Diagnosis Of Herpes Zoster Research Articles

Herpes Zoster (Shingles) Patient-Centered Wound Outcomes: A Literature Review.

ABSTRACTGENERAL PURPOSETo present a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs.TARGET AUDIENCEThis continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.LEARNING OBJECTIVES/OUTCOMESAfter participating in this educational activity, the participant will be able to:1. Explain the importance of early diagnosis and treatment of herpes zoster (HZ).2. Identify interventions that have resulted in documented improvement of validated patient-centered outcomes in patients with HZ or postherpetic neuralgia.3. Recognize the average per patient medical costs of HZ in the US.BACKGROUNDOne in three people endure herpes zoster (HZ; also known as shingles) during their lifetime, experiencing pain, secondary infections, postherpetic neuralgia, reduced quality of life, and considerable patient costs. These patient burdens remain to be reviewed.OBJECTIVETo perform a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs.DATA SOURCESThe PubMed database was searched with supplementary Google Scholar searches for Medical Subject Headings “shingles” or “post-herpetic neuralgia” to find clinical studies documenting validated patient-centered outcomes: pain, secondary infection, healing, function, depression, social isolation, treatment costs, or quality of life. Six representative case studies were examined.DATA SELECTIONPertinent original and derivative clinical study references were included. Preclinical studies, reviews, or studies of non-HZ conditions were excluded.DATA EXTRACTIONTwo authors tabulated clinical efficacy evidence for interventions affecting patient-centered outcomes.DATA SYNTHESISEvidence supported efficacy for systemic antiviral or topical anesthetic interventions improving pain, healing, sleep, vision, or quality of life for those with HZ or postherpetic neuralgia. Patient cases reported improved pain and/or sleep using occlusive dressings. Treatment costs and secondary infections were reported only in cases or cohort studies.CONCLUSIONSRandomized clinical research focused on medications improving patient pain, healing, sleep, or vision outcomes. Research is needed measuring outcomes of adding occlusive dressings to optimal care and effects on secondary infections and treatment costs.

Clinical and epidemiological characteristics of chickenpox in the adult population at the present stage

Chickenpox is an urgent problem, as it is widely spread with a high level of morbidity and an increasing share in the structure of the General infectious pathology with significant economic damage. The aim of the study is to study the epidemiological and clinical features of chickenpox in adults hospitalized in Krai government-owned publicy funded health care institution «City clinical hospital No. 5, Barnaul» for the period 2008‑2018. Content analysis included statistical reporting forms No. 2 of Federal state statistical supervision «Data on infectious and parasitic diseases» in the city of Barnaul during the period 2008‑2018 of medical archival documents adult infectious Department Krai government-owned publicy funded health care institution «City clinical hospital №5, Barnaul» for the same period. Data processing was performed using calculation of intensive and extensive indicators, calculation of the arithmetic mean (X) and standard error of the average (m). Calculations were made using the STATISTICA-10 program. Consistently high rates were recorded, with an average of 64.32 ± 3.46 per 100,000 population. The percentage of hospitalized adults averaged 18.5% during the study period. Adults aged 18‑30 were more likely to be admitted to the hospital (90.3%); 41.6% were students. Adults with moderate severity were hospitalized more often (70.6%); 7 patients (1.3%) had complications: aphthous stomatitis (3 cases), pustulosis (2 cases), and pneumonia (2 cases). Patients with severe severity of the disease accounted for 2.4%, the premorbid background was burdened in 48% (HIV infection, tuberculosis). In 35% of patients with severe severity, the final diagnosis of Herpes zoster was made, all patients older than 40 years, stayed in the hospital for 20‑25 days.

Association between Chronic Interstitial Cystitis and Herpes Zoster.

