Incidence of herpes zoster and its complications in ≥50-year-old Spanish adults: A prospective cohort study

• Published in: Vacunas (Barcelona. Internet. English ed.) 2022-09, Vol.23 (3), p.165-173
• Main Authors: Comas, Luis García, Cerdán, Teresa, Cambronero, Maria Del Rosario, García Martínez, Juan Antonio, Sanromà, Marta López, Gopala, Kusuma, Simone, Benedetto, Díez-Domingo, Javier
• Format: Article
• Language: English
• Subjects: Atención primaria; España; Estudio prospectivo; Herpes zoster; Neuralgia postherpética; Postherpetic neuralgia; Primary care; Prospective study; Spain
• ISSN: 2445-1460; 2445-1460
• DOI: 10.1016/j.vacune.2022.11.002

Herpes zoster (HZ) chiefly affects older individuals and the immunocompromised and may lead to persistent pain, postherpetic neuralgia (PHN), and other complications. From 2012–2015, we conducted a prospective observational cohort study of adults ≥50 years with HZ presenting in primary care in Spain (NCT01521286). We estimated HZ incidence rates (IR) per 1,000 person-years (PY) over a 12-month period, and prospectively followed up a broader patient cohort; assessing pain severity using the ‘Zoster Brief Pain Inventory (ZBPI) and PHN development (defined as ZBPI ‘worst pain’ ≥3 at Day 90). HZ IR in adults ≥50 years was 4.88/1,000 PY (95% confidence interval [CI]: 4.44–5.35), similar for both genders. Incidence increased with age, from 2.54 (95% CI: 1.84–3.41) in 50–54-year-olds to 6.40/1,000 PY (95% CI: 4.86–8.28) in 75–79-year-olds. In 545 HZ patients followed prospectively, the proportion of HZ patients with PHN was 4.59% (95% CI: 2.99–6.70); and 11.79% (95% CI: 7.78–16.91) in those 212 patients with available ZBPI scores at Day 90. The proportion of patients developing PHN increased with increasing age. Mean ZBPI ‘worst pain’ scores in patients not developing PHN showed a marked decline between Day 0–30 (from 5.4 to 1.6) and none at Day 90; in patients with PHN this score remained high (>5.5) up to Day 150. Other complications were observed in 10.3% of patients. HZ presents a considerable burden in adults aged ≥50 years in Spain, with an IR of ~5/1,000 PY. HZ and PHN risk increased with age. El herpes zoster (HZ) afecta principalmente a individuos mayores e inmunocomprometidos, pudiendo originar dolor persistente, neuralgia postherpética (PHN), y otras complicaciones. De 2012 a 2015, realizamos un estudio observacional prospectivo de cohorte de adultos ≥50 con HZ, que acudieron a atención primaria en España (NCT01521286). Calculamos las tasas de incidencia (TI) del HZ por 1.000 personas/año (PA) durante un periodo de 12 meses, y realizamos el seguimiento prospectivo de una cohorte de pacientes más amplia, evaluando la severidad del dolor utilizando la escala ZBPI (Zoster Brief Pain Inventory) y el desarrollo de PHN (definida como puntuación ≥3 de “peor dolor” ZBPI al 90º día). La TI de HZ en adultos ≥50 años fue de 4,88/1.000 PA (95% de intervalo de confianza [IC]: 4,44 -5,35), similar para ambos sexos. La incidencia incrementó con la edad, de 2,54 (95% IC: 1,84 -3,41) en los individuos de 50 -54 años de edad, a 6,40/1.000 PA (95% IC: 4,86 -8,28) en los