Background
Methodology
Literature search strategy
Data management
Inclusion and inclusion criteria
Literature search results
Clinicopathology
Atypical HZ
Zoster sine herpete
Multidermatomal, disseminated and visceral HZ
Pain
Epidemiology and risk factors
Seroepidemiology
Incidence
Country (source) | Study year(s) | HZ cases | Age range (years) | Incidence (cases/1000 person years) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Overall | By sex | Age-range (years) | |||||||||||||
Male | Female | <10 | 10–19 | 20–29 | 30–39 | 40–49 | 50–59 | 60–69 | 70–79 | >80 | |||||
Australia (MacIntyre 2003) [102] | 1999 | 59200 | All ages | 8.3a
| |||||||||||
1998–2005 | 379 | ≥50 | 9.7a
| 1.4 (<25) | 3.4 (25–49) | 6.5 | 8.6 | 14.5 | 15.6 | ||||||
Japan (Toyama 2009) [139] | 1997–2006 | 48388 | 0– ≥ 90 | 4.2 | 3.7 |
4.6* | 2.5 | 2.9 | 2.3 | 2.0 | 2.5 | 5.2 | 7.0 | 7.8 | 6.9b
|
New Zealand (Reid 2014) [17] | 2009–2013 | 339 | All ages | 3.0 | 5.8c
| 6.4c
| 1.3 (≤50) | 13.9 | |||||||
Korea (Kim YJ 2014) [138] | 2011 | 529690 | 0– ≥ 80 | 10.4 | 8.3 | 12.6 | 2.0 | 3.3 | 6.3 | 7.8 | 10.2 | 17.4 | 22.4 | 21.8 | 16.5 |
Korea (Kang 2008) [129] | 2004–2005 | 705 | 19–24 | 1.4 | 1.4 (19–24) | ||||||||||
Korea (Choi 2010) [130] | 2003–2007 | 2431744 | All ages | 10.0d
| |||||||||||
Korea (Park SY 2004) [26] | 1994–2003 | 1089 | All ages | 3.0 | |||||||||||
Thailand (Aunhachoke 2011) [30] | 2008 | 180 | ≥50 | 0.3e
| |||||||||||
Taiwan (Wu PY 2013) [141] | 2000–2009 | All ages | 6.2 | ||||||||||||
Taiwan (Wu CY 2010) [142] | 2000–2005 | 24527 | 20– ≥ 60 | 7.0 | |||||||||||
Taiwan (Chao DY 2012) [143] | 2004–2008 | 7574 | All ages | 5.7 | |||||||||||
Taiwan (Jih 2009) [137] | 2000–2006 | 34280 | 1– > 80 | 4.9 | 4.7 | 5.1 | 2.1 | 13.7 | |||||||
Taiwan (Lin 2010) [136] | 2000–2005 | 672782 | ≤1– ≥ 80 | 5.0 | 4.7 |
5.2* | 1.6 | 3.5 | 5.2 | 8.4 | 11.1 | 12.3 | 10.2 | ||
Median (range) | 5.0f (0.3–10.4) | 4.7 (3.7–8.3) | 5.2 (4.6–12.6) | 2.0 (1.6–2.5) | 3.1 (2.9–3.3) | 4.3 (2.3–6.3) | 3.5 (2.0–7.8) | 5.2 (2.5–10.2) | 7.4 (5.2–17.4) | 9.8 (7.0–22.4) | 13.4 (7.8–21.8) | 13.8 (6.9–16.5) | |||
Quartile range (IQR) | 3.6–7.3 (3.7) | 4.7–5.8 (1.0) | 5.1–6.4 (1.3) | 1.9–2.2 (0.3) | 3.0–3.2 (0.2) | 3.3–5.3 (2.0) | 2.7–5.7 (2.9) | 3.9–7.7 (3.8) | 6.8–12.9 (6.1) | 9.0–16.8 (7.7) | 10.1–17.1 (7.0) | 10.2–13.9 (3.7) |
Country (source) | Metric | Years compared | Herpes zoster rate | Annual increase (%) |
---|---|---|---|---|
Australia (Kelly 2014) [146] | Cases/1000 consultations | 1998 2006–12 | 1.03 1.81 | 6.3 |
Australia (Nelson 2010) [145] | Management/1000 GP consultations | 1998 2008 | 1.71 2.35 | 3.4 |
Australia (MacIntyre 2003) [102] | Hospitalisations/100000 population | 1993 1998 | 20 25 | 4.2 |
Australia (Carville 2010) [147] | Hospitalisations/100000 populationa