Objectives: Herpes zoster (HZ) infection has been associated with disease burdens such as infection and depression. However, the relationship between chronic interstitial cystitis (CIC) and HZ is unknown. This study investigated HZ risk in patients with CIC. Patients and Methods: The Longitudinal Health Insurance Database, which is a subset of the Taiwan National Health Insurance Research Database, was used in the study. The case cohort consisted of patients with newly diagnosed CIC between 2000 and 2012. Each patient with CIC was matched to four controls by age and index year. All participants were traced from the index date to HZ diagnosis, and loss to follow-up or death, or to the end of the study (31 December 2013). Results: A total of 1096 patients with CIC and 4384 controls were enrolled. The incidence rate of HZ in patients with CIC was 10.8 per 1000 person-years, whereas that for controls was 7.25 per 1000 person-years. HZ risk for the case cohort was 1.48 times that for the control cohort. Among participants aged ≤49 years, patients with CIC had a 1.91-fold-increased HZ risk compared to those without CIC. Conclusion: Patients with CIC had a higher risk of HZ than those without CIC. CIC should not be ignored, particularly in young adults.

Risk of herpes zoster after exposure to varicella to explore the exogenous boosting hypothesis: self controlled case series study using UK electronic healthcare data

ObjectiveTo assess the magnitude and duration of any hypothesised protective effect of household exposure to a child with varicella on the relative incidence of herpes zoster in adults.DesignSelf controlled case...

Encephalitis Following Herpes Zoster Ophthalmicus

85-year-old female had been hospitalized for a diagnosis of herpes zoster in the Dermatology Department 10 days ago due to redness and vesicular lesions on the left eyelids and the left side of the forehead, and had been started IV acyclovir 500 mg tid. She was consulted with us because of development of diplopia, […]

S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia.

The present guidelines are aimed at residents and board-certified specialists in the fields of dermatology, ophthalmology, ENT, pediatrics, neurology, virology, infectious diseases, anesthesiology, general medicine and any other medical specialties involved in the management of patients with herpes zoster. They are also intended as a guide for policymakers and health insurance funds. The guidelines were developed by dermatologists, virologists, ophthalmologists, ENT physicians, neurologists, pediatricians and anesthesiologists/pain specialists using a formal consensus process (S2k). Readers are provided with an overview of the clinical and molecular diagnostic workup, including antigen detection, antibody tests and viral culture. Special diagnostic situations and complicated disease courses are discussed. The authors address general and special aspects of antiviral therapy for herpes zoster and postherpetic neuralgia. Furthermore, the guidelines provide detailed information on pain management including a schematic overview, and they conclude with a discussion of topical treatment options.

Ramsay-Hunt syndrome

A 27-year-old man consulting in the emergency room for an acute facial paralysis with deafness and vertigo for 4 days. Physical examination shows clustered vesicles in the external auditory canal without any oral involvement. Laboratory investigations and computed tomography imaging were unremarkable. Thus, we diagnosed herpes zoster octicus (RHS, type 2). Treatment consists in the combination of antiviral drugs (valaciclovir 3 g/day) and corticosteroids (methylprednisolone 80 mg/day) with topical antibiotics for crusty lesions of the ear. The patient was finally referred to the otorhinolaryngology department for the management of facial paresis. Ramsay Hunt syndrome (RHS) is a localized herpes zoster infection involving the seventh nerve and geniculate ganglia, resulting in hearing loss, vertigo, and facial nerve palsy and remains one of the major causes of atraumatic peripheral facial paralysis. Immunodeficiency states, particularly HIV infection, should be considered in younger patients, severe cases and patients with a history of specific risk behavior. In our patient, HIV serology was negative.

Herpes zoster coinfection and the current COVID-19 pandemic

Clinical presentation of COVID-19 infection can be variable in the current pandemic, even in patients presenting to the clinic with mild history of upper respiratory complaints. Various cutaneous manifestations have been noticed in COVID-19 patients with herpes zoster (HZ) being one among them. HZ is an infection that results when varicella zoster virus reactivates from its latent state in a posterior dorsal root ganglion. Here, we aim to expand our knowledge by reporting three cases of associated zoster infection in COVID-19 patients admitted to our intensive care unit in view of respiratory complaints. All the three patients admitted had revealed lymphocytopenia at the time of HZ diagnosis and were managed conservatively throughout the course. In all the cases, acyclovir/valacyclovir led to the resolution of lesions in 10 days. No postherpetic sequelae were observed. We hereby suggest that the clinical presentation of HZ at the time of current pandemic should be considered as an alarming sign for a latent subclinical SARS-CoV-2 infection and thorough follow-up of such patients should be adopted.

