Cases Of Herpes Zoster Research Articles

Modelling the Public Health Burden of Herpes Zoster and the Impact of Adjuvanted Recombinant Zoster Vaccine in Five Selected Countries in Southeast Asia.

Herpes zoster (HZ) can cause substantial patient morbidity and lead to large healthcare costs. However, the disease burden of HZ in Southeast Asia may be underestimated. This study aimed to estimate the public health burden of HZ and the impact of vaccinating adults aged ≥ 50years old in five Southeast Asian countries (Indonesia, Malaysia, Philippines, Thailand, and Vietnam), with adjuvanted recombinant zoster vaccine (RZV) compared with no vaccination. For each country, we adapted a static multicohort Markov model developed with a 1-year cycle length and lifetime horizon. Demographics were obtained from the World Health Organization, HZ incidence from a worldwide meta-regression reporting Asian-specific values, proportions of postherpetic neuralgia (PHN) and non-PHN complications from local/regional studies, and vaccine efficacy from a long-term follow-up trial. First-dose coverage and second-dose compliance were assumed to be 30% and 70%, respectively. A one-way deterministic sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness and uncertainty of inputs for each country. Without RZV, it was estimated that there would be a total of approximately 10million HZ cases, 2.1million PHN cases, and 1.4million non-PHN complications in individuals aged ≥ 50years included in the model. Introducing RZV under 30% coverage could avoid approximately 2.2million (22%) HZ cases, almost 500,000 (21%) PHN cases, and around 300,000 (22%) non-PHN complications. OWSA showed that first-dose coverage and initial HZ incidence had the largest impact on the estimated number of HZ cases avoided. The number needed to vaccinate ranged from 15 to 21 to prevent one case of HZ and from 68 to 104 to prevent one case of PHN across each country. This study demonstrated that there is substantial HZ disease burden in older adults for the five selected countries in Southeast Asia, negatively impacting national healthcare systems. Introducing RZV could potentially reduce this burden. A graphical abstract is available with this article.

Multidermatomal Herpes Zoster of the trigeminal nerve in an immunocompetent patient: a case report

Herpes Zoster is a neurocutaneous viral infection caused by the reactivation of the Varicella Zoster Virus in the dorsal root ganglion. It is characterized as vesicular rash along a unilateral dermatome, usually associated with pain or paresthesia of the involved area. Multidermatomal involvement is rare in immunocompetent patients. We report an unusual case of Herpes Zoster involving the maxillary(V2) and mandibular(V3) branches of the trigeminal nerve in a healthy immunocompetent lady. Keywords: herpes zoster, neurocutaneous viral infection, trigeminal nerve

The Impact of the COVID-19 Pandemic on the Incidence of Herpes Zoster: A Narrative Literature Review.

Coronavirus disease 2019 (COVID-19) has had a broad impact on health services and health outcomes. During the pandemic, there were numerous reports of herpes zoster (HZ) in people with COVID-19 and in COVID-19 vaccine recipients. The aim of this review is to elucidate the global effects of the COVID-19 pandemic on HZ. It is postulated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces an immunosuppressive state that favours varicella zoster virus (VZV) reactivation. Three large cohort studies (a multinational study and studies from the USA and Spain) that excluded individuals vaccinated against HZ reported significantly increased risk of HZ following COVID-19 infection, especially in people aged ≥ 50years. In contrast, a large study from Israel that did not consider HZ vaccination status reported no such increase. Cases of HZ following COVID-19 vaccination have been reported and may be the result of attenuated cell-mediated immunity. This phenomenon appears to vary by vaccine type. Some (but not all) large analyses have reported a significant positive relationship between receipt of mRNA vaccines for COVID-19 and development of HZ. These include analyses of health records databases in Israel and Hong Kong and of spontaneous case reports in the US Vaccine Adverse Event Reporting System (VAERS) database. Routine vaccinations, including shingles vaccine programmes, were disrupted by the COVID-19 pandemic. It is estimated that missed shingles vaccinations may have resulted in 63,117 avoidable HZ cases in the USA. Now that the World Health Organization has declared an end to the COVID-19 pandemic as a health emergency and routine vaccination services have resumed, there is a need to increase awareness of HZ and HZ vaccination.Graphical abstract available for this article.

The impact of herpes zoster infection awareness program on myths, knowledge, and practices among the rural population of western Maharashtra

Background: In India, there is a paucity of population-based studies and data on herpes zoster in reporting herpes zoster cases. Several shreds of evidence reflect that the disease causes a burden on population health in India. Besides several known risk factors, myths, lack of knowledge, attitude, and practices towards treating this infection may affect the quality of life and disease burden. Imparting knowledge, awareness regarding myths and misconceptions, and early approaches for treatment can help prevent disease and complications in the population. Methods: Our study variables were myths about herpes zoster infection, knowledge about herpes zoster infection, and attitudes and practices towards the treatment of herpes zoster infection and to evaluate the impact of health awareness programme on it. It is an interventional study where study population is the families of adopted villages by D.Y. Patil Medical College, Kolhapur from the rural population of western Maharashtra. Results: The awareness programme which was the intervention in this study, was effective in increasing the awareness about myths and knowledge about herpes zoster infection as well as positive impact related to treatment practices for herpes zoster infection among the rural population in the adapted villages in western Maharashtra. Conclusions: The awareness programme which was the intervention in this study, was effective in increasing the awareness about myths and knowledge about herpes zoster infection as well as positive impact related to treatment practices for herpes zoster infection among the rural population in the adapted villages in western Maharashtra.

Real-world effectiveness and safety of baricitinib including its effect on biomarkers and laboratory data in Japanese adult patients with atopic dermatitis: a single-center retrospective study

Baricitinib demonstrated efficacy and tolerable safety in clinical trials for atopic dermatitis (AD); however, real-world data are limited. We examined effectiveness and safety of baricitinib, and laboratory data in AD patients treated with baricitinib in our department. We also evaluated baseline clinical severity in responders and non-responders. All adult AD patients treated with baricitinib in our department between January 2021 and February 2023 were included. Data on 30 Japanese AD patients were analyzed. Objective severity scores and patient-reported outcomes improved at one and 3 months, except for the affected body surface area at 1 month. The proportions of patients who achieved eczema area and severity index-50% improvement were 30.0% (9/30) at 1 month and 53.3% (16/30) at 3 months. There were no significant changes in AD biomarkers. No significant difference was observed in baseline clinical severity between responders and non-responders. No significant changes were observed in laboratory results except for increased serum creatine phosphokinase levels at 3 months. One case of herpes zoster and one case of ocular herpes were observed. Baricitinib showed mild effectiveness and favorable safety including laboratory findings. Biomarkers did not reflect clinical improvement. Further study is needed to identify characteristics of responders.

P943 Real world Effectiveness and safety of tofacitinib in patients with Ulcerative Colitis: 6 months follow-up of the French TOFAST study

Abstract Background TOFAST is an observational, prospective, multicenter cohort study aiming to describe the real-life clinical benefit of tofacitinib in moderate-to-severe Ulcerative Colitis (UC). Methods We report the results of the interim analysis after 6 months of follow-up, describing patient's characteristics, effectiveness, including change in daily PRO2 scores [RB and stool frequency (SF)] during the first 14 days and the median time to relief, and safety. Clinical response was defined as a decrease in partial Mayo score (PMS) (≥ 3 points and ≥30%) from inclusion with a concomitant decrease in rectal bleeding (RB) subscore ≥ 1 point (absolute subscore of 0 or 1). Clinical remission was defined as PMS ≤2 with no subscore >1. Symptomatic relief was reported by patients as the time in days from initiation of tofacitinib to improvement of their symptoms. Safety has been been reported as the % of Adverse Events (AE), serious AE and AE of special interest. Results 88 patients were included in the safety analysis (one patient was excluded from the effectiveness analysis as he did not meet the eligibility criteria) with a median exposure duration of 11.7 [Q1; Q3: 6.0; 22.1] months. Of these patients, 67 completed a 6-month follow-up visit by 15/07/2023 and were included in the effectiveness analysis. At inclusion 59.8% of patients were male with a mean (± SD) age of 37.5 ±13.2 years, a median disease duration of 5.9 years [Q1; Q3: 2.7; 13.1]. 46.5% of patients had pancolitis. The mean total Mayo Score was 8.1 ±2.4. 94.3% of patients had previously received at least one anti-TNF agent, 67.8% vedolizumab and 35.6% ustekinumab. Tofacitinib was initiated at 10 mg b.i.d, in combination with corticosteroids for 35.6% of patients. At 6 months, 53 (77.9%) patients were still treated with tofacitinib, 58.5% at 10 mg BID dose. Corticosteroids were ongoing in 22.9% of patients. Clinical response and remission were observed in 64.2% and 61.2% of patients, respectively. For the 68 (78.2%), patients who reported improvement the median time to relief was 7 days [Q1; Q3: 3.5 ;14.5]. PRO2 scores normalization during the first 14 days is shown in the figure. 84.1% of patients reported at least one adverse event (AE) and 21.6% reported at least one serious AE. Seventeen (19.3%) infections and 3 (3.4%) cases of herpes zoster were observed as well as one non-invasive low-grade urothelial carcinoma. No major cardiovascular or venous thromboembolic event, nor malignancy or death were observed (Table). Conclusion In this real-life cohort of patients with refractory UC, tofacitinib induced a clinical response and remission in over 60% of patients, with symptoms relief observed as early as the first two weeks. AEs were consistent with the known tofacitinib safety profile.

1938 Prevention of herpes zoster infection with a recombinant zoster vaccine to support healthy ageing in older adults

Abstract Introduction In the European Union, life expectancy has increased from 74 to 81 years between 1990 and 2018. Time spans living in ill health are also increasing. Vaccine recommendations focus primarily on vaccines that prevent death thereby extending length of life. The focus should also include vaccines that promote healthy ageing (HA), improving the quality of longer lifespans. The aims of this review are to describe the impact of herpes zoster (HZ) in adults ≥50 Years of Age (YOA), and to summarise the available evidence on how the recombinant zoster vaccine (RZV) contributes to HA. Methods We conducted a narrative review of published literature on the impact of developing HZ on HA and the ability of vaccination to prevent the subsequent burden of disease. Specifically, we describe HZ impact on functioning ability and quality of life, and impact of RZV on reducing the burden of HZ in adults ≥50 YOA. Results One in three people develop HZ in their lifetime. Approximately, 15 million cases of HZ occur annually worldwide in adults ≥50 YOA. Post-herpetic neuralgia (PHN, pain persisting for ≥ 90 days) occurs in up to 30% of patients, with HZ ophthalmicus affecting up to 25% of patients. HZ presents as a unilateral, vesicular rash with pain scored as “worst pain imaginable” in ≥15% of patients. Treatment options for HZ and its complications are limited and suboptimal with only 14% of patients with PHN satisfied with their treatment. Pain significantly impacts sleep, mood, physical, social and mental functioning. RZV elicits a strong and long-lasting immune response, targeting the decline in cellular immunity. RZV reduced the burden of HZ pain and interference on activities on daily living by >90% in adults aged ≥50 YOA. Conclusion RZV, by preventing HZ episodes, supports maintenance of functional ability contributing to wellbeing in older age.

Herpes zoster after the third dose of SARS-CoV-2 mRNA-BNT162b2 vaccine in actively treated cancer patients: a prospective study

Several concerns have been raised about a causal relationship between COVID-19 mRNA-based vaccines and the development of herpes zoster (HZ). We performed a prospective analysis of the Vax-On-Third-Profile study to investigate the incidence of HZ after the third dose of mRNA-BNT162b2 (tozinameran) and its correlation with immune responses. Patients who had received a booster dose and had been actively treated for at least 8 weeks were eligible. Serologic assessment was performed before the third dose of tozinameran (timepoint-1) and 4 weeks later (timepoint-2). We also assessed the incidence of SARS-CoV-2 breakthrough infections at predefined time points. The current analysis included 310 patients, of whom 109 (35.2%) and 111 (35.8%) were being treated with targeted therapies and cytotoxic chemotherapy, respectively. All participants received a third dose of tozinameran between September 26 and October 30, 2021. After a mean follow-up of 17.3 (IQR 15.1–18.4) months, HZ occurred in 8 recipients, for a cumulative incidence of 2.6%, and an incidence rate of 0.310 per person-year (95% CI 0.267–0.333). All HZ cases occurred within 30 days of booster dosing (range 5–29 days), with a median time to onset of 15 (IQR 9–22) days. Among the 7 patients (2.2%) who also contracted a SARS-CoV-2 infection, all cases preceded COVID-19 outbreaks. No instances of complicated HZ were reported. In multivariate analysis, impaired T helper and T cytotoxic cell counts independently correlated with HZ occurrence. These findings provide the first evidence that cancer patients on active treatment have a not negligible risk of developing HZ within 30 days after the third dose of tozinameran. The favorable clinical outcome of all observed cases confirms that protective effects of boosters in reducing the risk of severe COVID-19 outweigh the potential risk of HZ occurrence.

Herpes zoster, complicated with thoracic wall phlegmon in a patient with HIV-infection: a case report

Herpes zoster is often associated with HIV infection. The article presents a clinical case of herpes zoster, complicated by the thoracic wall phlegmon in a 41-year-old male infected with HIV. Dissection and debridement of the phlegmon were performed. Antibacterial and pain relief therapy, start of antiretroviral therapy and treatment of the concomitant diseases were carried out. The residual thoracic wall skin and soft tissue defect on the site of the phlegmon was healed with surgery.Conclusions. Secondary manifestations of HIV infection present with the diversity of symptoms and severe clinical performance. Herpes zoster may be complicated with the purulent inflammation of surrounding tissue in the patients with HIV-infection. A multidisciplinary approach to the diagnosis and treatment of such patients is required.

The Risk of Herpes Zoster Events in Patients with Spondyloarthritis and the Effect of BNT162b2 mRNA COVID-19 Vaccine.

The data on the risk of herpes zoster (HZ) in spondyloarthropathy (SpA) patients are sparse, especially regarding its association with the novel mRNA COVID-19 vaccines and immunosuppressants. We aimed to evaluate whether SpA diagnosis and/or immunosuppressant use affect HZ risk and the influence of mRNA COVID-19 vaccination. We assessed the association between SpA (psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) diagnoses and HZ in a large population database with patients matched by age and sex to controls. We also assessed the association between the COVID-19 vaccine and new-onset HZ using two nested case-control studies, identifying all new HZ cases diagnosed from 1 January-31 December 2021 within the SpA and general population cohorts, matched randomly by sex, age and HZ index date to controls without HZ. Exposure to mRNA COVID-19 vaccination was ascertained in the 6 weeks prior to the index date both in cases and controls. In our results, the incidence rate of HZ was higher in PsA patients vs. the general population, at 1.03 vs. 0.64 per 100 person-years, respectively (adjusted HR = 1.55; 95%CI, 1.19-2.02). Within the SpA group, Jak-I treatment was associated with a higher risk of developing new-onset HZ (adjusted OR = 3.79; 1.15-12.5). Multivariable conditional logistic regression models we used showed no association between COVID-19 vaccination and new-onset HZ among the SpA patients (OR = 1.46; 0.68-3.14).

A retrospective cohort study evaluating the incidence of herpes zoster and postherpetic neuralgia after a live attenuated Oka-strain herpes zoster vaccine in a real-world setting in Japan

BackgroundIn Japan, freeze-dried live attenuated Oka-strain varicella-zoster virus vaccine, VVL (BIKEN), is available for adults aged ≥50 years to prevent herpes zoster (HZ). Although an increase in the antibody titer and cellular immune response has been demonstrated following vaccination with VVL (BIKEN), to date, no clinical studies have shown that the vaccine decreases the incidence of HZ and postherpetic neuralgia (PHN). This study investigated the incidence of HZ and PHN among adults aged ≥50 years who received a single dose of VVL (BIKEN) to prevent HZ. MethodsThis retrospective cohort study investigated the incidence of HZ and PHN among adults aged ≥50 years who received a single dose of VVL (BIKEN) at a large hospital and affiliated clinics in Japan. A dispensing database and electronic medical records were used to identify vaccine recipients and cases of HZ and PHN. The end date of the follow-up period and the reason to end the follow-up were defined to avoid underestimating the incidence. The analysis was stratified according to age, sex, immunocompromising conditions, and use of immunosuppressant therapy. Vaccine effectiveness was estimated using published estimates of the incidence of HZ and PHN in the unvaccinated population in Japan. ResultsA total of 1175 patients were enrolled in the study. During a median follow-up period of 3.36 years, HZ was diagnosed in 27 participants (15 men [2.8%] and 12 women [1.9%]). The incidence of HZ among VVL (BIKEN) recipients was 7.67/1000 person-years. The incidence of PHN was 0.82/1000 person-years. The vaccine effectiveness was estimated as 27.8% [95% confidence interval (CI), −29.8 to 63.9%] and 73.8% [95% CI, 38.6–100%] against HZ and PHN, respectively. ConclusionsThe VVL (BIKEN) had limited effectiveness at preventing HZ, but relatively good effectiveness at preventing PHN. VVL (BIKEN) might have a role as an affordable alternative.

Clinical and epidemiological profile of herpes zoster cases and its complications: A prospective study

Background: The varicella-zoster virus, which is known to lie dormant in the dorsal root ganglia after primary chickenpox infection or immunization, and in rare instances, intrauterine infection, is the source of the common viral infection known as herpes zoster (HZ). In healthy people, the illness usually goes away on its own, but in severely immunocompromised patients, it can cause persistent debilitation through multi-dermatomal, severe, vesiculo-pustular, nodular, crusted, and ecthymatous manifestations. Aims and Objectives: The aim of this study was to better understand the clinical profile and epidemiological patterns of HZ and various postherpetic complications. Materials and Methods: A prospective cross-sectional study was conducted at a tertiary care hospital in Karnataka for 24 months during August 2013–August 2015. Seventy-five patients with HZ and postherpetic complications attending the dermatology outpatient department were included in the study. Pre-existing comorbidities and patient details were recorded. The Hayes and Patterson Visual Analog Scale (VAS) was used to record the kind, duration, and intensity of the pain. Results: The current cross-sectional study was done in a tertiary care hospital, and a total of 75 patients were considered for the study. The youngest patient was a 12-year-old male and the eldest patient was a 90-year-old male. The average age of patients was 52.45 ± 12.5 years. Cutaneous examination showed erythema (84%) and vesicles (84%). The intensity of pain was classified based on the VAS. About 54.6% of patients had a moderate degree of pain. Conclusion: Acute vesicles with erythema and radicular pain with a unilateral dermatomal distribution are the most typical presentation of HZ infection, and they are most frequently seen in the thoracic area.

Skin manifestations after immunisation with an adjuvanted recombinant zoster vaccine, Germany, 2020.

BackgroundShortly after the launch of a novel adjuvanted recombinant zoster vaccine (RZV), Shingrix, cases of suspected herpes zoster (HZ) or zoster-like skin reactions following immunisation were reported.AimWe aimed to investigate if these skin manifestations after administration of RZV could be HZ.MethodsBetween April and October 2020, general practitioners (GP) reporting a suspected case of HZ or zoster-like skin manifestation after RZV vaccination to the Paul-Ehrlich-Institut, the German national competent authority, were invited to participate in the study. The GP took a sample of the skin manifestation, photographed it and collected patient information on RZV vaccination and the suspected adverse event. We analysed all samples by PCR for varicella-zoster virus (VZV) and herpes-simplex virus (HSV) and genotyped VZV-positive samples. In addition, cases were independently assessed by two dermatologists.ResultsEighty eligible cases were enrolled and 72 could be included in the analysis. Of the 72 cases, 45 were female, 33 were 60-69 years old, 32 had skin symptoms in the thoracic and 27 in the cervical dermatomes. Twenty-seven samples tested PCR positive for VZV (all genotyped as wild-type, WT), three for HSV-1 and five for HSV-2.ConclusionIt may be difficult to distinguish HZ, without a PCR result, from other zoster-like manifestations. In this study, VZV-PCR positive dermatomal eruptions occurring in the first weeks after immunisation with RZV were due to WT VZV, which is not unexpected as HZ is a common disease against which the vaccine is unlikely to provide full protection at this time.

Multidermatomal herpes zoster triggered by psychological stress in an immunocompetent young adult: a rare case report and clinical insights

Introduction and Importance: Herpes zoster (HZ), a reactivated varicella zoster virus infection arising from dormant viral latency after initial chickenpox, manifests as localized skin rashes along dermatomes. Multidermatomal involvement, especially in immunocompetent individuals, is rare. The potential link between psychological stress and HZ reactivation remains underexplored. The authors present a case of multidermatomal HZ triggered by psychological stress in a young immunocompetent adult. Case presentation: A 26-year-old male presented with vesicular lesions spanning C5, C8, T1, and T2 dermatomes, triggered by psychological stress. The disease exhibited a unique midline-crossing presentation. The Varicella zoster virus IgM test result was positive. Treatment included acyclovir, pain management, and stress reduction strategies, yielding complete resolution within 3 weeks. Clinical discussions: The case highlights a distinctive multidermatomal HZ presentation, defying conventional dermatomal restrictions. Psychological stress potentially influenced viral reactivation. Immunocompetence and stress interplay merit further exploration. Multidermatomal HZ necessitates prompt clinical recognition and comprehensive evaluation. Antiviral therapy and integrated stress management may contribute to successful outcomes. Conclusion: This case underscores the rare occurrence of multidermatomal HZ in an immunocompetent young adult triggered by psychological stress. The atypical presentation and potential role of stress in viral reactivation emphasize the complex interaction between the nervous and immune systems. Integrated clinical management, stress reduction strategies, and antiviral therapy were effective in resolving the condition. Further research is warranted to elucidate the mechanisms underlying stress-induced viral reactivation and its clinical implications.

Burden of Herpes Zoster in Individuals with Immunocompromised Conditions and Autoimmune Diseases in the Republic of Korea: A Nationwide Population-Based Database Study.

To estimate herpes zoster (HZ) incidence rate (IR) and economic burden in individuals with immunocompromised conditions and autoimmune diseases (IC/AID) in the Republic of Korea (ROK). The nationwide Health Insurance Review and Assessment Service database was used to identify HZ cases from 2016 to 2020 in ROK. HZ and non-HZ IC/AID cases were matched 1:3 using age, sex, institution, Charlson comorbidity index, IC/AID, and index date. Annual HZ IRs/1000 persons and 1-year HZ-associated all-cause direct medical costs for IC/AID cases were calculated. Among 65,976 individuals with IC/AID (mean age 57.14years [standard deviation 14.1]; 64.94% female), annual HZ IR (95% confidence interval) fluctuated from 2016 to 2020, averaging 23.41/1000 persons (22.21-24.62) and was higher in women (26.85 [25.40-28.31]) than men (18.96 [18.03-19.89]). IRs were highest in individuals aged ≥ 50years, and in those with transplants (including solid organ and hematopoietic stem cell transplants; 37.12 [35.45-38.79]) and hemato-oncology conditions (35.5 [31.6-39.3]). Mean 12-month all-cause direct medical costs were higher in individuals with IC/AID and HZ (4,759,671 Korean Republic won [KRW]; approximately 4046 United States dollar [USD; according to the 2020 conversion rate from UNCTAD; 1 KRW = 0.00085 USD]) than those without HZ (3,786,658 KRW; 3219 USD). Individuals with IC/AID have a substantial disease and economic burden from HZ in ROK, highlighting the need for appropriate HZ prevention measures in the IC/AID population.

