title: A meta-analysis of stroke risk following herpes zoster infection.
abstract: The incidence of herpes zoster (HZ) is increasing and poses a significant health concern to aging populations. Several studies suggest an increased risk of stroke following zoster infection, but the results are conflicting. We conducted a systematic review and meta-analysis to determine if stroke risk is increased following HZ infection.
  
  
  
  A search of MEDLINE, EMBASE, Google scholar, Web of Science, CAB Direct, Cumulative Index to Nursing and Allied Health Literature, and Evidence Based Medicine Reviews was conducted for observational studies of adults with HZ infection that examined stroke and TIA risk from January 1, 1966 to May 31, 2016. Adjusted relative risks reported for similar follow-up durations were pooled across studies separately using random-effects inverse variance models.
  
  
  
  Data were pooled from nine studies. Relative risk for stroke after zoster was 1.78 (95% CI 1.70-1.88) for the first month following herpes zoster, dropping progressively to 1.43 (95% CI 1.38-1.47) after 3 months, to 1.20 (95% CI 1.14-1.26) after 1 year. We found that stroke risk increases by a larger margin during the first month after a herpes zoster ophthalmicus episode: relative risk 2.05 (95% CI 1.82-2.31). The risk remains elevated one year after the acute episode.
  
  
  
  Herpes zoster is an established risk factor for increasing the risk of stroke, especially shortly after infection. Vaccination should be encouraged in patients at high risk of cardiovascular disease.
authors.affiliation: University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. fawziah@mail.ubc.ca.
authors.forename: Fawziah
authors.identifier: 0000-0002-1266-1901
authors.initials: F
authors.lastname: Marra
authors.affiliation: University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ruckenstein
authors.affiliation: University of East Anglia, Norwich, United Kingdom.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Richardson
mesh_terms: D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000821:virology*
keywords: Aging; Herpes zoster; Meta-analysis; Stroke; TIA; Transient ischemic attacks