Complications of herpes zoster in children.

Herpes zoster (HZ) may cause complications; however, information regarding complications of HZ in children is relatively sparse. We reviewed cases of HZ in children retrospectively and investigated the risk factors contributing to the development of complications. A retrospective observational study was conducted at a tertiary care children's hospital in Japan. Children receiving a diagnosis of HZ between January 2010 and October 2016 were identified from electronic medical records. In this study, the following diseases were recognized as complications of HZ: bacterial skin infection, facial paralysis, meningitis, uveitis and keratitis, postherpetic neuralgia, acute retinal necrosis, pneumonia, and otitis interna. Details regarding clinical information of HZ patients with complications were described. We found 138 cases with HZ. Among these, 58 (42%) occurred in immunocompetent children and 80 cases (58%) occurred in immunocompromised children. Complications were observed in 10 cases of immunocompromised children and in eight cases of immunocompetent children. Although secondary bacterial skin infection was the most common complication (n = 6, 33.3%), severe complications such as facial paralysis (n = 3, 16.7%), meningitis (n = 2, 11.1%), uveitis and keratitis (n= 2, 11.1%), acute retinal necrosis (n = 1, 5.6%), pneumonia (n = 1, 5.6%), and otitis interna (n = 1, 5.6%) were observed. Patients with complications tended to have a rash on the head or neck, compared with those without complications (n = 9, 50% vs n = 18, 15%; P = 0.001). Severe HZ complications may occur in immunocompetent children. Development of a rash on the head or neck might be a risk factor for complications.

AGE PECULIARITIES OF HERPES ZOSTER CLINIC

Herpes zoster is a viral disease that occurs as a result of reactivation of Varicella zoster virus and is characterized by damage to the skin, nervous tissue. This disease develops as a secondary endogenous infection in individuals who have previously had chickenpox. Potential risk factors for herpes zoster are old age, the presence in patients of cancer and / or hematological diseases, diabetes, HIV infection, drug immunosuppression. Changes in socio-economic conditions are accompanied by pathomorphosis of diseases. This fully applies to the infection caused by Varicella zoster virus. Diagnosis of herpes zoster in the prodromal period is difficult, since there are no characteristic bubble rashes. Late diagnosis leads to delayed medical care. The clinical differences of herpes zoster in 78 patients of different age categories were studied: up to 60 years, and after 60 years. The terms of diagnosis, duration of prehospital and hospital stages, clinical symptoms, presence of concomitant pathology and complications were studied. It was shown that the diagnosis of herpes zoster at the prehospital stage was established only in half of the patients, which led to late hospitalization and may have contributed to the development of complications. Among the features of the clinical course, a lower incidence of concomitant pathology and adequate immunoreactivity were noted in persons under the age of 60 years, compared with patients over the age of 60 years. It is assumed that the reactivation of Varicella zoster virus, which is associated in the elderly with immunosuppression against the background of combined chronic somatic pathology, in young people may be due to other reasons, among which may be, including the features of the pathogen.

AGE PECULIARITIES OF HERPES ZOSTER CLINIC

Herpes zoster is a viral disease that occurs as a result of reactivation of Varicella zoster virus and is characterized by damage to the skin, nervous tissue. This disease develops as a secondary endogenous infection in individuals who have previously had chickenpox. Potential risk factors for herpes zoster are old age, the presence in patients of cancer and / or hematological diseases, diabetes, HIV infection, drug immunosuppression. Changes in socio-economic conditions are accompanied by pathomorphosis of diseases. This fully applies to the infection caused by Varicella zoster virus. Diagnosis of herpes zoster in the prodromal period is difficult, since there are no characteristic bubble rashes. Late diagnosis leads to delayed medical care. The clinical differences of herpes zoster in 78 patients of different age categories were studied: up to 60 years, and after 60 years. The terms of diagnosis, duration of prehospital and hospital stages, clinical symptoms, presence of concomitant pathology and complications were studied. It was shown that the diagnosis of herpes zoster at the prehospital stage was established only in half of the patients, which led to late hospitalization and may have contributed to the development of complications. Among the features of the clinical course, a lower incidence of concomitant pathology and adequate immunoreactivity were noted in persons under the age of 60 years, compared with patients over the age of 60 years. It is assumed that the reactivation of Varicella zoster virus, which is associated in the elderly with immunosuppression against the background of combined chronic somatic pathology, in young people may be due to other reasons, among which may be, including the features of the pathogen.