Short-term risk and long-term incidence rate of infection and malignancy with IL-17 and IL-23 inhibitors in adult patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022363127.

917. Development and Validation of an Automated Natural Language Processing Method for Identifying Postherpetic Neuralgia from Electronic Health Records

Abstract Background Postherpetic neuralgia (PHN) is a debilitating complication of herpes zoster (HZ). PHN diagnosis codes tend to be inaccurate or incomplete. The criterion standard for identifying PHN in electronic health records (EHR) is manual chart review, which can be costly and time-consuming. We developed and validated a method to automatically identify PHN from free-text EHR data using natural language processing (NLP). Methods This study utilized EHR data of patients aged ≥50 years who had an incident HZ diagnosis and associated antiviral prescription between 2018-2022 at Kaiser Permanente Southern California. Among patients with ≥1 encounter during the 90-180 days after the incident HZ diagnosis, PHN was defined as pain/discomfort consistent with the HZ episode between 90-180 days after the initial HZ diagnosis; the symptoms were at the location of the initial HZ rash and were not due to other obvious causes. Trained research associates and an infectious disease physician manually reviewed and identified PHN cases from EHR. From these reviewed HZ cases, we randomly selected 500 and 800 cases for NLP development and validation, respectively. We developed and validated an NLP algorithm to identify PHN based on our case definition. Using chart-reviewed results as the criterion standard, the accuracy of NLP-based results was compared with that of diagnosis code-based results (ICD-10 codes B02.22, B02.23, B02.29 from all clinical encounters during the 90-180-day period). Results Compared to the criterion standard, the NLP algorithm achieved 100% sensitivity (code-based 64.8%), 99.9% specificity (code-based 97.0%), 98.6% positive predictive value (code-based 67.7%), and 100% negative predictive value (code-based 96.6%) in identifying PHN cases. In the validation data, the prevalence of PHN was 8.9% based on manual chart review. Although the prevalence of PHN identified by the two methods was similar (NLP-based 9.0%, code-based 8.5%), the code-based method misclassified more than one-third of chart-confirmed PHN cases. Accuracy measurements of NLP and diagnosis codes in identifying PHN, as compared with chart-confirmed validation data. Conclusion We developed and validated an automated method to identify PHN cases using the clinical text from EHR of HZ patients with high accuracy. This method can be a valuable tool to facilitate population-based studies of PHN. Disclosures Bradley Ackerson, MD, Dynavax: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Leticia I. Vega Daily, MSW, GlaxoSmithKline: Grant/Research Support Jeannie Song, MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Lina S. Sy, MPH, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Lei Qian, PhD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Ana Florea, PhD MPH, Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Jennifer H. Ku, PhD MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Hung Fu Tseng, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support

Effectiveness of the live zoster vaccine during the 10 years following vaccination: real world cohort study using electronic health records

ObjectivesTo assess the effectiveness of live zoster vaccine during more than 10 years after vaccination; and to describe methods for ascertaining vaccine effectiveness in the context of waning.DesignReal world cohort...

Maintenance Therapy with Chidamide Plus Azacitidine after Allogeneic Hematopoietic Stem Cell Transplantation for High-Risk Acute Myeloid Leukemia Patients

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is theoretically the only curative option for high-risk acute myeloid leukemia (AML) patients. However, many patients relapse after allo-HSCT, and treatment options are very limited. Azacitidine, a DNA methyltransferase inhibitor exhibits anti-leukemia activity in myeloid diseases. Chidamide, a selective histone deacetylase inhibitor, effectively induces apoptosis of AML cells. They have synergistic inhibitory effect on AML cells when combined together. Therefore, we conducted a multicentre, prospective study (ChiCTR2300067593) to examine the tolerability and efficacy of a combination of both chidamide and azacitidine as a maintenance therapy for high-risk AML patients after allo-HSCT. Patients and methods： Patients ≤ 60 years of age with high-risk AML post- allo-HSCT were enrolled. The high-risk characteristics of AML were defined as one or more of the following criteria: a) Patients with poor prognosis according to the genetic risk stratification assessment of European Leukmia Net (ELN) in 2022; b) Primary refractory or recurrent AML; c) Secondary AML (secondary to MDS or treatment-related AML). All patients received Chidamide 5 mg/d combined with azacitidine 75 mg/m2/d for 5 days. The cycle interval was 6-8 weeks. A total of 6 cycles was recommended. Treatment started as early as 3 months after transplantation. The primary endpoint of this study was cumulative incidence of relapse (CIR). The secondary endpoints included rates of overall survival (OS) and event-free survival (EFS). Survival outcomes were estimated using Kaplan-Meier analysis. Results： Thirty-six patients have been recruited. The median age was 42 years (range, 16-59). Baseline characteristics are shown in Table 1. With a median follow-up time of 412（185-762）days, the 1-year CIR was 12.3 (6.5-18.1) %, the 1-year OS and EFS rates were 100.0% and 87.7 (81.9-93.5) %, respectively. The median OS and EFS time were not reached. Four patients relapsed, two died, and two are still alive and ready for the second transplantation. The most common adverse events (AEs) were thrombocytopenia reaction and gastrointestinal tract reaction. Grade 2 or 3 AEs were observed in 16.7% (6/36) and 25.0% (9/36) of the patients, respectively. No grade >3 AEs were noted. 9 patients (6/36,16.7%) developed grade 3-4 thrombocytopenia, without active hemorrhage. All of them received blood transfusion and thrombopoietin receptor agonist. The median persistence of thrombocytopenia was 3 (2-5) d. Chronic graft-versus-host-disease (cGVHD) occurred in 25.0% (9/36) of patients. Four cases (4/36, 11.1%) were complicated with infection. They were one case of intestinal infection, one case of pulmonary and EBV infections, one case of hepatitis B virus activation and one case of herpes zoster. And all infected patients recovered safely after anti-infection and symptom-oriented treatment. CMV activation was not observed. Non relapse mortality (NRM) was zero. Conclusions： We conclude that chidamide plus azacitidine can be administered safely after allo- HSCT with no evidence of an increased incidence of GVHD, and this combination may decrease the relapse rate in high-risk AML patients. This novel maintenance therapy may be a promising way to prevent relapse in high-risk AML patients.

Validity of claims-based diagnoses for infectious diseases common among immunocompromised patients in Japan

BackgroundTo validate Japanese claims-based disease-identifying algorithms for herpes zoster (HZ), Mycobacterium tuberculosis (MTB), nontuberculous mycobacteria infections (NTM), and Pneumocystis jirovecii pneumonia (PJP).MethodsVALIDATE-J, a multicenter, cross-sectional, retrospective study, reviewed the administrative claims data and medical records from two Japanese hospitals. Claims-based algorithms were developed by experts to identify HZ, MTB, NTM, and PJP cases among patients treated 2012–2016. Diagnosis was confirmed with three gold standard definitions; positive predictive values (PPVs) were calculated for prevalent (regardless of baseline disease-free period) and incident (preceded by a 12-month disease-free period for the target conditions) cases.ResultsOf patients identified using claims-based algorithms, a random sample of 377 cases was included: HZ (n = 95 [55 incident cases]); MTB (n = 100 [58]); NTM (n = 82 [50]); and PJP (n = 100 [84]). PPVs ranged from 67.4–70.5% (HZ), 67.0–90.0% (MTB), 18.3–63.4% (NTM), and 20.0–45.0% (PJP) for prevalent cases, and 69.1–70.9% (HZ), 58.6–87.9% (MTB), 10.0–56.0% (NTM), and 22.6–51.2% (PJP) for incident cases, across definitions. Adding treatment to the algorithms increased PPVs for HZ, with a small increase observed for prevalent cases of NTM.ConclusionsVALIDATE-J demonstrated moderate to high PPVs for disease-identifying algorithms for HZ and MTB using Japanese claims data.