccinated and that their burden of HZ and PHN remains high, especially among the very elderly
Summary
Herpes zoster (HZ, shingles) is caused by the reactivation of the varicella zoster virus within the sensory ganglia [1, 2] and occurs most frequently in older adults. [3,4,5] The most common complication of HZ is post-herpetic neuralgia (PHN), a persistent neuropathic pain after the onset of the acute HZ episode. [6, 7] Older individuals are more likely to develop PHN and experience more severe acute pain. ZVL was routinely offered to adults aged over 70 years and to those aged 78 to 79 years as part of a catch-up campaign. Three observational studies using primary care databases in the UK have demonstrated a good vaccine effectiveness (VE) of ZVL in both the routine cohort (aged 70 years) and the catch-up cohort (aged 78–79 years) with similar results reported for both cohorts, regardless of the age difference. Public Health England reported a decrease in vaccine coverage over time for the catch-up cohort (from 57.8% in 2014–2015 to 46.2% in 2017–2018), suggesting a large proportion of those aged 80 who were previously eligible for vaccination had likely been missed. This study aimed to quantify the number of individuals 80 years who missed HZ vaccination and the consequent epidemiological and economic burden of HZ and post-herpetic neuralgia (PHN).
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