Herpes zoster related healthcare burden and costs in immunocompromised (IC) and IC-free populations in England: an observational retrospective database analysis

ObjectiveIndividuals with immunocompromised (IC) conditions are at a higher risk of developing herpes zoster (HZ) than IC-free individuals. This study assessed the healthcare resource utilisation (HCRU) burden and costs, of...

The risk of herpes zoster among patients with ankylosing spondylitis: A population-based cohort study in Taiwan.

The incident rate of herpes zoster (HZ) is higher in some autoimmune diseases; however the relationship of HZ and ankylosing spondylitis (AS) is still unclear. This research aims to determine the incidence of HZ in Taiwan AS patients. This study included 2819 AS patients and 11276 non-AS controls between 2003 and 2013. All participants were selected from the Longitudinal Health Insurance Database 2000 Taiwan. The endpoint was diagnosis of HZ by International Classification of Diseases, Ninth Revision, Clinical Modification coding for at least 3 outpatient visits or one admission until the end of 2013. We used Chi-square test, Cox proportional hazard models and a Kaplan-Meier analysis to calculate the hazards ratio (HR), disease-free survival and incidental density of HZ. Subgroup analysis and sensitivity tests were also done. Comorbidities such as chronic urticaria, inflammatory bowel disease, thyroid disorders, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, cerebrovascular accident, were higher in patients with AS than that in controls. Patients age ≥60 or comorbid disease such as thyroid disorders or cancer had a higher HR of HZ; the adjusted HRs were 2.273 (95% CI 1.314-3.931), 1.577 (95% CI 1.008-2.466) and 1.855 (95% CI 1.248-2.758) respectively, on multivariable modeling. The crude HR for HZ among AS patient was 1.178 (95% CI 0.953-1.455, P>0.05), and the adjust HZ was 1.070 (95% CI 0.835-1.371, P>0.05), compared to non-AS controls. There is no difference in incidence rate of HZ between Taiwan AS patients and non-AS controls. Among AS patients, age and cancer were major risk factors for incidental HZ.

P067 Immunosuppressive therapy in inflammatory bowel disease patients is associated with reactivation of Herpes Zoster: A tertiary center experience

BACKGROUND: Herpes Zoster (HZ), also known as shingles, is the reactivation of the varicella zoster virus (VZV). The incidence of HZ is 4 per 1,000 person-years. Though HZ can occur at any age and in any population, the incidence increases with age and is up to ten times higher in immunocompromised patients. Vaccine guidelines for inflammatory bowel disease (IBD) patients on immunosuppressive therapy recommend obtaining age appropriate non-live attenuated vaccinations while strongly considering risks and benefits when administering the live-attenuated vaccines. Currently, CDC guidelines recommend the new non-live HZ vaccine, Shingrix, in patients over the age of 50. As this is a non-live vaccine it is safe to administer in patients on immunosuppressive therapy. The purpose of our study was to identify risk factors associated with the development of HZ among IBD patients. METHODS: Using our institution’s electronic research data warehouse, we performed a case-control study including IBD patients enrolled in the prospectively maintained IBD patient database at the University of Chicago IBD Center between January 1, 2005 and January 1, 2017. Controls included individuals presenting to the general gastroenterology and hepatology clinics. The diagnosis of HZ was identified using ICD codes (053.9, 053.19, B029, B028) and documentation of a characteristic rash at the corresponding clinic visit. Demographic variables, disease-related and therapy-related factors including HZ vaccination were recorded. Data were analyzed using Wilcoxon rank-sum test for continuous variables and Fischer’s exact test for dichotomous variables. RESULTS: We identified 88 unique patients encounters (57 IBD, 34 non-IBD) with a diagnosis of HZ. The non-IBD controls primarily included individuals with a history of liver disease (n = 21). The IBD patients were predominantly Caucasian (80%) and of younger age when compared to the control population (P < 0.001). Among the 57 IBD patients, 20 (35%) had active disease and 51 (89%) were on active immunosuppression. There were no other statistically significant demographic features between the groups with regards to active smoking or prior HZ vaccination. Only 6 (19%) IBD patients who were over the age of 50 were vaccinated. IBD patients were more likely to be on active immunosuppression or have a history of immunosuppression (P < 0.001) compared to controls. Despite a high level of active disease and immunosuppression, IBD patients had higher albumin and hemoglobin levels compared to the controls. Following the onset of HZ, there was no significant difference in the onset of post-herpetic neuralgia. CONCLUSION(S): Active immunosuppression in IBD patients is a risk for HZ, but no other variables were identified. The disease course with respect to development of post-herpetic neuralgia is not different compared to controls. Only a small number of eligible patients received vaccination for HZ and none of these developed HZ. Further studies should identify independent risk factors for vaccination or expand the eligibility of vaccination to larger cohorts of patients in order to prevent the onset of HZ.

