Abstract
BackgroundHerpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ≥50 years. The forthcoming European launch of a vaccine against HZ (Zostavax®) prompts the need for a better understanding of the epidemiology of HZ in Europe. Therefore the aim of this systematic review was to summarize the available data on HZ incidence in Europe and to describe age-specific incidence.MethodsThe Medline database of the National Library of Medicine was used to conduct a comprehensive literature search of population-based studies of HZ incidence published between 1960 and 2010 carried out in the 27 member countries of the European Union, Iceland, Norway and Switzerland. The identified articles were reviewed and scored according to a reading grid including various quality criteria, and HZ incidence data were extracted and presented by country.ResultsThe search identified 21 studies, and revealed a similar annual HZ incidence throughout Europe, varying by country from 2.0 to 4.6/1 000 person-years with no clearly observed geographic trend. Despite the fact that age groups differed from one study to another, age-specific HZ incidence rates seemed to hold steady during the review period, at 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. They then increased rapidly after age 50 years to around 7–8/1 000, up to 10/1 000 after 80 years of age. Our review confirms that in Europe HZ incidence increases with age, and quite drastically after 50 years of age. In all of the 21 studies included in the present review, incidence rates were higher among women than men, and this difference increased with age. This review also highlights the need to identify standardized surveillance methods to improve the comparability of data within European Union Member States and to monitor the impact of VZV immunization on the epidemiology of HZ.ConclusionsAvailable data in Europe have shortcomings which make an accurate assessment of HZ incidence and change over time impossible. However, data are indicative that HZ incidence is comparable, and increases with age in the same proportion across Europe.
Highlights
Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ≥50 years
Varicella-zoster virus (VZV) is a herpes virus that infects most humans and causes two distinct diseases: varicella, the primary infection which usually occurs in childhood, and herpes zoster (HZ), a result of reactivation of VZV which remains latent in the sensory ganglia following varicella
Anyone who has had varicella is at risk of HZ, and in Europe varicella affects over 90% of children before the age of 15 years [8]
Summary
Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ≥50 years. Varicella-zoster virus (VZV) is a herpes virus that infects most humans and causes two distinct diseases: varicella, the primary infection which usually occurs in childhood, and herpes zoster (HZ), a result of reactivation of VZV which remains latent in the sensory ganglia following varicella. This reactivation occurs when VZVspecific cellular-mediated immunity decreases, mainly. For individuals aged 85 and over, this risk increases to 1 in 2 people [6]. Anyone who has had varicella is at risk of HZ, and in Europe varicella affects over 90% of children before the age of 15 years [8]
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