Skip to main content

Advertisement

SpringerLink
Log in

Herpes zoster in frail elderly patients: prevalence, impact, management, and preventive strategies

  • Review
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Population aging is a worldwide phenomenon with significant and manifold impacts on society. Advanced age correlates with the onset of frailty. In this vulnerable state, the immune response is weakened and a higher susceptibility to infectious diseases is observed. The present narrative review aims to cover the topic of herpes zoster (HZ) and its complications in frail populations. The lifetime risk of developing HZ is estimated at about 20–30%, and the risk increases with age. In older people, HZ can lead to the inability to recover the lifestyle, the interests, and the level of activity that existed before its development. Severity of the disease at presentation and depression are the major correlates of pain burden in patients with acute HZ and postherpetic neuralgia (PHN). The frail elderly need careful assessment prior to treatment initiation and could be affected to a greater extent by treatment-related adverse events. In light of the significant burden caused by HZ and its complications in the frail elderly, the adoption of a preventive strategy appears to be promising, particularly using vaccination in appropriate age- and risk-groups. Although very few vaccine studies consider explicitly the frail elderly as their study population, there is evidence that the live, attenuated vaccine induces significant immunological responses. An adjuvanted recombinant subunit vaccine has recently been approved in Canada, in the United States, in the European Union, and in Japan, and will likely provide additional opportunities for prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United Nations, Department of Economic and Social Affairs, Population Division (2017) World population prospects: The 2017 revision, key findings and advance tables. Working paper no. ESA/P/WP/248. https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_KeyFindings.pdf. Accessed 10 July 2017

  2. Fried LP, Ferrucci L, Darer J et al. (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59:255–263

    Article  PubMed  Google Scholar 

  3. Fried LP, Tangen CM, Walston J et al (2001) Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146-56

    Article  PubMed  Google Scholar 

  4. Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495

    Article  PubMed  PubMed Central  Google Scholar 

  5. British Geriatrics Society (2014) Fit for Frailty—consensus best practice guidance for the care of older people living in community and outpatient settings—a report from the British Geriatrics Society

  6. Rockwood K, Mitnitski A, MacKnight C (2002) Some mathematical models of frailty and their clinical implications. Rev Clin Gerontol 12:109–117

    Article  Google Scholar 

  7. Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT et al. (2010) In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc 11:338–343

    Article  PubMed  Google Scholar 

  8. Clegg A, Young J, Iliffe S et al. (2013) Frailty in elderly people. Lancet 381 868:752–762

    Article  Google Scholar 

  9. Wilson D, Jackson T, Sapey E et al. (2017) Frailty and sarcopenia: the potential role of an aged immune system. Ageing Res Rev 36:1–10

    Article  PubMed  Google Scholar 

  10. Baylis D, Bartlett DB, Syddall HE et al (2013) Immune-endocrine biomarkers as predictors of frailty and mortality: a 10-year longitudinal study in community-dwelling older people. Age (Dordr) 35:963–971

    Article  CAS  Google Scholar 

  11. Wang GC, Casolaro V (2014) Immunologic changes in frail older adults. Transl Med UniSa 24:1–6

    Google Scholar 

  12. Caruso C, Buffa S, Candore G et al (2009) Mechanisms of immunosenescence. Immun Ageing 6:10

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Cohen JI (2014) Introduction to Herpesviridae. In: Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 8th edn. Elsevier, Philadelphia

    Google Scholar 

  14. Wang GC, Han C, Detrick B et al (2016) Herpesvirus infections and risk of frailty and mortality in older women: Women’s Health and Aging Studies. J Am Geriatr Soc 64:998–1005

    Article  PubMed  PubMed Central  Google Scholar 

  15. Haeseker MB, Pijpers E, Dukers-Muijrers NH et al (2013) Association of cytomegalovirus and other pathogens with frailty and diabetes mellitus, but not with cardiovascular disease and mortality in psycho-geriatric patients; a prospective cohort study. Immun Ageing 10:30

    Article  PubMed  PubMed Central  Google Scholar 

  16. Goldeck D, Pawelec G, Norman K et al (2016) No strong correlations between serum cytokine levels, CMV serostatus and hand-grip strength in older subjects in the Berlin BASE-II cohort. Biogerontology 17:189–198

    Article  PubMed  CAS  Google Scholar 

  17. Levin MJ (2012) Immune senescence and vaccines to prevent herpes zoster in older persons. Curr Opin Immunol 24:494–500