The Epidemiology of Herpes Zoster and Postherpetic Neuralgia in China: Results from a Cross-Sectional Study.

IntroductionFew studies have examined the epidemiology of herpes zoster (HZ) and postherpetic neuralgia (PHN) in China. The aim of this study was to estimate the prevalence of HZ and PHN in China, and to examine the clinical characteristics of patients identified with PHN.MethodsThis was a cross-sectional study conducted in 24 hospitals in seven cities in China. Prevalence of HZ and PHN was determined by physician (n = 100) chart review of patients (n = 36,170) aged ≥ 40 years seeking medical care over a 30- to 60-day period. The health history of patients identified with PHN was obtained and included time since diagnosis of HZ or PHN, time since onset of PHN-related pain, and the methods used for diagnosing HZ and PHN.ResultsThe prevalence rates of HZ and PHN were 7.7% [95% confidence interval (CI) 7.5–8.0] and 2.3% (95% CI 2.2–2.5), respectively. Of patients with HZ, 29.8% developed PHN. Rates of HZ and PHN increased with age and were highest in patients aged ≥ 70 years (10.6% and 4.1%, respectively). The majority of patients with PHN were diagnosed with HZ (80.9%) and PHN (83.8%) for < 1 year, and had experienced PHN-related pain for < 1 year (80.5%). Patient description and clinical examination were most commonly used to diagnose HZ and PHN.ConclusionThese results provide current estimates of the prevalence of HZ and PHN in the general adult population in urban China. These rates are similar to previously reported rates in China and worldwide, and highlight the global nature of HZ and PHN.FundingPfizer Inc.

Neurological and Ophthalmological Manifestations of Varicella Zoster Virus.

Approximately 1 million new cases of herpes zoster (HZ) occur in the United States annually, including 10%-20% with herpes zoster ophthalmicus (HZO). Postherpetic neuralgia, a debilitating pain syndrome occurs in 30% HZ, whereas 50% HZO develop ophthalmic complications. Diplopia from cranial nerve palsy occurs in less than 30% HZO, whereas optic neuropathy is seen in less than 1% HZO. We reviewed recent developments in the diagnosis, treatment, and prevention of HZ as well as neurological and ophthalmological complications of relevance to the neuro-ophthalmologist. We searched the English language literature on Pubmed and Google scholar for articles relevant to the various sections of this review. Antiviral treatment should be initiated within 48-72 hours of onset of HZ and HZO to decrease pain and reduce complications. We recommend neuroimaging in all patients with neuro-ophthalmic manifestations such as diplopia and acute vision loss. Diagnostic confirmation using polymerase chain reaction and serology on paired serum and cerebrospinal fluid samples should be obtained in those with neurological signs and symptoms or abnormal imaging. Patients with neurological and/or retinal varicella zoster virus (VZV) infection should be treated promptly with intravenous acyclovir. Patients with isolated optic neuropathy or cranial nerve palsy can be managed with oral antivirals. The prognosis for visual recovery is good for patients with isolated optic neuropathy and excellent for patients with isolated ocular motor cranial nerve palsy. HZ produces a spectrum of potentially blinding and life-threatening complications that adversely affect quality of life and increase health care costs. Individuals at risk for HZ, such as the elderly and immunocompromised, should be encouraged to receive the highly effective VZV vaccine to prevent HZ and its complications.

