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Abstract
Objectives Herpes zoster (HZ) is caused by reactivation of varicella-zoster virus which remains latent in individuals after a varicella infection. It is expected that HZ will be more frequent in immunocompromised (IC) individuals than in immunocompetent (IC-free). This study assessed the incidence rate (IR) of HZ in individuals with a wide set of IC conditions and in IC-free individuals.
Setting A retrospective cohort study was conducted in England using data (January 2000 to March 2012) from the Clinical Practice Research Datalink with linkage to the Hospital Episodes Statistics.
Participants A cohort of 621 588 individuals with 16 selected IC conditions and a gender/age-matched cohort of IC-free individuals were identified. The IC conditions included haematopoietic stem cell transplant (HSCT), solid organ transplant, malignancies, autoimmune diseases and users of immunosuppressive medications.
Outcomes IR of HZ per 1000 person-years (PY) was estimated. Proportions of postherpetic neuralgia (PHN) and other HZ complications within 90 days of HZ onset were also estimated among patients with HZ. Risk factors for PHN in IC individuals with HZ were assessed by a multivariate regression model.
Results The overall IR of HZ in the IC cohort was 7.8/1000 PY (95% CI 7.7 to 7.9), increasing with age from 3.5/1000 PY (3.4–3.7) in individuals aged 18–49 years to 12.6/1000 PY (12.2–13.0) in individuals aged ≥80 years. This IR in the IC-free cohort was 6.2/1000 PY (6.1–6.3). The overall IR of HZ varied across IC conditions, ranging from 5.3 (5.1–5.5) in psoriasis to 41.7/1000 PY (35.7–48.4) in HSCT. The proportions of PHN and other HZ complications were 10.7% (10.2–11.1) and 2.9% (2.7–3.2) in the IC cohort, but 9.1% (8.7–9.5) and 2.3% (2.1–2.6) in the IC-free cohort, respectively.
Conclusion IC population contributes to the public health burden of HZ in England. Vaccination might be the most preferable HZ preventive measure for the IC population.
- herpes zoster
- database
- burden
- complications
- immunocompromised conditions
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Footnotes
Contributors VB, AEG, YEH, GF, MG, FH and EAY participated in the conception and design of the study. VB, AEG, YEH, GF, MG, FH and EAY participated in the collection or generation of the study data. VB, AEG, YEH, MG and EAY performed the study. VB, AEG, YEH, MG and FH contributed to the material. VB, AEG, YEH, GF, MG, FH, EE and EAY were involved in the analysis or interpretation of the data. All named authors provided substantial intellectual and scientific input during the manuscript development, critically reviewing the content, revising the manuscript and giving final approval before submission. The work described was carried out in accordance with the ICMJE recommendations for conducting, reporting, editing and publishing scholarly work in medical journals.
Funding GlaxoSmithKline Biologicals was the funding source and was involved in all study (e-track number: 201615) activities and data analysis. GlaxoSmithKline Biologicals also funded all costs associated with the development and the publishing of the present manuscript. All authors had full access to the data and the corresponding author was responsible for the submission of the manuscript. Confirmed
Competing interests VB, FH, EE and EAY are employees of the GSK group of companies. AEG, YEH and MG have nothing to disclose. GF was employed by the GSK group of companies between 2012 and February 2015, during which the study was designed and implemented. Later, as an employee of P-95 Epidemiology and Pharmacovigilance, GF provided contracted consultancy services to the GSK group of companies for this and other GSK-sponsored studies. P-95 provides contracted services to the GSK group of companies beyond the scope of this study.
Patient consent Not required.
Ethics approval Approval was obtained from the Clinical Practice Research Datalink Independent Scientific Advisory Committee (14_222R).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data used in this study are presented in the manuscript, references to the original material are provided. Please contact the corresponding author should you require any additional information.