| 1995–99 2006–07 | 6.3 9.1 | 3.1 |
Australia (Heywood 2014) [2] | Hospitalisations/100000 population | 1998 2004 2006–10 | 9.2 10.6 10.4 | 2.2 −0.4 |
Korea (Choi 2010) [130] | Hospitalisations/1000 population | 2003 2007 | 0.22 0.32 | 9.1 |
Consultations/1000 population | 2003 2007 | 7.93 12.54 | 11.6 | |
Total socioeconomic cost (US$) | 2003 2007 | 75,921,348 143,774,888 | 17.9 | |
Japan (Toyama 2009) [139] | Incidence/1000 person-years | 1997 2006 | 3.61 4.55 | 2.6 |
Taiwan (Lin 2010) [136] | Healthcare cost (NT$) | 2000 2004 | 250,000,000 319,000,000 | 5.5 |
Taiwan (Wu CY 2010) [142] | Incidence/1000 population | 2000 2005 | 4.94 7.00 | 7.0 |
Taiwan (Chao DY 2012) [143] | Incidence/1000 population | 2000 2008 | 4.45 6.89 | 6.1 |
Taiwan (Wu PY 2013) [141] | Incidence/1000 person-years | 2000 2009 | 4.40 6.24 | 5.5 |
Thailand (Bureau of Epidemiology) | Reported cases/100000 population | 2001 2010 2014 | 6.44 40.49 7.65 | 52.9 −8.1 |
Median (range) | 5.5 (−8.1–17.9) | |||
Quartile range (IQR) | 3.0–7.5 (4.6) |
Country | Varicella vaccine schedule | Planned extent of coverage | Programme commenced (month, year) | |
---|---|---|---|---|
Dose(s) | Age | |||
Australia | 1 | 18 months, with catch-up at 10–13 yearsa
| Entire population | November 2005 |
Hong Kong | 2 | 12 months & 6 yearsb
| Entire population | November 2005 |
Japan | 2 | 12–36 months | Entire population (voluntary category)c
| October 2014 |
New Zealand | 1 | 15 months, with catch-up at 11 yearsd
| Entire population | July 2017 |
South Korea | 1 | 12–15 months | Entire population | January 2005 |
Taiwan | 1 | 12–18 months | Entire population | January 2004 |
Risk factors and comorbidities
Immunosuppressant therapies
Anti-inflammatory and cytotoxic agents
Other iatrogenic risk factors
Infections
Intrinsic risk factors
Associated diseases
Country (source) | Setting (patient number) | Age profile (years) | Proportions with comorbidities (%) | |||||
---|---|---|---|---|---|---|---|---|
Any | Hypertension | Diabetes | Malignancy | Pulmonary | Cardiovascular | |||
Korea (Park SY 2004) [26] | Dermatology (1089) | NA | 36.5 | 12.6 | 7.9 | 0.6 | 1.7a
| 1.6c
|
Korea (Kim YM 2008) [11] | Dermatology (297) | NA | 56.2 | 32.1 | 17.5 | 10.4 | 7.5a
| NA |
China (Yuan LL 2014) [339] | Hospitals (2960) | Median 60 | 22.2 | 11.7 | 6.2b
| 10.7 | ||
Philippines (Jara 2010) [15] | Hospital (221) | Mean 43 | 28.0 | 13.6 | 1.8 | 8.1 | 2.7 | |
Japan (Kurokawa 2002) [23] | Hospitals (263) | Mean 59 | 41.1 | 9.6 | 13.7 | |||
Thailand (Tunsuriyawong 2005) [154] | Hospital (339) | Mean 59 | 26.8 | 4.0 | 2.5 | 1.0 | ||
India (Abdul Latheef 2011) [12] | Hospital (205) | 47% >40 | 14.6 | 5.3 | 9.2 | |||
Taiwan (Jih 2009) [137] | National (34380) | 33% >60 | 20.6 | 2.7 | ||||
Taiwan (Hu 2013) [166] | Hospital (2306) | 24.3 | 14.8 | |||||
Taiwan (Wu CY 2010) [142] | National (702932) | 1.0 | ||||||
Japan (Kurokawa 2007) [28] | Dermatology (316) | 42.1 | 4.1 | 6.6 | 15.2 | |||
Median (range) | 32.3 (14.6–56.2 | 13.1 (4.0–32.1 | 8.8 (2.5–20.6) | 6.0 (0.6–14.8) | 6.9 (1.7–8.1) | 2.7 (1.6–10.7) | ||
Quartile range (IQR) | 26.2–41.4 (15.2) | 6.2–20.1 (13.8) | 6.3–13.2 (6.9) | 1.2–12.9 (11.7) | 5.1–7.7 (2.6) | 2.2–6.7 (4.6) |
Complicating presentations and disease associations
Post-herpetic neuralgia
Country (source) | Setting (number of patients) | Age profile (years) | Proportions with complications (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Post-herpetic neuralgia (months) | Ocular | Otic | Motor | Infections | ≥1 overall | |||||||
NS | ≥1 | ≥3 | ≥6 | Skin | LRT | |||||||
Taiwan (Lin 2010) [136] | Hospitals (2.93% of 672783) | 63% >40 | 52.5 (neurologic including PHN) | 24.1 | 52.4 | 19.0 | 10.1 | 47.0 | ||||
Australia (MacIntyre 2003) [102] | Hospitals (4718) | Mean 69 | 33.1 neurologic | 16.0 | 58.5 | |||||||
Korea (Kim YM 2008) [11] | Dermatology (297) | NA | 30.0 | 7.7 | NA | 1.4a
| 9.8 | 40.7 | ||||
Korea (Lee 2006) [354] | Hospital (333) | NA | 15.6 | 6.9 | 0.6 | 0.3a
| 1.5 | NA | ||||
Korea (Park 2004) [26] | Dermatology (1089) | NA | 7.4 | 3.2 | 0.2 | 0.4a
| 1.8 | NA | ||||
Philippines (Jara 2010) [15] | Hospital (221) | Mean 43 | 2.3 | 5.0 | 6.3 | 12.2 | ||||||
Thailand (Aunhachoke 2011) [30] | Hospitals/tertiary centres (180) | Mean 59 | 19.4 | 7.2 | ||||||||
Singapore (Oh 1997) [340] | Hospital (67) | Mean 50 | 13.4 | 5.0 | 61.0 | 85.0 | ||||||
India (Abdul Latheef 2011) [12] | Hospital (205) | 47% >40 | 10.2 | 1.0 | 0.5 | 13.6 | 34.6 | |||||
Australia (Stein 2009) [104] | General Practice (379)b
| 100% >50 | 15.0 | 16.2c
| 61.3c
| |||||||
Japan (Akiyama 2000) [454] | Hospital (1432) | Mean 54 | 0.8 | |||||||||
India (Gopal 2010) [449] | Dermatology (100) | 3.0 | ||||||||||
Korea (Son 2011) [448] | Hospital (711) | 2.1 | ||||||||||
Korea (Min 2007) [418] | Dermatology (1787) | Mean 62 | 4.7 | |||||||||
Korea (Kim SH 2008) [372] | Dermatology (1496) | 8.7 | ||||||||||
New Zealand (Wallis 2014) [22] | General Practice (278) | 55% >50 | 11.2 | |||||||||
New Zealand (Reid 2014) [17] | General Practice (339) | 71% ≥51 | 6.3 | |||||||||
Thailand (Tunsuriyawong 2005) [154] | Hospital (399) | Mean 59 | 16.8 | 6.3 | ||||||||
Singapore (Goh 1997) [18] | Dermatology outpatients (164) | Mean 49 | 50.0 | 28.0 | 17.0 | |||||||
Japan (Imafuku 2014) [359] | Dermatology (764) | Median 61 | 31.6 | 12.4 | 7.1 | |||||||
Taiwan (Tsai TF 2014) [20] | General Practice & Hospitals (150) | Mean 65 | 20.7 | |||||||||
Korea (Song 2014) [25] | Specialist centres (151) | Mean 64 | 38.4 | 24.1 | ||||||||
