title: Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific.
abstract: Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.
  
  
  
  We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.
  
  
  
  From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years - lifetime risk is approximately one-third. Average incidence of 3-10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients' quality of life and incur heavy healthcare utilisation.
  
  
  
  Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan. lkchen2@vghtpe.gov.tw.|Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan. lkchen2@vghtpe.gov.tw.
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
authors.affiliation: National Center for Geriatrics and Gerontology, 7-340 Morioka-cho, Obu, Aichi, 474-8511, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Arai
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.
authors.forename: Liang-Yu
authors.initials: LY
authors.lastname: Chen
authors.affiliation: Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.|Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan.
authors.forename: Ming-Yueh
authors.initials: MY
authors.lastname: Chou
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Salemba Raya No. 6, Jakarta, 10430, Indonesia.
authors.forename: Samsuridjal
authors.initials: S
authors.lastname: Djauzi
authors.affiliation: The Center of Gerontology and Geriatrics, West China Medical School/West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Renmin Nan Lu, Chengdu, Sichuan, 610041, China.
authors.forename: Birong
authors.initials: B
authors.lastname: Dong
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Jongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Division of Infectious Diseases, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu, 710-600, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kwon
authors.affiliation: Rophi Clinic, 38 Irrawaddy Rd. #07-54/55, Mount Elizabeth Novena Specialist Centre, Singapore, 329563, Singapore.
authors.forename: Hoe Nam
authors.initials: HN
authors.lastname: Leong
authors.affiliation: Geriatric Medicine Centre (Healthy Ageing), Hong Kong Sanatorium and Hospital, 2 Village Rd. Happy Valley, Hong Kong S.A.R., China.
authors.forename: Edward M F
authors.initials: EM
authors.lastname: Leung
authors.affiliation: Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.|Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan.|Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chih-Kuang
authors.initials: CK
authors.lastname: Liang
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, 100730, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Liu
authors.affiliation: Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Jubilee Hills, Hyderabad, 500096, India.
authors.forename: Dilip
authors.initials: D
authors.lastname: Mathai
authors.affiliation: National Skin Centre, 1 Mandalay Rd., Singapore, 308205, Singapore.
authors.forename: Jiun Yit
authors.initials: JY
authors.lastname: Pan
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.|Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
authors.forename: Li-Ning
authors.initials: LN
authors.lastname: Peng
authors.affiliation: Geriatric Center, St. Luke's Medical Center, 279 E. Rodriguez Sr. Ave., Quezon City, 1102, Philippines.
authors.forename: Eduardo Rommel S
authors.initials: ER
authors.lastname: Poblete
authors.affiliation: Division of Geriatrics, Department of Medicine, University Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia.
authors.forename: Philip J H
authors.initials: PJ
authors.lastname: Poi
authors.affiliation: Ropata Medical Centre, Lower Hutt, 5010, New Zealand.
authors.forename: Stewart
authors.initials: S
authors.lastname: Reid
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Terapong
authors.initials: T
authors.lastname: Tantawichien
authors.affiliation: Department of Family Medicine, College of Medicine, Kyung Hee University, 1 Hoigi-dong, Dongdaemun-gu, Seoul, 130-720, Korea.
authors.forename: Chang Won
authors.initials: CW
authors.lastname: Won
mesh_terms: D001208:Asia / Q000453:epidemiology; D054869:Clinical Audit; D003362:Cost-Benefit Analysis; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006562:Herpes Zoster / Q000453:epidemiology* / Q000517:prevention & control; D053061:Herpes Zoster Vaccine / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D051474:Neuralgia, Postherpetic / Q000453:epidemiology / Q000517:prevention & control*; D010139:Pacific Islands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053061:Herpes Zoster Vaccine
keywords: Asia-Pacific; Complications; Epidemiology; Healthcare burden; Herpes zoster; Immunisation; Management; Post-herpetic neuralgia; Prevention; Vaccine