Patient report of herpes zoster pain: Incremental benefits of zoster vaccine live

IntroductionPain following herpes zoster (HZ) can persist for months and negatively impact quality of life. To evaluate the effect of zoster vaccine live (ZVL) on progression of pain following HZ, we conducted a prospective cohort study of HZ cases at Kaiser Permanente Southern California. MethodsZVL vaccinated and unvaccinated members aged ≥60 years with laboratory-confirmed HZ from January 18, 2012 to February 26, 2015 were followed up within 5 days of HZ diagnosis, and at 30, 60, and 90 days after diagnosis. Pain was assessed with the Zoster Brief Pain Inventory (ZBPI) on a 0–10 scale, using cut-points of ≥3, ≥5, and ≥7, with postherpetic neuralgia (PHN) defined as pain ≥3 at 90 days. Log binomial regression was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) associated with pain, comparing vaccinated versus unvaccinated HZ patients. ResultsWe interviewed 509 vaccinated and 509 unvaccinated HZ patients. ZVL was associated with significantly lower risks of HZ-related pain at all time-points. The risk of PHN in vaccinated and unvaccinated patients, respectively, was 9.2% and 15.4% (aRR = 0.594, 95% CI: 0.413, 0.854); 2.0% and 4.8% of these patients reported pain ≥7 (aRR = 0.332, 95% CI: 0.153, 0.721). Irrespective of vaccination, the risk of PHN was lower in adults aged <70 years versus those ≥70 years and was similar or lower in females versus males. ConclusionWe used laboratory confirmation of HZ cases and patient survey to show that aside from preventing HZ, ZVL reduced HZ-related pain and prevented PHN among vaccine recipients who experienced HZ. Observational studies will be needed to evaluate long-term effectiveness of the new recombinant zoster vaccine and its benefits in protecting patients against PHN.

Analysis of Vascular Event Risk After Herpes Zoster From 2007 to 2014 US Insurance Claims Data

ObjectiveTo estimate the risk of transient ischemic attack (TIA), stroke, and myocardial infarction in periods covering 4 weeks before to 52 weeks after herpes zoster (HZ) diagnosis in US adults. Patients and MethodsThis retrospective study (GSK study identifier: HO-15-15771) with matched cohorts used the Truven Health MarketScan Commercial and Medicare claims data set linked with obesity and smoking status information. Patients 18 years and older at the date of HZ diagnosis and 1-year pre- and post-HZ diagnosis continuous insurance enrollment (from January 1, 2007, through December 31, 2014) were propensity score matched to controls in terms of demographic characteristics, risk factors for vascular events, other comorbid disorders, general health, obesity, and smoking status. A post hoc sensitivity analysis was performed not matching for obesity and smoking status information. Adjusted incidence rate ratios (IRRs) were estimated using multivariate Poisson models during an aggregate period (1-month before and after the index date). ResultsA total of 23,339 patients with HZ were matched to 46,378 controls (mean age, 56 years; 45,173 [65%] women). During the aggregate period, patients with HZ were statistically significantly more likely to suffer a TIA: IRRs for all patients and patients aged 18 to 49 years were 1.56 (95% confidence interval [CI], 1.13-2.15) and 5.12 (95% CI, 1.37-19.10), respectively (P<.05); the respective IRRs for stroke were 1.40 (95% CI, 0.93-2.11) and 8.12 (95% CI, 0.93-71.27). In the sensitivity analysis, IRRs for TIA and stroke were statistically significantly increased regardless of age. ConclusionHerpes zoster was associated with an increased risk of composite events, TIA, and stroke in adults in the period around diagnosis. More research on the HZ and vascular risk association is needed. GSK Study IdentifierHO-15-15771