Japan (Kurokawa 2002) [23] | Hospitals (263) | Mean 59 | 26.2 | |||||||||
Japan (Kurokawa 2007) [28] | Hospitals (316) | 24.7 | 12.4 | |||||||||
Korea (Cho 2014) [357] | Dermatology (305) | Mean 53 | 6.2 | |||||||||
Taiwan (Jih 2009) [137] | National (34280) | 33% >60 | 13.3 | 8.6 | ||||||||
Korea (Choi 2010) [130] | Cancer screening (282) | 17.7 | ||||||||||
China (Yang 2005) [355] | Dermatology (178) | NA | 21.9 | |||||||||
Korea (Herr 2002) [356] | Dermatology (188) | NA | 17.0 | |||||||||
China (Zhu 2009) [358] | Anaesthesiology (49) | Mean 65 | 20.4 | |||||||||
Korea (Cheong 2014) [96] | National (11502) | 100% >50 | 20.6 | |||||||||
China (Song 2002) [21] | Dermatology (522) | Mean 47 | 6.9 | |||||||||
Median (range) | 17.0 (2.3–50.0) | 7.2 (3.2–24.1) | 1.0 (0.2–52.4) | 0.8 (0.8–3.0) | 10.0 (1.5–61.0) | 47.0 (12.2–85.0) | ||||||
Quartile range (IQR) | 11.3–23.0 (11.7) | 6.3–11.2 (4.9) | 0.6–4.7 (4.1) | 0.5–1.8 (1.3) | 5.6–15.0 (9.4) | 37.7–59.9 (22.3) |
Neuropathy, inflammation and secondary complications
Eye
Ear, nose and throat
Neuromuscular
Vasculopathy
Skin
Dental
Disease associations
Healthcare utilisation
Hospitalisation
Country (source) | Study period | Age profile (years) | Hospitalisations (100000 person years) | Hospitalisation duration (days) | Healthcare costs (US$ equivalent)c
| ||||
---|---|---|---|---|---|---|---|---|---|
Overall average | Complications | Per patient | Annual total (millions) | ||||||
None | With | Outpatient | Inpatient | ||||||
Taiwan (Lin 2010) [136] | 2000–2005 | All ages | 14.6 | 8.3 | 8.0 | 8.6 | 7.7 in 2000 → 9.8 in 2004 (NT$ 319,000,000) | ||
≥80 | 105.1 | 204.0 | |||||||
Taiwan (Jih 2009) [137] | 2000–2006 | All ages | 16.1 | 8.3 | 78.4 | 1800.3 | 0.669773 (NT$ 14,147,543) | ||
0–20 | 6.06 | ||||||||
≥60 | 59.5% of total | 9.19 | 59.5% of total | ||||||
Korea (Cheong 2014) [96] | 2009 | ≥50 years | 88.8d
| 10.93 | 14.75e
| 176.0 (161.0–240.0f) | 63.2 | ||
Australia (Stein 2009) [104] | 1998–2005 | ≥50 years | 28.0a
| 6.8a
| 6.0 | 8.6 (5.2–14.6b) | 3922.2a
| 27.5 | |
≥80 | 95.8 | ||||||||
Thailand (Aunhachoke 2011) [30] | 2007–2008 | Mean 59 | 90.4 (by 180 days follow-up) | ~1.1% per capita income | |||||
Korea (Choi WS) [140] | 2003–2007 | All ages | 22.0–32.0 | 75.9 increasing by 14–20% per year to 143.8 | |||||
Australia (MacIntyre 2003) [102] | 1998–1999 | Mean 69 | 25.0 | 12.7 | |||||
>50 | 53.0% of total | ||||||||
≥80 | >150.0 | ||||||||
Korea (Song 2014) [25] | 2009–2010 | Mean 64 | 8.9 | ||||||
Korea (Kim YJ) [138] | 2011 | All ages | 51.2 | ||||||
≥80 | 266.3 | ||||||||
Australia (Carville 2010) [147] | 2006–2007 | All ages | 9.1a
| ||||||
≥80 | 89.4a
| ||||||||
Australia (Araújo 2007) [7] | 2000–2002 | All ages | 10.0a
| ||||||
Australia (Heywood 2014) [2] | 2006–2010 | All ages | 10.4 |
Healthcare expenditure