    Article  PubMed  CAS  Google Scholar 

  18. Weinberg A, Zhang JH, Oxman MN et al (2009) US Department of Veterans Affairs (VA) Cooperative Studies Program Shingles Prevention Study Investigators. Varicella-zoster virus-specific immune responses to herpes zoster in elderly participants in a trial of a clinically effective zoster vaccine. J Infect Dis 200:1068–1077

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. SAGE Working Group on Varicella and Herpes Zoster Vaccines. Background paper on Herpes zoster vaccines. 2014 Mar. http://www.who.int/immunization/sage/meetings/2014/april/2_Background_document_Herpes_Zoster.pdf?ua=1. Accessed 10 July 2017

  20. Franco E, Zorzoli E, Valente N et al. (2016) Aspetti epidemiologici dell’Herpes zoster e della nevralgia post-erpetica [Epidemiological aspects of Herpes zoster and post-herpetic neuralgia]. In: Gabutti G (ed) Herpes zoster e nevralgia post-erpetica. Edizioni Minerva medica, Torino, pp 17–26 (Italian)

    Google Scholar 

  21. Varghese L, Standaert B, Olivieri A et al. (2017) The temporal impact of aging on the burden of herpes zoster. BMC Geriatr 17:30

    Article  PubMed  PubMed Central  Google Scholar 

  22. Maggi S, Gabutti G, Franco E et al (2015) Preventing and managing herpes zoster: key actions to foster healthy aging. Aging Clin Exp Res 27:5–11

    Article  PubMed  Google Scholar 

  23. WHO. Active ageing: a policy framework. WHO/NMH/NPH/02.8. 2002. http://apps.who.int/iris/bitstream/10665/67215/1/WHO_NMH_NPH_02.8.pdf. Accessed 10 July 2017

  24. Gabutti G, Bonanni P, Conversano M et al (2017) Prevention of Herpes Zoster and its complications: from clinical evidence to real life experience. Hum Vaccin Immunother 13:391–398

    Article  PubMed  Google Scholar 

  25. Stefanati A, Kuhdari P, Bertoni L et al. (2016) Storia naturale e risposta immunitaria nell’infezione da Varicella-zoster virus: varicella ed Herpes zoster [Natural history and immune response in Varicella-zoster virus infection: varicella and herpes zoster]. In: Gabutti G (ed) Herpes zoster e nevralgia post-erpetica. Edizioni Minerva medica, Torino, pp 9–16 Italian.

    Google Scholar 

  26. Dworkin RH, Schmader KE (2001) The epidemiology and natural history of herpes zoster and post-herpetic neuralgia. In: Watson CP, Gershon AA (eds) Herpes zoster and post-herpetic neuralgia, 2nd edn. Elsevier Press, New York, pp 39–64

    Google Scholar 

  27. Gershon AA, Gershon MD, Breuer J et al (2010) Advances in the understanding of the pathogenesis and epidemiology of herpes zoster. J Clin Virol 48:S2–S7

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Opstelten W, Mauritz JW, de Wit NJ, et al (2002) Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Fam Pract 19:471–475

    Article  PubMed  Google Scholar 

  29. Cohen JI (2013) Clinical practice: Herpes zoster. N Engl J Med 369:255–263

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Bricout H, Perinetti E, Marchettini P et al (2014) Burden of herpes zoster-associated chronic pain in Italian patients aged 50 years and over (2009–2010): a GP-based prospective cohort study. BMC Infect Dis 14:637

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kawai K, Gebremeskel BG, Acosta CJ (2014) Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 4:e004833

    Article  PubMed  PubMed Central  Google Scholar 

  32. Jung BF, Johnson RW, Griffin DRJ, et al (2004) Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology 62:1545–1551

    Article  PubMed  Google Scholar 

  33. Volpi A, Gatti A, Serafini G et al (2007) Clinical and psychosocial correlates of acute pain in herpes zoster. J Clin Virol 38:275–279

    Article  PubMed  Google Scholar 

  34. Volpi A, Gatti A, Pica F et al (2008) Clinical and psychosocial correlates of post-herpetic neuralgia. J Med Virol 80:1646–1652

    Article  PubMed  CAS  Google Scholar 

  35. Gatti A, Pica F, Boccia MT et al (2010) No evidence of family history as a risk factor for herpes zoster in patients with post-herpetic neuralgia. J Med Virol 82:1007–1011

    Article  PubMed  CAS  Google Scholar 

  36. Pica F, Gatti A, Divizia M et al (2014) One-year follow-up of patients with long-lasting post-herpetic neuralgia. BMC Infect Dis 14:556