P066 A VIRAL TREND: HERPES ZOSTER ERUPTING AT A YOUNGER AGE IN IBD PATIENTS

There have been uptrending rates of Herpes Zoster (HZ) in the U.S. in recent years, with an estimated lifetime incidence of 1 in 3 individuals in the general population. Patients with inflammatory bowel disease (IBD), especially those on immunosuppressant or biologic therapies, have an increased risk of developing more frequent and severe complications from HZ. Although HZ is typically observed in patients of older age, it is unclear if the prevalence among IBD patients correlates with that of the general population due to treatment with immunosuppressants and factors intrinsic to the disease itself. This study investigated the rate and age of HZ diagnosis among IBD patients in a university medical center. A retrospective chart review evaluating all IBD patients seen in the gastroenterology clinic of a university medical center throughout a five-year period was performed. Patient gender, age, IBD diagnosis, date of HZ diagnosis and medications during time of zoster outbreak were recorded and a database was generated using Microsoft Excel. Statistical analysis was performed using two-sample T-tests and two-tailed Fisher’s Exact Tests with significance set at P<0.05. The study was approved by the IRB. 393 IBD patients were identified (175 males, 218 females) with a mean age of 44.4 (age range: 20-82). 279 (71.0%) had Ulcerative Colitis (UC), 96 (24.4%) had Crohn’s disease (CD), 7 (1.8%) with unspecified colitis, and 11 (2.8%) had microscopic colitis. 11 (2.80%) had a documented diagnosis of HZ during the 5-year period of data collection. Of those, 5 had Ulcerative Colitis (UC), 5 had Crohn’s disease (CD), and 1 patient had unspecified colitis. There was no significant difference in HZ diagnosis between men and women (p=0.54). All 11 patients diagnosed with HZ were on immunosuppressant or biologic therapy at the time of diagnosis, and none of these patients had previously received HZ vaccination. The average age of diagnosis for HZ was 36.6 years (Crohn’s 42.6, UC 33.8, unspecified colitis 22 years) with a standard deviation of 11.5 years, significantly below the nationally reported mean age of 59.4 years (p<0.0001). This study revealed that IBD patients are potentially at risk for earlier onset of HZ outbreaks as compared to the general population. All patients in our cohort who had a zoster outbreak were on some form of immunosuppressant therapy and were significantly younger than the national reported average for HZ incidence. Notably, the IBD patients with HZ were younger than the CDC recommended age of 50 years for HZ vaccination. While this study may be limited based upon retrospective evaluation and single institution design, it highlights the need for improvement in vaccination rates for IBD patients and supports consideration for earlier vaccination in IBD patients at increased risk for HZ infection.

Herpes zoster incidence in Germany - an indirect validation study for self-reported disease data from pretest studies of the population-based German National Cohort

BackgroundUntil now, herpes zoster (HZ)-related disease burden in Germany has been estimated based on health insurance data and clinical findings. However, the validity of self-reported HZ is unclear. This study investigated the validity of self-reported herpes zoster (HZ) and its complication postherpetic neuralgia (PHN) using data from the pretest studies of the German National Cohort (GNC) in comparison with estimates based on health insurance data.MethodsData of 4751 participants aged between 20 and 69 years from two pretest studies of the GNC carried out in 2011 and 2012 were used. Based on self-reports of physician-diagnosed HZ and PHN, age- and sex-specific HZ incidence rates and PHN proportions were estimated. For comparison, estimates based on statutory health insurance data from the German population were considered.ResultsEleven percent (95%-CI, 10.4 to 12.3, n = 539) of the participants reported at least one HZ episode in their lifetime. Our estimated age-specific HZ incidence rates were lower than previous estimates based on statutory health insurance data. The PHN proportion in participants older than 50 years was 5.9% (1.9 to 13.9%), which was in line with estimates based on health insurance data.ConclusionAs age- and sex-specific patterns were comparable with that in health insurance data, self-reported diagnosis of HZ seems to be a valid instrument for overall disease trends. Possible reasons for observed differences in incidence rates are recall bias in self-reported data or overestimation in health insurance data.