Herpes zoster-associated mortality in Europe: a systematic review.
BACKGROUND
Reactivation of latent varicella zoster virus, partly due to age-related immunosenescence and immunosuppressive conditions, results in herpes zoster (HZ) and its associated complications. The management of the most important complication, post-herpetic neuralgia (PHN), is challenging, particularly in the elderly, and is generally unsatisfactory. No previous reviews have reported the incidence of HZ-associated mortality.


METHODS
We carried out a systematic literature review to identify studies and databases providing data for HZ-associated mortality in adults aged ≥ 50 years in Europe.


RESULTS
We identified 12 studies: Belgium (1); France (1); Germany (1); the Netherlands (2); Portugal (1); Spain (4) and England/Wales (2) and 4 databases from Europe: France; Germany and England/Wales. The incidence was available from eight studies; it was highest in those aged ≥ 95 in France (19.48/100,000). In the European (WHO) database, the overall mortality ranged from 0 to > 0.07/100,000. The age- and gender-specific HZ mortality rates from the other databases showed that while in younger age groups the HZ mortality rate was higher in males, in older patients the rate was much higher in women. The case fatality rate was 2 and 61/100,000 in those 45-65 and ≥ 65 years, respectively. A similar increase with age was seen for the hospital fatality rate; 0.6% in those 45-65 years in the UK and 7.1% in those ≥ 80 in Spain.


CONCLUSIONS
Although the data were sparse and heterogeneous, HZ-associated mortality clearly increases with age. In addition, the elderly who develop HZ often have underlying diseases and are at increased risk of functional decline and loss of independence. Mortality should be taken into account in health-economics models.
Epidemiology Department, Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367, Lyon cedex 07, France. hbricout@spmsd.com.
Hélène
H
Bricout
MediCom Consult, 39 rue Clement Michut, 69100, Villeurbanne, France. mhaugh@medicom-consult.com.
Margaret
M
Haugh
Life Events and Population Sources, Office for National Statistics, Government Buildings, Newport, NP10 8XG, UK. olugbenga.olatunde@ons.gsi.gov.uk.
Olugbenga
O
Olatunde
Department of Preventive Medicine and Public Health, Rey Juan Carlos University, Avda. Atenas s/n, CP: 28922, Alcorcón, Madrid, Spain. ruth.gil@urjc.es.
Ruth Gil
RG
Prieto
D000368:Aged; D001530:Belgium / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006562:Herpes Zoster / Q000401:mortality*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage; D014645:Herpesvirus 3, Human; D049671:History, 18th Century; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D051474:Neuralgia, Postherpetic / Q000401:mortality*; D011174:Portugal / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology
D053061:Herpes Zoster Vaccine