    Article  PubMed  PubMed Central  Google Scholar 

  37. Johnson RW, Bouhassira D, Kassianos G et al. (2010) The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Med 8:37

    Article  PubMed  PubMed Central  Google Scholar 

  38. WHO (2014) Varicella and herpes zoster vaccines: WHO position paper, June 2014. Wkly Epidemiol Rec 89:265–288 (English, French)

    Google Scholar 

  39. Johnson RW, Wasner G, Saddier P et al (2008) Herpes Zoster and postherpetic neuralgia: optimizing management in the elderly patient. Drugs Aging 25:991–1006

    Article  PubMed  CAS  Google Scholar 

  40. Pinchinat S, Cebrián-Cuenca AM, Bricout H et al (2013) Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis 13:170

    Article  PubMed  PubMed Central  Google Scholar 

  41. Sato K, Adachi K, Nakamura H et al (2017) Burden of herpes zoster and postherpetic neuralgia in Japanese adults 60 years of age or older: Results from an observational, prospective, physician practice-based cohort study. J Dermatol 44:414–422

    Article  PubMed  Google Scholar 

  42. Alicino C, Trucchi C, Paganino C et al (2017) Incidence of herpes zoster and post-herpetic neuralgia in Italy: Results from a 3-years population-based study. Hum Vaccin Immunother 13:399–404

    Article  PubMed  Google Scholar 

  43. Gialloreti LE, Merito M, Pezzotti P et al (2010) Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: a retrospective, population-based study. BMC Infect Dis 10:230

    Article  PubMed  PubMed Central  Google Scholar 

  44. Torcel-Pagnon L, Bricout H, Bertrand I et al (2017) Impact of underlying conditions on Zoster-related pain and on quality of life following Zoster. J Gerontol A Biol Sci Med Sci 72:1091–1097

    PubMed  Google Scholar 

  45. Nagel MA, Jones D, Wyborny A (2017) Varicella zoster virus vasculopathy: The expanding clinical spectrum and pathogenesis. J Neuroimmunol 308:112–117

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  46. Marra F, Ruckenstein J, Richardson K (2017) A meta-analysis of stroke risk following herpes zoster infection. BMC Infect Dis 17:198

    Article  PubMed  PubMed Central  Google Scholar 

  47. Gater A, Uhart M, McCool R et al. 2015) The humanistic, economic and societal burden of herpes zoster in Europe: a critical review. BMC Public Health 15:193

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lukas K, Edte A, Bertrand I (2012) The impact of herpes zoster and post-herpetic neuralgia on quality of life: patient-reported outcomes in six European countries. Z Gesundh Wiss 20:441–451

    Article  PubMed  Google Scholar 

  49. Jackson LA, Reynolds MA, Harpaz R (2008) Hospitalizations to treat herpes zoster in older adults: causes and validated rates. Clin Infect Dis 47:754–759

    Article  PubMed  Google Scholar 

  50. Panatto D, Bragazzi NL, Rizzitelli E et al (2015) Evaluation of the economic burden of Herpes Zoster (HZ) infection. Hum Vaccin Immunother 11:245–262

    Article  PubMed  Google Scholar 

  51. Hobbelen PH, Stowe J, Amirthalingam G et al. (2016) The burden of hospitalisation for varicella and herpes zoster in England from 2004 to 2013. J Infect 73:241–253

    Article  PubMed  Google Scholar 

  52. Valente N, Cocchio S, Stefanati A et al (2017) Temporal trends in herpes zoster-related hospitalizations in Italy, 2001–2013: differences between regions that have or have not implemented varicella vaccination. Aging Clin Exp Res 29:771–779

    Article  PubMed  Google Scholar 

  53. Schmader K (2016) Herpes zoster. Clin Geriatr Med 32:539–553

    Article  PubMed  Google Scholar 

  54. Kaye AD, Baluch A, Scott JT (2010) Pain management in the elderly population: a review. Ochsner J 10:179–187

    PubMed  PubMed Central  Google Scholar 

  55. Gnann J (2006) Antiviral therapy for herpes zoster. Herpes 13:16A-20A

    Google Scholar 

  56. Volpi A (2007) Severe complications of herpes zoster. Herpes 14 :35–39

    PubMed  Google Scholar 

  57. di Luzio PU, Arpinelli F, Visonà G (1999) Herpes zoster and its complications in Italy: an observational survey. J Infect 38:116–120

    Article  Google Scholar 

  58. Oxman MN (2000) Clinical manifestations of herpes zoster. In: Arvin AM, Gershon AA (ed) Varicella-zoster virus: virology and clinical management. Cambridge University Press, Cambridge, pp 246–275

    Chapter  Google Scholar 

  59. Haanpää M, Rice ASC, Rowbotham MC (2015) Treating herpes zoster and postherpetic neuralgia. PAIN Clin Updates 23:1–8

    Google Scholar 

  60. Hempenstall K, Nurmikko TJ, Johnson RW et al. (2005) Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLoS Med 2:e164

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  61. VARIVAX Summary of Product Characteristics. https://www.medicines.org.uk/emc/medicine/15264. Accessed 12 July 2017

  62. ZOSTAVAX Summary of Product Characteristics. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000674/WC500053462.pdf. Accessed 12 July 2017

  63. Watson CPN et al (2017) Herpes zoster: postherpetic neuralgia and other complications. Springer, Switzerland

    Book  Google Scholar 

  64. Amanna IJ (2012) Balancing the Efficacy and Safety of vaccines in the elderly. Open Longev Sci 6:64–72

    Article  PubMed  PubMed Central  Google Scholar 

  65. Lelic A, Verschoor CP, Lau VW et al (2016) Immunogenicity of varicella vaccine and immunologic predictors of response in a cohort of elderly nursing home residents. J Infect Dis 214:1905–1910

    Article  PubMed  CAS  Google Scholar 

  66. Redman RL, Nader S, Zerboni L et al (1997) Early reconstitution of immunity and decreased severity of herpes zoster in bone marrow transplant recipients immunized with inactivated varicella vaccine. J Infect Dis 176:578–585

    Article  PubMed  CAS  Google Scholar 

  67. Hata A, Asanuma H, Rinki M et al (2002) Use of an inactivated varicella vaccine in recipients of hematopoietic-cell transplants. N Engl J Med 347:26–34

    Article  PubMed  Google Scholar 

  68. Mullane KM, Winston DJ, Wertheim MS et al (2013) Safety and immunogenicity of heat-treated zoster vaccine (ZVHT) in immunocompromised adults. J Infect Dis 208:1375–1385

    Article  PubMed  CAS  Google Scholar 

  69. Lal H, Cunningham AL, Godeaux O et al (2015) Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Eng J Med 372:2087–2096

    Article  Google Scholar 

  70. Cunningham AL, Lal H, Kovac M et al (2016) Impact of the herpes zoster subunit vaccine in adults 70 years of age or older. N Eng J Med 375:1019–1032

    Article  CAS  Google Scholar 

  71. SHINGRIX Product Monograph (Approved 13 October 2017). https://pdf.hres.ca/dpd_pm/00041658.PDF Accessed 20 Dec 2017

  72. European Commission (2018) Community register of medicinal products for human use. http://ec.europa.eu/health/documents/community-register/html/h1272.htm#EndOfPage Accessed 26 Mar 2018

Download references

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Postgraduate School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy

    Ermanno Zorzoli

  2. Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy

    Francesca Pica

  3. Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy

    Giulia Masetti

  4. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

    Elisabetta Franco

  5. Our Lady of Good Counsel University, Tirana, Albania

    Antonio Volpi

  6. Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 64, 44121, Ferrara, Italy

    Giovanni Gabutti

Authors
  1. Ermanno Zorzoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Pica
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giulia Masetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabetta Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Volpi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Gabutti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni Gabutti.

Ethics declarations

Conflict of interest

Ermanno Zorzoli Congress attendance sponsored by Sanofi. Francesca Pica has no conflict of interest. Giulia Masetti has no conflict of interest. Elisabetta Franco had scientific collaboration with GSK, Merck, Pfizer and Sanofi, and reimbursement for participation to meetings and advisory boards without personal fees. Antonio Volpi was involved in clinical trials for GSK and Achaogen, and participated to advisory board meetings for GSK and Sanofi Pasteur MSD. Giovanni Gabutti has received grants from GlaxoSmithKline Biologicals SA, Sanofi Pasteur MSD, Novartis,Crucell/Janssen, Seqirus, Sanofi Pasteur, Merck Italy, and Pfizer for being consultant or taking part in advisory board, expert meetings, being a speaker or an organizer of congresses/conferences, and acting as investigator in clinical trials.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zorzoli, E., Pica, F., Masetti, G. et al. Herpes zoster in frail elderly patients: prevalence, impact, management, and preventive strategies. Aging Clin Exp Res 30, 693–702 (2018). https://doi.org/10.1007/s40520-018-0956-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-018-0956-3

Keywords

Search

Navigation