Increased Incidence of Herpes Zoster and Postherpetic Neuralgia in Adult Patients following Traumatic Brain Injury: A Nationwide Population-Based Study in Taiwan.

Yi-Ching Tung,Cheng-Sheng Chen,Wen-Chan Tsai,Hon-Yi Shi,Chih-Lung Lin,Hung-Pin Tu,Chen-Hsiang Su,Li-Min Huang

doi:10.1371/journal.pone.0129043

Abstract

The aims of this study were to estimate the incidences of herpes zoster (HZ) and postherpetic neuralgia (PHN) in patients after traumatic brain injury (TBI). Furthermore, we aimed to explore the risk factors of the development of HZ and PHN in patients after TBI. This population-based, longitudinal analysis was conducted using the Taiwan National Health Insurance Research Database (consisting of 1,000,000 beneficiaries) from 1996 to 2010. Using the longitudinal National Health Insurance Research Database, we conducted a retrospective population-based cohort study to evaluate the incidence of HZ and PHN in adult TBI patients and controls. Kaplan-Meier analysis and Cox regression were used to compare differences in the development of HZ and PHN. The effects of gender, comorbidity and surgery on the risk of HZ and PHN development were assessed by subgroup analyses. Over a 15-year follow-up, the cumulative incidence of HZ in 28,234 TBI patients (604.00/100,000 person-years) was significantly higher than 34,085 controls (322.21/100,000 person-years) (P<0.0001, by log-rank test). Females showed a significantly higher incidence of HZ than males (p for interaction = 0.0010). The time to HZ development in the follow-up period was 5.9 years in TBI patients compared to 9.9 years in the control set (p <0.0001). TBI patients were 2.93 and 2.11 times likely to develop HZ and PHN, respectively, than the general population. The incidences of HZ and PHN in TBI patients were also significantly greater than for controls in the CCI = 0 subgroup. To our knowledge, this is the first population-based cohort study to reveal that TBI is an independent risk factor for HZ and PHN in TBI patients, especially in females. Physician should pay attention to the possibility of HZ and PHN in TBI patients and be aware that HZ vaccination early after brain trauma may lower the incidence of HZ and PHN.

Highlights

Herpes zoster (HZ) is a neurocutaneous disease caused by the reactivation of the latent varicella zoster virus (VZV)
The aims of this study were to estimate the rates of HZ and postherpetic neuralgia (PHN) in patients following traumatic brain injury (TBI) using the National Health Insurance Research Database (NHIRD) and to determine whether individuals with TBI were at increased risk for HZ and PHN
We found that TBI patients following surgery had a higher tendency to develop HZ and PHN compared with TBI patients without surgery

Summary

Introduction

Herpes zoster (HZ) is a neurocutaneous disease caused by the reactivation of the latent varicella zoster virus (VZV). Specific T-cell immunity is responsible for the body’s defense against VZV infection [3]. Declining cellular immunity due to increasing age or immunosuppression has been known to trigger reactivation of VZV [5]. HZ has been known to occur more frequently in patients with malignancies, human immunodeficiency virus (HIV) infection, transplantation, and immunosuppressive disorders, as well as in those undergoing treatment with immune suppressants [5]. Various diseases associated with impaired immunity, for example, rheumatic and peptic ulcer diseases and malignancies, have been reported to be correlated with an increased risk of HZ [6,7,8]. Successful identification of potential predictors of HZ may help to define high risk patients and assist in the decision-making of administration of HZ vaccinations

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