Management and prevention
Antiviral therapies
Pain relief
Corticosteroids
Analgesia
Alternative treatment modalities
Unmet treatment needs
Prevention approaches
Antiviral prophylaxis in high-risk patients
VZV immunisation
HZ immunisation guidelines and recommendations
Country | Title | Issuing organisation | Year (last update) | Age thresholds | ||
---|---|---|---|---|---|---|
Name | Status | Routine | Optional | |||
Australia [8] | The Australian Immunisation Handbook | Technical Advisory Group on Immunisation | Government | 2015 | 60–79 | |
Australia & New Zealand [5] | Immunisation of Older People | Australia & New Zealand Society for Geriatric Medicine | Society | 2011 | ≥60 | |
India [803] | Medicine Update. Adult Immunization | Association of Physicians of India | Society | 2013 | No recommendationa
| |
Indonesia [793] | Adult Immunization Schedule | Specialist Doctors Association of Indonesia | Society | 2014 | ≥50 | |
Malaysia [792] | Position Statement on Vaccination Against the Herpes Zoster Virus in Older Adults | Malaysian Society of Geriatric Medicine | Society | 2014 | 60–79 | 50–59 |
New Zealand [642] | Immunisation Handbook | New Zealand Ministry of Health | Government | 2016 | >50 | |
Philippines [794] | Handbook on Adult Immunization for Filipinos | Philippine Society for Microbiology and Infectious Diseases | Society | 2012 | ≥60 | |
South Korea [791] | Recommended Immunization Schedule for Adults in Korea | Korean Society of Infectious Diseases | Society | 2012 | >65 | 50–59 |
Taiwan [796] | Clinical Handbook for Adult Immunization | Taiwan Association of Family Medicine | Society | 2010 | ≥60 | |
Thailand [795] | Recommended Adult and Elderly Immunization Schedule | Thailand Royal College of Physicians | Society | 2014 | ≥60 |
Indications and administration | • Routine immunisation with one dose of HZ vaccine for all persons age ≥60: – With or without prior HZ – With chronic medical conditions (eg, chronic kidney disease, diabetes, rheumatoid arthritis, lung disease), except those listed as contraindications or precautions • HZ vaccine can be co-administered with other indicated adult vaccines, eg, influenza |
Unlicensed categories/ purposes | • Persons immunised with varicella zoster vaccine • Persons younger than the minimum recommended or optional age threshold • HZ vaccine is not to be used to treat existing HZ or its complications |
Precautions | • Moderate/severe acute illness • Anticipated immunosuppression • Anti-herpetic pharmacotherapy |
Contraindications | • Hypersensitivity to vaccine components • Morbid or medical immunosuppression or immunodeficiency: – HIV/AIDS – Transplant recipients – Systemic immunosuppressive therapy (including high-dose steroids and recombinant immune modulators • Pregnancy |