Herpes zoster-related deaths in the United States: validity of death certificates and mortality rates, 1979-2007.
BACKGROUND
Herpes zoster (HZ) vaccine was recommended in the United States to reduce HZ-associated morbidity. Vaccination may reduce HZ-associated mortality, but no strategy exists to monitor mortality trends.


METHODS
We validated HZ coding on death certificates from California, using hospital records as the gold standard, and applied the results to national-level data to estimate HZ mortality.


RESULTS
In the validation phase of the study, among 40 available hospital records listing HZ as the underlying cause of death, HZ was the underlying cause for 21 (52.5%) and a contributing cause for 5 (12.5%). Among the 21 hospital records listing HZ as the underlying cause of death, the median age of decedents was 84 years (range, 50-99); 60% had no contraindications for HZ vaccination. Of the 37 available records listing HZ as a contributing cause of death, HZ was a contributing cause for 2 (5.4%) and the underlying cause for 6 (16.2%). Nationally, in the 7 years preceding the HZ vaccination program, the average annual number of deaths in which HZ was reported as the underlying cause of death was 149; however, based on our validation study, we estimate the true number was 78 (range, 31-118).


CONCLUSIONS
National death certificate data greatly overestimate deaths in which HZ is the underlying or contributing cause of death. The HZ vaccination program could prevent some HZ-related deaths, but the impact will be difficult to assess using national mortality data.
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. amahamud@cdc.gov
Abdirahman
A
Mahamud
Mona
M
Marin
Steven P
SP
Nickell
Trevor
T
Shoemaker
John X
JX
Zhang
Stephanie R
SR
Bialek
D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D003644:Death Certificates; D005260:Female; D006562:Herpes Zoster / Q000401:mortality*; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis