Herpes zoster poses a significant health threat to the aging population in China. This study aimed to analyze the cost burden and temporal trends of herpes zoster in China.

This study encompassed herpes zoster outpatients from 15 hospitals between 2016 and 2023 and herpes zoster inpatients from 175 hospitals between 2013 and 2023. We used descriptive analysis and log-linear model to investigate herpes zoster related cost burden and their temporal trends during the selected period.

Over the past eight years, outpatient visits increased by about 23.8 % across the selected hospitals, while inpatient discharges increased by approximately 124.8 %. About 23.6 % of the outpatient cases were under 45 years of age. The cost per outpatient visit fluctuated at approximately 57 USD, while the cost per hospitalization increased by over 20 %, reaching around 1931 USD in 2023. Older patients and those with post-herpetic neuralgia experienced higher herpes zoster related healthcare costs and utilization.

Our findings suggest that although the average cost per visit or discharge changed little in China, the growing demand for herpes zoster healthcare highlights the necessity of more preventive efforts to reduce the burden on both individuals and the healthcare system.

Varicella Zoster Virus (VZV), a member of the herpes virus family, causes varicella (chicken pox) upon primary infection and later manifests as herpes zoster ([HZ] or shingles) upon reactivation. VZV-specific T-cell immunity acquired during primary infection aids recovery, with the virus lying latent in neuronal ganglia until it transports to the skin axonally during reactivation. It has been well-established that reduced T-cell recognition and proliferation, as well as immunosuppression more generally, contribute to VZV reactivation. It has also been discovered that seasonal variation, which is linked to ultraviolet radiation (UVR), correlates with increased HZ cases. This correlation may be explained by the direct immunosuppressant effects of UVR, with melanin offering photoprotective effects that decrease reactivation rates. However, an underexplored aspect of this correlation is the potential role of the skin microbiome in UVR-induced VZV reactivation. Vital for skin homeostasis and immune modulation, the skin microbiome has been found to influence various skin conditions. Preliminary evidence suggests that microbiome diversity may influence VZV reactivation rates, supported by antibiotic-induced effects on HZ incidence. Research also indicates the microbiome's modulating effect on UVR-induced immune suppression, emphasizing its potential significance in VZV reactivation. The skin microbiome's contribution may also help further explain sex and ethnicity-specific variations in VZV reactivation rates. Understanding the interplay between UVR, the skin microbiome, and VZV reactivation warrants further investigation and may help uncover preventive strategies for mitigating VZV reactivation.

Recent observational investigations suggest a likely correlation between stroke lacking a blood supply-cerebral arterial thrombosis (ischemic stroke) and herpes zoster (HZ), although the causality remains unclear. This study aims to explore the potential causal link in relation to ischemic stroke and HZ. We performed a Mendelian randomization analysis (MR). Our objective is to provide fresh perspectives for the clinical prevention of ischemic stroke in individuals with HZ.

Data from the European Molecular Biology Laboratory were utilized in the genome-wide association study (GWAS) of ischemic stroke. The study included data from 484,121 participants, with the FinnGen Consortium contributing data for zoster outcomes (n_case = 2080; n_control = 211,856), primarily focusing on European population samples. We conducted a comparative analysis of figures from the GWAS for ischemic stroke alongside that for zoster within a MR framework. Employing inverse variance weighting as our primary method of analysis, we undertook a thorough investigation into the potential causal relationship between ischemic stroke and zoster. Additionally, we adopted complementary approaches, including maximum likelihood estimation, MR-Egger, weighted median, and MR-Polyvalent Residuals and Outliers method to provide a comprehensive assessment of causality. To examine the variability among the instrumental variables, we utilized Cochran's Q statistic as a key indicator.

The analysis weighted by inverse variance indicated a significant impact of ischemic stroke on zoster within the zoster GWAS databases, yielding an odds ratio (OR) of 1.463 (95% confidence interval [CI]: 1.001-2.138; P value = 0.04). However, the MR-Egger analysis failed to yield substantial evidence for this relationship, presenting an OR of 0.599 (95% CI: 0.129-2.773; P value = 0.52).Similarly, the weighted median analysis failed to offer compelling endorsement of the association between ischemic stroke and zoster incidence, reporting an OR of 1.15 (95% CI: 0.736-1.806; P = 0.53).

The implications of the MR analysis demonstrate a causal linkage between ischemic stroke and zoster.

Varicella-zoster virus (VZV) affects over 90% of the global population. The initial encounter with VZV, often in the early years of childhood, results in varicella. From latency, VZV can reactivate in later stages of life, leading to the development of herpes zoster. Considering the importance of host immune responses in preventing reactivation and clinical manifestations associated with VZV infection, a therapy that sustains the immune system could be of great interest.

The present work aimed to set the basis of the possible mode of action of 2LZONA®, a micro-immunotherapy medicine composed of five different capsules. Thus, the effects of several active substances employed in this medicine were assessed in human primary immune-related cells.

Our results showed that DNA (8 CH) and RNA (8 CH), two active substances used in 2LZONA, displayed phagocytosis-enhancing capabilities in granulocytes and contained sub-micron particles that could explain, at least partially, the observed effect. These two active substances tested singularly and together with other actives of 2LZONA's capsules, modulated the proliferation of immature, transitory, and mature subsets of natural killer (NK) cells in an IL-15-like pattern, suggesting an enhancement of their activation levels. Moreover, the tested items of 2LZONA increased the secretion of IL-2, IL-6, IL-13, and TNF-α in human peripheral blood mononuclear cells (PBMCs). Furthermore, the proliferation of PBMCs-derived NK cells, intermediate monocytes, and neutrophils was slightly increased by this treatment. In CD3 and CD3/CD28 pre-primed conditions, actives present in one capsule of 2LZONA enhanced the secretion of IL-6 and TNF-α. Finally, one capsule of 2LZONA reduced the expression of human leukocyte antigen (HLA) in IFN-inflamed endothelial cells. Overall, these data provide, for the first time, preliminary experimental evidence of the mechanisms of action of some of the active ingredients employed in 2LZONA capsules.

The determinants of varicella-zoster virus (VZV)-associated central nervous system (CNS) infection have not been fully elucidated. This study aimed to investigate the incidence and risk factors, including immunosuppression, for different manifestations of VZV-associated CNS infection. Patient registers were used to include adults diagnosed with VZV-associated CNS infections between 2010 and 2019 in Sweden. Nationwide registers covering specialized care, and regional registers covering primary care, were used. Controls without a VZV diagnosis during the study period were matched by age and sex. Risk factors were calculated using multivariable logistic regression. A total of 1488 adult cases with VZV-associated CNS infection were identified, yielding an incidence of 1.92/100 000 person-years, which increased over the study period. Meningitis was the most frequent (45%), followed by encephalitis (38%), and Ramsay Hunt syndrome (17%). The highest incidence was observed in individuals over 70 years of age (4.15/100 000 person-years), in whom encephalitis was most common. Statistically significant risk factors for VZV-associated CNS infection were HIV, hematological cancer, treatment with specific immunosuppressants or glucocorticoids, chronic obstructive pulmonary disease, diabetes, solid cancer, stroke, and congestive heart failure. Encephalitis was associated with older age, more immunosuppressive conditions, and more comorbidities than other manifestations. In conclusion, VZV is a common cause of adult viral CNS infection, for which elderly individuals with immunosuppressive or comorbid conditions are at the highest risk. The strongest risk factors found were HIV, hematological cancer, and treatment with specific immunosuppressants or high-dose glucocorticoids.

Postherpetic neuralgia (PHN) is a common complication of herpes zoster (HZ). This study aimed to use a large real-world electronic medical records database to determine the optimal machine learning model for predicting the progression to severe PHN and to identify the associated risk factors.

We analyzed the electronic medical records of 23,326 patients diagnosed with HZ from January 2010 to June 2020. PHN was defined as pain persisting for ≥90 days post-HZ, based on diagnostic and prescription codes. Five machine learning algorithms were compared with select the optimal predictive model and a subsequent risk factor analysis was conducted.

Of the 23,326 patients reviewed, 8,878 met the eligibility criteria for the HZ cohort. Among these, 801 patients (9.0%) progressed to severe PHN. Among the various machine learning approaches, XGBoost-an approach that combines multiple decision trees to improve predictive accuracy-performed the best in predicting outcomes (F1 score, 0.351; accuracy, 0.900; area under the receiver operating characteristic curve, 0.787). Using this model, we revealed eight major risk factors: older age, female sex, history of shingles and cancer, use of immunosuppressants and antidepressants, intensive initial pain, and the neutrophil-to-lymphocyte ratio. When patients were categorized into low-risk and high-risk groups based on the predictive model, PHN was seven times more likely to occur in the high-risk group (p<0.001).

Leveraging machine learning analysis, this study identifies an optimal model for predicting severe PHN and highlights key associated risk factors. This model will enable the establishment of more proactive treatments for high-risk patients, potentially mitigating the progression to severe PHN.

Herpes Simplex Virus (HSV) types 1 and 2 are significant etiologies to central nervous system (CNS) infections, leading to potential severe neurological consequences. Despite their global impact, our region's data on the epidemiology of HSV CNS infections remains limited. This study assessed the epidemiology and diagnostic trends of HSV-1 and HSV-2 CNS infections in a tertiary hospital in Southwestern Saudi Arabia from 2018 to 2023. A retrospective study was conducted using data from cerebrospinal fluid (CSF) samples collected from patients with suspected CNS infection between 2018 and 2023. Polymerase Chain Reaction (PCR) results for detecting HSV-1 and HSV-2, performed as part of routine clinical diagnostics, were analyzed. Data on patient demographics, specimen collection times (including months and years), laboratory processing times, and seasonal trends were collected and analyzed using descriptive statistics and univariate analysis. Of the 280 samples, 11.0% were positive for HSV, with 10.0% positive for HSV-1 and 1.0% for HSV-2. Most HSV-positive cases were found in patients aged ≥51 years (27.0%). Peak detection occurred in 2020, with seasonal spikes in May and September. The turnaround time significantly varied, with the shortest laboratory turnaround time for PCR results recorded in 2020 (35.54 hours), while the longest was in 2021 (167.38 hours). This study reports an important burden of HSV-related CNS infections in Southwestern Saudi Arabia, indicating the importance of timely diagnosis through PCR testing. Our findings highlight the need for improved diagnostic workflows and enhanced epidemiological surveillance. Future research should explore broader regional and clinical data related to HSV CNS infection epidemiology.

We evaluated the vaccine effectiveness (VE) of two doses of recombinant zoster vaccine (RZV) against herpes zoster (HZ) and postherpetic neuralgia (PHN) in Chinese adults at Kaiser Permanente Southern California (KPSC). Chinese KPSC members were identified based on self-reported ethnicity or self-reported preferred spoken/written language. Those aged ≥50 years who received two doses of RZV 4 weeks to ≤ 6 months apart were matched 1:4 to RZV unvaccinated Chinese members and followed through June 2022; second doses were accrued 6/1/2018-12/31/2020. We estimated incidence and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) comparing outcomes (HZ and PHN). Adjusted VE (%) was calculated as (1-aHR)×100. 3978 RZV vaccinated Chinese members were matched to 15,912 RZV unvaccinated Chinese members. The incidence per 1000 person-years (95% CI) of HZ in the vaccinated group was 1.5 (0.9-2.5) and 10.9 (9.8-12.1) in the unvaccinated group; aHR (95% CI) was 0.12 (0.07-0.21). Adjusted VE (95% CI) was 87.6% (78.9-92.7) against HZ. We identified 0 PHN cases in the vaccinated group and 19 in the unvaccinated group. Among Chinese adults aged ≥50 years, two doses of RZV provided substantial protection against HZ and PHN supporting the real-world effectiveness of the vaccine in this population.

Shingles, also known as herpes zoster, is a reactivation of the chickenpox virus that causes a painful, blistering rash. After a chickenpox infection, the virus lies dormant in nerve cells. When reactivated, usually in older adults or those with weakened immune systems, it travels along nerves, typically affecting a single strip of skin called a dermatome. Shingles usually presents as a painful, one-sided rash that may involve nerves in the head, face, and body. While it typically resolves on its own, it can lead to complications, especially in older adults. Antiviral medications are effective in reducing the severity and duration of shingles and should be started as soon as the rash appears. This report describes an unusual case of an elderly patient who developed shingles on their face after a wound, notably without experiencing any pain.

Assess the risk of incident gout following exposure to recombinant zoster vaccine (RZV).

This case-only, self-controlled risk interval study included a cohort of US fee-for-service Medicare (Part A, B, and D) beneficiaries aged ≥65 years. The exposure was receipt of at least one dose of the two-dose RZV regimen in 2018 or 2019. The risk and control windows were days 1-30 and days 31-60, respectively, following vaccination. Incident gout was defined as the first episode of gout during the risk or control window, with no evidence of gout in the last 365 days. We estimated the relative risk (RR) and 95 % confidence interval (CI) of incident gout in the risk window relative to the control window, using conditional Poisson regression models. Sensitivity analyses included a dose-compliant subanalysis of individuals who received dose 2 60-183 days after dose 1; dose-specific analysis; seasonality adjustment; and COVID-19 adjustment for potential detection bias due to the pandemic.

The 1290 RZV-exposed individuals with incident gout were primarily White (86.98 %), male (61.16 %), and aged 70-79 years (55.82 %). The RR of incident gout was 1.00 (95 % CI 0.90, 1.12). In the dose-compliant sensitivity analysis (n = 959 cases of incident gout), the RR of incident gout was 0.99 (95 % CI 0.87, 1.13). The findings were unchanged in the dose-specific, seasonality, and COVID-19 sensitivity analyses.

The findings suggest that RZV is not significantly associated with an increased risk of incident gout in the Medicare population aged ≥65 years.

This population-based study investigated the risk of having had prior herpes zoster within five years preceding a diagnosis of head and neck cancer. We conducted a case-control study that included 9,191 patients with a diagnosis of head and neck cancer in Taiwan's Longitudinal Health Insurance Database 2010 and 36,764 matched controls. We assessed the odds of patients with head and neck cancer having had a diagnosis of herpes zoster during the five years preceding head and neck cancer using multiple logistic regression analysis. The prevalence of prior herpes zoster among the total sample was 4.6%, 7.9% and 3.8% among patients with and without head and neck cancer, respectively (p < 0.001). The odds ratio of herpes zoster among the head and neck cancer- versus control group was 2.198 (95% CI = 2.001 ~ 2.415) after adjusting for sociodemographic characteristics and hypertension, diabetes, hyperlipidemia, tobacco use disorder, HPV infection, and alcohol dependence syndrome. Statistically significant excess odds were observed for all specific subtypes of head and neck cancer except for sinonasal cancer. Herpes zoster infection within the 5 years preceding a diagnosis of head and neck cancer may be a harbinger of developing head and neck cancer.

Varicella zoster virus (VZV) is an enveloped, linear double-stranded DNA virus. It belongs to the Herpesviridae family and can manifest as primary varicella infection or secondary infection, also known as herpes zoster. Varicella pneumonia is an uncommon but potentially life-threatening complication of primary varicella infection. It mainly affects adults, and, if left untreated, the mortality rate is high. We report two cases involving adult male patients who presented with a generalized widespread vesicular rash compatible with primary varicella. Each patient had a different clinical presentation; the first patient had respiratory symptoms, while the second patient did not. Chest radiographs of both patients showed bilateral infiltrates. Treatment was initiated with the administration of intravenous acyclovir with a very good response. This report of two cases highlights the importance of early detection and prompt treatment of varicella-related complications, especially in higher-risk patients, to reduce morbidity and mortality and improve overall clinical outcomes. We also aim to reinforce the importance of immunization, which would aid in reducing the incidence of vaccine-preventable diseases such as varicella and its life-threatening complications.

Herpes Zoster (HZ) or shingles is the reactivation of the Varicella Zoster Virus (VZV), usually along a single sensory nerve, but can affect both sensory and motor cranial nerves. Major risk factors for HZ include immunosuppressed status and age older than 60 years. In the United States, the lifetime risk of HZ is approximately 30%. Worldwide, the median incidence of HZ is 4-4.5 per 1000 person-years across the Americas, Eurasia, and Australia. HZ ophthalmicus, occurring in 10-20% of patients, is an ophthalmic emergency characterized by VZV reactivation along the V1 branch of the trigeminal nerve. Approximately half of this patient subgroup will go on to develop ocular manifestations, requiring prompt diagnosis and management. While anterior segment complications are more common, neuro-ophthalmic manifestations are rarer and can also occur outside the context of overt HZ ophthalmicus. Neuro-ophthalmic manifestations include optic neuropathy, acute retinal necrosis or progressive outer retinal necrosis, cranial neuropathy (isolated or multiple), orbitopathy, and CNS manifestations. Although typically a clinical diagnosis, diagnosis may be aided by neuroimaging and laboratory (e.g., PCR and serology) studies. Early antiviral therapy is indicated as soon as a presumptive diagnosis of VZV is made and the role of corticosteroids remains debated. Generally, there is wide variation of prognosis with neuro-ophthalmic involvement. Vaccine-mediated prevention is recommended. In this review, we summarize neuro-ophthalmic manifestations of VZV.

Herpes zoster (HZ) is a painful, vesicular, cutaneous eruption from reactivation of varicella zoster virus (VZV), which can lead to potentially debilitating complications. The lifetime risk of HZ is estimated to be 20%-30% in the general population, with an increased risk in the elderly and immunocompromised populations. The most effective strategy to prevent HZ and its complications is by vaccination. Two types of HZ vaccines, zoster vaccine live and recombinant zoster vaccine, have been approved for use. This guidance offers recommendations and suggestions for HZ vaccination in adults, aiming to reduce the disease burden of HZ and its complications. It is intended as a guide to first-line healthcare providers, but does not supersede clinical judgement when assessing risk and providing recommendations to individuals. The Working Group on Adult Immunization Practice was appointed by the Infectious Diseases Society of Taiwan (IDST) and recommendations were drafted after a full literature review, using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. The recommendations were reviewed and revised by expert review panels during a series of consensus meetings and endorsed by the IDST, Taiwan Association of Family Medicine, the Taiwanese Dermatological Association, the Taiwan Oncology Society, the Taiwan Society of Blood and Marrow Transplantation, the Transplantation Society of Taiwan, the Taiwan AIDS Society, and the Taiwan College of Rheumatology. This guidance describes the epidemiology of HZ and provides recommendations for HZ vaccination in adults with varying levels of risk, differing history of previous VZV infection and past varicella or zoster vaccinations.

Tofacitinib is one of the Janus kinase inhibitors approved for the treatment of rheumatoid arthritis. The major adverse event of this drug is herpes zoster, which can lead to death in severe cases. The risk of herpes zoster has been studied at 10 mg/day of tofacitinib; however, 5 mg/day, which is recommended in patients with chronic kidney disease, is unclear.

To investigate whether 5 mg/day of tofacitinib reduced the risk of herpes zoster compared with 10 mg/day in rheumatoid arthritis patients.

We analyzed the Japanese Adverse Drug Event Report Data (JADER) database and compared the frequency of herpes zoster in rheumatoid arthritis patients treated with tofacitinib 5 mg/day and 10 mg/day. Multivariable logistic regression analysis was performed to identify the risk factors for herpes zoster in tofacitinib users.

A total of 812 tofacitinib users with rheumatoid arthritis were identified, including 131 with herpes zoster. Disproportionality for herpes zoster was observed between 5 mg/day and 10 mg/day (reporting odds ratio (OR): 0.68, 95% confidence interval (CI): 0.47-0.98, P = 0.045). Multivariable logistic regression analysis showed that the risk of herpes zoster was significantly increased in female patients (OR: 1.87, 95% CI: 1.12-3.12, P = 0.016) and methotrexate users (OR: 1.69, 95% CI: 1.12-2.54, P = 0.013) and significantly decreased with tofacitinib 5 mg/day compared with 10 mg/day (OR: 0.62, 95% CI: 0.40-0.96, P = 0.032).

We suggest that tofacitinib 5 mg/day may decrease the risk of herpes zoster compared with 10 mg/day in rheumatoid arthritis patients.

The share of the elderly population is growing worldwide as life expectancy increases. Immunosenescence and comorbidities increase infectious diseases' morbidity and mortality in older adults. Here, we aimed to summarize the latest findings on vaccines for the elderly against herpes zoster, influenza, respiratory syncytial virus (RSV), COVID-19, and pneumococcal disease and to examine vaccine recommendation differences for this age group in Europe and the United States. PubMed was searched using the keywords "elders" and "vaccine" alongside the disease/pathogen in question and paraphrased or synonymous terms. Vaccine recommendations were also sought in the European and US Centers for Disease Control and Prevention databases. Improved vaccines, tailored for the elderly, mainly by using novel adjuvants or by increasing antigen concentration, are now available. Significant differences exist between immunization policies, especially between European countries, in terms of the recipient's age, number of doses, vaccination schedule, and implementation (mandatory or recommended). Understanding the factors that influence the immune response to vaccination in the elderly may help to design vaccines that offer long-term protection for this vulnerable age group. A consensus-based strategy in Europe could help to fill the gaps in immunization policy in the elderly, particularly regarding vaccination against RSV and pneumococcus.

The adjuvanted recombinant zoster vaccine (RZV), consisting of varicella-zoster virus glycoprotein E (gE) and the AS01B adjuvant system, effectively prevents herpes zoster (HZ). In the absence of a well-defined correlate of protection, it is important to monitor the RZV immune response, as a proxy of clinical effectiveness.

This systematic review examined post-vaccination parameters: humoral and cell-mediated immunity, avidity index, geometric mean concentration of antibody (GMC), and immunity persistence. The meta-analysis used a random-effects model, and subgroup and meta-regression analyses were conducted.

Among 37 included articles, after one month from RZV-dose 2, the pooled response rate for anti-gE humoral immunity was 95.2% (95%CI 91.9-97.2), dropping to 77.6% (95%CI 64.7-86.8) during immunosuppression. The anti-gE cell-mediated immunity-specific response reached 84.6% (95%CI 75.2-90.9). Varying factors, such as age, sex, coadministration with other vaccines, prior HZ, or live-attenuated zoster vaccine, did not significantly affect response rates. RZV induced a substantial increase in gE avidity. Immunity persistence was confirmed, with more rapid waning in the very elderly.

This systematic review indicates that RZV elicits robust immunogenicity and overcomes immunocompromising conditions. The findings underscore the need for further research, particularly on long-term immunity, and have the potential to support HZ vaccination policies and programs.

(1) Background: Herpes zoster (HZ) is a disease caused by the reactivation of the Varicella Zoster Virus (VZV). Clinical reactivation, herpes zoster, takes place in 10-20% of subjects who contracted the primary infection, with a higher risk of developing zoster increasing proportionally with age, especially after 50 years of age. HZ is a common clinical problem, particularly among patients aged over 50 years and immunocompromised patients. Immunocompromised patients and adults could present an atypical and more severe course. In addition, they are at greater risk of complications. For this reason, it is important to understand the real burden of the disease and to identify the subjects who are at higher risk of HZ and its complications, also to direct preventive strategies at the right targets. The aim of the present study is to analyze HZ-related hospitalization trends in Abruzzo in the period of 2015-2021. (2) Methods: Data related to hospital admissions were extracted from the hospital discharge records (HDRs) of the whole region, considering all admissions during the years of 2015-2021. The trends in hospital admissions and length of stay were evaluated and analyzed. (3) Results: A total of 768 hospital discharges with a diagnosis of herpes zoster were registered in Abruzzo during the 7-year study period. During the study period, an increasing trend was observed from the year 2015 to the year 2017, ranging from 8.19 cases/100,000 to 11.5 cases/100,000 (APC (Annual percentage change) +20.8%; 95%CI -2.3; 47.6). After the year 2017, a significantly decreasing trend was observed, reaching 5.46 cases/100,000 in the year 2021 (APC -18.4%; 95%CI -31.5; -12.0). Across the entire study period, an average annual percentage change (AAPC) of -7.0% (95%CI -13.0; -1.3) was observed. (4) Conclusions: Despite the trend of a reduction in hospitalizations, this study highlights that HZ continues to have a great impact on public health. So, it is important to update recommendations for the use of the already available HZ vaccine and to implement new strategies to increase awareness of the prevention of the disease.

Evidence regarding Korean medicine treatment (KMT) for neuropathic pain is lacking. We aimed to identify the effects of integrative KMT in patients with postherpetic neuralgia (PHN). We retrospectively analyzed the electronic medical records of patients with PHN who received KMT at Kyung Hee University Korean Medicine Hospital between August 2021 and July 2022. We evaluated the effects of KMT-comprising acupuncture, pharmacopuncture, herbal medicine, cupping, and moxibustion-on pain intensity using the numerical rating scale (NRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Scale-Anxiety (HADS-A), Hospital Anxiety and Depression Scale-Depression (HADS-D), Daily Sleep Interference Scale (DSIS), Fatigue Severity Scale (FSS), and EuroQol-5D. Among 53 patients with PHN, 13 were included. The NRS score for worst pain over 1 week decreased from 6.54 ± 0.64 at baseline to 3.85 ± 0.63 at 8 weeks (41% reduction, p < 0.01), while that for average pain over 1 week decreased from 4.93 ± 0.67 at baseline to 3.08 ± 0.46 at 8 weeks (37% reduction, p < 0.01). From baseline to 8 weeks, there were significant reductions in the SF-MPQ, HADS-A, FSS, and EuroQol-5D scores. No adverse events were reported after KMT. Therefore, KMT may be an effective treatment option for patients with PHN.

Postherpetic neuralgia (PHN) is a chronic pain syndrome occurring after a herpes zoster outbreak. While there is no effective treatment available today, autologous fat grafting has shown promise. This randomized controlled trial investigated the effectiveness of fat grafting as treatment for PHN compared with a sham treatment.

A total of 46 participants with PHN were included. After liposuction under general anesthesia, participants were randomly assigned to receive either autologous fat grafting or saline injection to the area of pain. The primary outcomes were the average and maximum degree of pain measured on an 11-point numeric rating scale. Secondary outcomes were quality and degree of neuropathic pain (Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey).

Forty-two participants completed follow-up of 6 months. For maximal degree of pain, a reduction of -1.1 ± 0.6 and -1.0 ± 0.5 mean change (±SE) on the numeric rating scale was observed in the intervention and control groups, respectively. For average degree of pain, the reduction was -1.2 ± 0.5 and -1.3 ± 0.4 in the intervention and control groups, respectively. The authors did not observe any significant changes in the neuropathic pain and quality-of-life parameters. For all measured outcomes, the differences between the groups were not statistically significant.

The authors did not find autologous fat grafting superior to a placebo when treating PHN of the skin. Given their results, they cannot recommend the routine use of this method to treat these pains.

Since autologous fat grafting was not proven to be more effective than a placebo in treating PHN, alternative treatment options should be explored. It is also essential to emphasize the importance of prophylactic vaccination against herpes zoster.

Therapeutic, I.

To estimate herpes zoster (HZ) incidence rate (IR) and economic burden in individuals with immunocompromised conditions and autoimmune diseases (IC/AID) in the Republic of Korea (ROK).

The nationwide Health Insurance Review and Assessment Service database was used to identify HZ cases from 2016 to 2020 in ROK. HZ and non-HZ IC/AID cases were matched 1:3 using age, sex, institution, Charlson comorbidity index, IC/AID, and index date. Annual HZ IRs/1000 persons and 1-year HZ-associated all-cause direct medical costs for IC/AID cases were calculated.

Among 65,976 individuals with IC/AID (mean age 57.14 years [standard deviation 14.1]; 64.94% female), annual HZ IR (95% confidence interval) fluctuated from 2016 to 2020, averaging 23.41/1000 persons (22.21-24.62) and was higher in women (26.85 [25.40-28.31]) than men (18.96 [18.03-19.89]). IRs were highest in individuals aged ≥ 50 years, and in those with transplants (including solid organ and hematopoietic stem cell transplants; 37.12 [35.45-38.79]) and hemato-oncology conditions (35.5 [31.6-39.3]). Mean 12-month all-cause direct medical costs were higher in individuals with IC/AID and HZ (4,759,671 Korean Republic won [KRW]; approximately 4046 United States dollar [USD; according to the 2020 conversion rate from UNCTAD; 1 KRW = 0.00085 USD]) than those without HZ (3,786,658 KRW; 3219 USD).

Individuals with IC/AID have a substantial disease and economic burden from HZ in ROK, highlighting the need for appropriate HZ prevention measures in the IC/AID population.

Herpes zoster (HZ), a reactivated varicella zoster virus infection arising from dormant viral latency after initial chickenpox, manifests as localized skin rashes along dermatomes. Multidermatomal involvement, especially in immunocompetent individuals, is rare. The potential link between psychological stress and HZ reactivation remains underexplored. The authors present a case of multidermatomal HZ triggered by psychological stress in a young immunocompetent adult.

A 26-year-old male presented with vesicular lesions spanning C5, C8, T1, and T2 dermatomes, triggered by psychological stress. The disease exhibited a unique midline-crossing presentation. The Varicella zoster virus IgM test result was positive. Treatment included acyclovir, pain management, and stress reduction strategies, yielding complete resolution within 3 weeks.

The case highlights a distinctive multidermatomal HZ presentation, defying conventional dermatomal restrictions. Psychological stress potentially influenced viral reactivation. Immunocompetence and stress interplay merit further exploration. Multidermatomal HZ necessitates prompt clinical recognition and comprehensive evaluation. Antiviral therapy and integrated stress management may contribute to successful outcomes.

This case underscores the rare occurrence of multidermatomal HZ in an immunocompetent young adult triggered by psychological stress. The atypical presentation and potential role of stress in viral reactivation emphasize the complex interaction between the nervous and immune systems. Integrated clinical management, stress reduction strategies, and antiviral therapy were effective in resolving the condition. Further research is warranted to elucidate the mechanisms underlying stress-induced viral reactivation and its clinical implications.

To evaluate the prevalence, incidence, and predictors of herpes zoster (HZ) development in lupus nephritis (LN).

This retrospective study included 292 LN patients to determine HZ incidence during the last decades and its correlation with LN activity. LN patients with HZ were matched with LN patients without HZ in a 1:2 ratio based on sex, age, year of LN diagnosis, and LN histological class at kidney biopsy to assess HZ risk factors. Statistical tests included t-test, U-test, and Fisher's test. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors.

HZ occurred after LN diagnosis in 66 patients (prevalence 22.6%) with an average of 8.7 years (range 0.2-28.4 years). Although with the potential limitations of the retrospective nature and the extensive duration of the study, the incidence of HZ was 15.6/1,000 person-years, increasing from 6.9 before 1980 to 16.0 in the 1990s and 43.9 after 2010. HZ onset was unrelated to LN activity. LN was active in 43% of cases and quiescent in the other 57% of cases at HZ diagnosis. The percentage of patients who developed lupus flares during the year after HZ (18.9%) was not different from that which occurred during the year before HZ (17.2%, p = 0.804). After excluding confounding factors through matching, the univariate analysis suggested that cyclosporin during induction therapy (p = 0.011) and higher cumulative doses of glucocorticoids (GCs; >50 g, p = 0.004), cyclophosphamide (CYC; >5 g, p = 0.001), and mycophenolate mofetil (MMF > 1,000 g, p = 0.007) predisposed patients to HZ. Univariate and multivariate analyses revealed a protective role of azathioprine (p = 0.008) and methylprednisolone pulses (p = 0.010) during induction therapy.

HZ occurs unpredictably throughout the course of LN, underscoring the importance of continuous monitoring for these patients. In addition, the incidence of HZ seems to have increased in recent decades. Induction therapy with azathioprine and methylprednisolone pulses appears to provide protection, while higher cumulative doses of GCs, CYC, and MMF increase susceptibility.

Herpes zoster, commonly known as shingles, is a neurocutaneous disease caused by the reactivation of the virus that causes varicella (chickenpox). After resolution of the varicella episode, the virus can remain latent in the sensitive dorsal ganglia of the spine. Years later, with declining immunity, the varicella zoster virus (VZV) can reactivate and cause herpes zoster, an extremely painful condition that can last many weeks or months and significantly compromise the quality of life of the affected person. The natural process of ageing is associated with a reduction in cellular immunity, and this predisposes older adults to herpes zoster. Vaccination with an attenuated form of the VZV activates specific T-cell production avoiding viral reactivation. Two types of herpes zoster vaccines are currently available. One of them is the single-dose live attenuated zoster vaccine (LZV), which contains the same live attenuated virus used in the chickenpox vaccine, but it has over 14-fold more plaque-forming units of the attenuated virus per dose. The other is the recombinant zoster vaccine (RZV) which does not contain the live attenuated virus, but rather a small fraction of the virus that cannot replicate but can boost immunogenicity. The recommended schedule for the RZV is two doses two months apart. This is an update of a Cochrane Review first published in 2010, and updated in 2012, 2016, and 2019.

To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults.

For this 2022 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2022, Issue 10), MEDLINE (1948 to October 2022), Embase (2010 to October 2022), CINAHL (1981 to October 2022), LILACS (1982 to October 2022), and three trial registries.

We included studies involving healthy older adults (mean age 60 years or older). We included randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine (any dose and potency) versus any other type of intervention (e.g. varicella vaccine, antiviral medication), placebo, or no intervention (no vaccine). Outcomes were cumulative incidence of herpes zoster, adverse events (death, serious adverse events, systemic reactions, or local reaction occurring at any time after vaccination), and dropouts.

We used the standard methodological procedures expected by Cochrane.

We included two new studies involving 1736 participants in this update. The review now includes a total of 26 studies involving 90,259 healthy older adults with a mean age of 63.7 years. Only three studies assessed the cumulative incidence of herpes zoster in groups that received vaccines versus placebo. Most studies were conducted in high-income countries in Europe and North America and included healthy Caucasians (understood to be white participants) aged 60 years or over with no immunosuppressive comorbidities. Two studies were conducted in Japan and one study was conducted in the Republic of Korea. Sixteen studies used LZV. Ten studies tested an RZV. The overall certainty of the evidence was moderate, which indicates that the intervention probably works. Most data for the primary outcome (cumulative incidence of herpes zoster) and secondary outcomes (adverse events and dropouts) came from studies that had a low risk of bias and included a large number of participants. The cumulative incidence of herpes zoster at up to three years of follow-up was lower in participants who received the LZV (one dose subcutaneously) than in those who received placebo (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.43 to 0.56; risk difference (RD) 2%; number needed to treat for an additional beneficial outcome (NNTB) 50; moderate-certainty evidence) in the largest study, which included 38,546 participants. There were no differences between the vaccinated and placebo groups for serious adverse events (RR 1.08, 95% CI 0.95 to 1.21) or deaths (RR 1.01, 95% CI 0.92 to 1.11; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of one or more adverse events (RR 1.71, 95% CI 1.38 to 2.11; RD 23%; number needed to treat for an additional harmful outcome (NNTH) 4.3) and injection site adverse events (RR 3.73, 95% CI 1.93 to 7.21; RD 28%; NNTH 3.6; moderate-certainty evidence) of mild to moderate intensity. These data came from four studies with 6980 participants aged 60 years or older. Two studies (29,311 participants for safety evaluation and 22,022 participants for efficacy evaluation) compared RZV (two doses intramuscularly, two months apart) versus placebo. Participants who received the new vaccine had a lower cumulative incidence of herpes zoster at 3.2 years follow-up (RR 0.08, 95% CI 0.03 to 0.23; RD 3%; NNTB 33; moderate-certainty evidence), probably indicating a favourable profile of the intervention. There were no differences between the vaccinated and placebo groups in cumulative incidence of serious adverse events (RR 0.97, 95% CI 0.91 to 1.03) or deaths (RR 0.94, 95% CI 0.84 to 1.04; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of adverse events, any systemic symptom (RR 2.23, 95% CI 2.12 to 2.34; RD 33%; NNTH 3.0), and any local symptom (RR 6.89, 95% CI 6.37 to 7.45; RD 67%; NNTH 1.5). Although most participants reported that their symptoms were of mild to moderate intensity, the risk of dropouts (participants not returning for the second dose, two months after the first dose) was higher in the vaccine group than in the placebo group (RR 1.25, 95% CI 1.13 to 1.39; RD 1%; NNTH 100, moderate-certainty evidence). Only one study reported funding from a non-commercial source (a university research foundation). All other included studies received funding from pharmaceutical companies. We did not conduct subgroup and sensitivity analyses AUTHORS' CONCLUSIONS: LZV (single dose) and RZV (two doses) are probably effective in preventing shingles disease for at least three years. To date, there are no data to recommend revaccination after receiving the basic schedule for each type of vaccine. Both vaccines produce systemic and injection site adverse events of mild to moderate intensity. The conclusions did not change in relation to the previous version of the systematic review.

Immune memory is a requisite and remarkable property of the immune system and is the biological foundation of the success of vaccinations in reducing morbidity from infectious diseases. Some vaccines and infections induce long-lasting protection, but immunity to other vaccines and particularly in older adults rarely persists over long time periods. Failed induction of an immune response and accelerated waning of immune memory both contribute to the immuno-compromised state of the older population. Here we review how T cell memory is influenced by age. T cell memory is maintained by a dynamic population of T cells that are heterogeneous in their kinetic parameters under homeostatic condition and their function. Durability of T cell memory can be influenced not only by the loss of a clonal progeny, but also by broader changes in the composition of functional states and transition of T cells to a dysfunctional state. Genome-wide single cell studies on total T cells have started to provide insights on the influence of age on cell heterogeneity over time. The most striking findings were a trend to progressive effector differentiation and the activation of pro-inflammatory pathways, including the emergence of CD4+ and CD8+ cytotoxic subsets. Genome-wide data on antigen-specific memory T cells are currently limited but can be expected to provide insights on how changes in T cell subset heterogeneity and transcriptome relate to durability of immune protection.

Herpes zoster (HZ) and its complication postherpetic neuralgia (PHN), whose incidence are both expected to increase with an ageing population, have demonstrated high costs on healthcare systems and burden on individual quality of life. Previous studies have shown the possibility of assessing public interest in a disease and factors that influence search behaviour using internet search data. The aim of this study was to analyze internet search data for HZ in Germany to evaluate public interest in the disease and relevant influential temporal and geographic factors that modify search behavior.

Google Ads Keyword Planner was used to generate a list of HZ-related keywords including their search volume for Germany as a whole and its sixteen federal states from October 2016 to September 2020. All keywords were qualitatively categorized, and changes over time and correlations with population density, physician density, and vaccination rates were assessed using Welch's ANOVA, Bonferroni correction for post-hoc analyses, and Pearson's correlation.

A total of 1,651 relevant keywords with a search volume of 20,816,210 searches were identified. Overall, national search volume increased each year of the study period with a peak in August 2020. More than half of the total search volume related to general queries (55.1%). The highest average monthly search volumes were observed in the states of Hamburg, Saarland, and Bremen. Average monthly search volume showed strong positive correlations with population density (r = .512, p = .043) and a strong negative correlation with the number of inhabitants per working physician (r = -.689, p = .003).

The study demonstrated that evaluating internet search data is a viable method for assessing public interest in HZ, thereby identifying areas of unmet need to support targeted public health campaigns.

Objective: Janus kinase (JAK) inhibitors are a novel class of drugs that have shown efficacy in treating immune-mediated inflammatory diseases (IMIDs). However, their safety profile in terms of herpes zoster infection remains unclear. We aimed to evaluate the risk of herpes zoster associated with JAK inhibitors in patients with IMIDs. Methods: A systematic search of electronic databases was conducted to identify randomized controlled trials (RCTs) that evaluated the safety of JAK inhibitors in patients with IMIDs including inflammatory bowel disease (IBD), rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriasis (PsO), and psoriatic arthritis (PsA). The primary outcome of interest was the incidence of herpes zoster infection. Network meta-analysis was performed to compare the risk of herpes zoster among different JAK inhibitors and placebo. Results: A network meta-analysis was conducted using data from 47 RCTs including 24,142 patients. In patients with IMIDs, peficitinib 100 mg QD was associated with the highest risk of herpes zoster infection in patients with IMIDs, followed by baricitinib 4 mg QD and upadacitinib 30 mg QD. No difference in herpes zoster risk was found for other JAK inhibitors compared with placebo. Subgroup analysis indicated that higher incidence of herpes zoster was found in patients treated by baricitinib 4 mg QD, peficitinib 100 mg QD, and upadacitinib 30 mg QD only in patients with RA. Conclusion: Our study suggests that some JAK inhibitors, particularly peficitinib, baricitinib, and tofacitinib, are associated with a higher risk of herpes zoster infection in patients with IMIDs.

The aim of this study was to evaluate the cases of herpes simplex and zoster ophthalmicus after SARS-CoV-2 vaccination and assess the clinical presentations in patients.

A retrospective analysis of cases reported to the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System (VAERS) between December 11, 2020, and July 1, 2022. Patients diagnosed with herpes simplex ophthalmicus (HSO) and herpes zoster ophthalmicus (HZO) after vaccination with BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and Ad26.COV2.S (Janssen) were included in the study. We performed a descriptive analysis of patient demographics, history, and ophthalmic and systemic clinical presentations. The correlations between vaccine type and continuous variables were assessed by the one-way analysis of variance test. In addition, we used the Pearson χ 2 test to assess the association between 3 vaccines and categorical variables. A post hoc analysis was performed between HSO and HZO onset intervals after vaccination, dose, and vaccine type. The 30-day risk analysis was also performed for HSO and HZO onset postvaccination using the reverse Kaplan-Meier analysis.

A total of 1180 cases of HZO (983, 83.30%) and HSO (180, 15.25%) were reported. The mean age of patients with HZO and HSO was 59.02 ± 19.05 and 52.68 ± 17.83 years, respectively. Most of the cases of HZO (795, 80.87%) and HSO (131, 72.78%) were reported in patients who received BNT162b2. In the cohort, 63.28% and 65.56% diagnosed with HZO and HSO were women. About one third of HZO (36.52%) and HSO (35.56%) cases were reported after the first dose. More than half of the cases of HZO (61.34%) and HSO (64.45%) were reported within the first 2 weeks after vaccination. The estimated crude reporting rate (per million doses) in the United States was 0.25, 0.22, and 0.47 for BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively. The onset interval for HZO was significantly shorter in patients who received BNT162b2 (20.51 ± 56.20 days, P = 0.030) compared with patients who received mRNA-1273 (36.56 ± 108.67 days) and Ad26.COV2.S (39.66 ± 60.15 days) vaccines. The 30-day risk analysis showed a significantly higher risk of HZO after BNT162b2 than the other 2 vaccines ( P = 0.011).

The low crude reporting rate suggests that HZO and HSO after SARS-CoV-2 vaccination occur rarely. This study provides insights into the possible temporal association between reported HSO and HZO after SARS-CoV-2 vaccines; however, further investigations are required to delineate the possible underlying immunological mechanisms.

Varicella-zoster virus (VZV) causes varicella and herpes zoster (VHZ), which is endemic worldwide. Although infection with VZV represents a considerable health threat, the global, regional and national burden of VZV infection, especially the probable relationship between VZV vaccines and the epidemiology of VZV infection, is poorly known. We sought to estimate the global spatial patterns and temporal trends of VHZ burden in 204 countries and territories from 1990 to 2019.

Numbers and age-standardized rates (ASR) of VHZ incidence, and disability-adjusted life years (DALYs) were estimated using data from the Global Burden of Diseases Study (GBD) 2019. Spatiotemporal trends in ASR were evaluated by estimated annual percentage change (EAPC).

Worldwide, in 2019, there were approximately 84.0 million incidence and 0.9 million DALYs due to VHZ. The corresponding ASIR (age-standardized incidence rate) and ASDR (age-standardized DALY rate) drastically decreased in children (aged <20 years old), while the ASIR and ASDR of VHZ significantly increased in middle- and old-aged adults (aged >50 years old), with highest ASIR and ASDR in the High-income Asia Pacific and Western Sub-Saharan Africa, respectively. From 1990-2019, the corresponding EAPC in ASIR were 0.03 (95% uncertainty interval [UI]: 0.02-0.04). Whereas the global EAPC in ASDR decreased in all regions (-1.59, 95% UI: -1.64 to -1.55), expect for Australasia (0.46, [0.05, 0.88]). Notably, in 2019, age-specific rates of VHZ DALYs presented a rapid growth trend after 70 years old.

The spatiotemporal trends of VHZ were heterogeneous across countries from 1990 to 2019. The spatiotemporal trend in ASIR is highest in the High sociodemographic index (SDI) region, however the EAPC in ASDR is lowest, in part probably due to VHZ vaccination. Therefore, reducing morbidity and burden strategies such as vaccines programs for the prevention of VHZ should be promoted in those regions with high growth incidence and/or burden, especially for the population after 70 years old.

This epidemiologic study evaluates the variance in incidence of Herpes Zoster (HZ) and Herpes Zoster Ophthalmicus (HZO) within a single healthcare system with an aim to analyze their relationship to the COVID-19 pandemic.

All patients attending the Duke University Health System (DUHS) from January 1, 2018, to December 31, 2021, were included. General and COVID-related trends of HZO and HZ were analyzed based on new ICD-9 or ICD-10 diagnosis codes, compared with the total number of patients seen at DUHS during this period, and the number of reported COVID-19 cases in North Carolina obtained using the CDC data tracker.

This study included 16,287 cases of HZ of whom 1,294 (7.94%) presented with HZO. The overall incidence of HZO showed an average yearly increase of 5.6%, however HZ incidence decreased by 5.3% per year. When comparing incidence rates of HZO in the 12-months before and after the COVID-19 pandemic onset in the United States (March 2020), the average incidence from March 2020 to February 2021 was 27.6 ± 11.6 compared to 18.0 ± 2.7 from March 2019 to February 2020 (p = 0.01). Moreover, 10/12 (83.3%) of the months had a higher incidence rate of HZO in the post-COVID onset year compared to their corresponding month in the pre-COVID year.

The results show HZO incidence may be increasing, despite an overall lower HZ incidence. This could suggest a distinct mechanism for HZO appearance. The COVID pandemic, directly or indirectly, may have accelerated the already increasing HZO incidence.

The aim of this study is to report the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management outcomes in a series of three cases of varicella zoster virus (VZV) reactivation following one dose of coronavirus disease 2019 (COVID-19) vaccination. This was a retrospective and observational study. All the patients who developed uveitis post-vaccination were pooled together. Patients who had VZV reactivation were included. Two cases had polymerase chain reaction positive for VZV from aqueous humor. At the time of presentation, IgG and IgM spike protein antibodies for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were tested. Out of this pool, three patients with classical features to describe pole-to-pole manifestations were chosen. A 36-year-old lady with post-vaccination sclerokeratouveitis associated with reactivation of herpes zoster ophthalmicus, a 56-year-old lady with post-vaccination acute anterior uveitis associated with herpes zoster ophthalmicus, and a 43-year-old gentleman with post-vaccination acute retinal necrosis were included. We present a possible link between anti-SARS-CoV-2 virus vaccination and varicella zoster reactivation in these patients and also describe the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management with detailed discussion.

Current methods for detecting infections either require a sample collected from an actively infected site, are limited in the number of agents they can query, and/or yield no information on the immune response. Here we present an approach that uses temporally coordinated changes in highly-multiplexed antibody measurements from longitudinal blood samples to monitor infection events at sub-species resolution across the human virome. In a longitudinally-sampled cohort of South African adolescents representing >100 person-years, we identify >650 events across 48 virus species and observe strong epidemic effects, including high-incidence waves of Aichivirus A and the D68 subtype of Enterovirus D earlier than their widespread circulation was appreciated. In separate cohorts of adults who were sampled at higher frequency using self-collected dried blood spots, we show that such events temporally correlate with symptoms and transient inflammatory biomarker elevations, and observe the responding antibodies to persist for periods ranging from ≤1 week to >5 years. Our approach generates a rich view of viral/host dynamics, supporting novel studies in immunology and epidemiology.

Patients after solid organ transplantation (SOT) are more susceptible to various viral infections, including alphaherpesviruses. Therefore, the aim of our study was to investigate the risk of alphaherpesvirus infections, including herpes simplex and herpes zoster, after solid organ transplantation. Inpatient records from the Taiwan National Health Insurance Research Database (NHIRD) defined solid organ recipients, including heart, liver, lung, and kidney, hospitalized for alphaherpesvirus infections as a severe case group of transplants and matched them with a nontransplant cohort. We enrolled 18,064 individuals, of whom 9032 were in each group. A higher risk of severe alphaherpesvirus infection was noted in solid organ recipients (aHR = 9.19; p < 0.001) than in the general population. In addition, solid organ transplant recipients had the highest risk of alphaherpesvirus infection within 1 year after transplantation (aHR = 25.18). The comparison found a higher risk of herpes zoster and herpes simplex infections in recipients of kidney (aHR = 9.13; aHR = 12.13), heart (aHR = 14.34; aHR = 18.54), and liver (aHR = 5.90; aHR = 8.28) transplants. Patients who underwent solid organ transplantation had a significantly higher risk of alphaherpesvirus infection than the general population.

BackgroundHerpes zoster (HZ) affects 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age and the presence of immunocompromising conditions. In Spain, vaccination guidelines were recently updated to include the recommendation of the new recombinant zoster vaccine (RZV) for certain risk groups.AimTo describe the epidemiology of HZ-related hospitalisations in Spain in order to prioritise vaccination recommendations and define a baseline to monitor the effectiveness of vaccination policies.MethodsRetrospective study using the National Health System's Hospital Discharge Records Database, including all HZ-related hospitalisations from 1998 to 2018.ResultsThe 65,401 HZ-related hospitalisations, corresponded to an annual mean hospitalisation rate of 6.75 per 100,000 population. There was an increasing trend of HZ hospitalisations over the study period. This rate was higher in males and older age groups, particularly over 65 years. Comorbidities with higher risk of readmission were leukaemia/lymphoma (RR 2.4; 95% CI: 2.3-2.6) and solid malignant neoplasm (RR 2.2; 95% CI: 2.1-2.4). Comorbidities associated with higher risk of mortality were leukaemia/lymphoma (RR 2.9; 95% CI: 2.7-3.2), solid malignant neoplasm (RR 2.9; 95% CI: 2.7-3.1) and HIV infection (RR 2.2; 95% CI: 1.8-2.7).ConclusionOf all patients hospitalised with HZ, those with greater risk of mortality or readmission belonged to the groups prioritised by the current vaccination recommendations of the Spanish Ministry of Health. Our study provided relevant information on clinical aspects of HZ and established the base for future assessments of vaccination policies.

Although loneliness and social isolation have been linked to an increased risk of non-communicable diseases such as cardiovascular disease and dementia, their association with the risk of severe infection is uncertain. We aimed to examine the associations between loneliness and social isolation and the risk of hospital-treated infections using data from two independent cohort studies.

We assessed the association between loneliness and social isolation and incident hospital-treated infections using data for participants from the UK Biobank study aged 38-73 years at baseline and participants from the nationwide population-based Finnish Health and Social Support (HeSSup) study aged 20-54 years at baseline. For inclusion in the study, participants had to be linked to national health registries, have no history of hospital-treated infections at or before baseline, and have complete data on loneliness or social isolation. Participants with missing data on hospital-treated infections, loneliness, and social isolation were excluded from both cohorts. The outcome was defined as a hospital admission with a primary diagnosis of infection, ascertained via linkage to electronic health records.

After exclusion of 8·6 million participants for not responding or not providing appropriate consent, the UK Biobank cohort consisted of 456 905 participants (249 586 women and 207 319 men). 26 860 (6·2%) of 436 001 participants with available data were reported as being lonely and 40 428 (9·0%) of 448 114 participants with available data were socially isolated. During a median 8·9 years (IQR 8·0-9·6) of follow-up, 51 361 participants were admitted to hospital due to an infectious disease. After adjustment for age, sex, demographic and lifestyle factors, and morbidities, loneliness was associated with an increased risk of a hospital-treated infection (hazard ratio [HR] 1·12 [95% CI 1·07-1·16]), whereas social isolation was not (HR 1·01 [95% CI 0·97-1·04]). Of 64 797 individuals in the HeSSup cohort, 18 468 (11 367 women and 7101 men) were eligible for inclusion. 4466 (24·4%) of 18 296 were lonely and 1776 (9·7%) of 18 376 socially isolated. During a median follow-up of 10·0 years (IQR 10·0-10·1), 814 (4·4%) participants were admitted to hospital for an infectious disease. The HRs for the HeSSup study replicated those in the UK Biobank (multivariable-adjusted HR for loneliness 1·32 [95% CI 1·06-1·64]; 1·08 [0·87-1·35] for social isolation).

Loneliness might increase susceptibility to severe infections, although the magnitude of this effect appears modest and residual confounding cannot be excluded. Interventional studies are required before policy recommendations can advance.

Academy of Finland, the UK Medical Research Council, and Wellcome Trust UK.

Rheumatoid arthritis (RA) was associated with the risk of incident herpes zoster (HZ), which might be influenced by medication use by RA patients. We aimed to investigate the association of RA with the risk of incident HZ and how the HZ risk effected by RA medications in CIC RA patients. We conducted an observational study including population-based representative insurance claims data of 19,673 patients with RA and 39,346 matched patients without RA during 1997-2010 from the Taiwan National Health Insurance Research Database; we identified 1651 patients with catastrophic illness-certified (CIC) RA and 11,557 matched patients with non-CIC RA. Exploratory analyses assessed the association between RA/CIC RA and risk of incident HZ and its complications. The association of prescribed medications with HZ risk in CIC RA patients was also estimated. The incidence rates of HZ were higher in CIC RA patients and non-CIC RA than in the matched people without RA (21.95 and 14.03 vs. 7.36 events per 1000 person-years, respectively). The adjusted incidence rate ratio (95% confidence interval (CI)) for HZ was 1.74 (1.65-1.84) in RA patients vs. matched non-RA and 1.65 (1.44-1.89) in CIC RA patients vs. non-CIC RA. For HZ complications, RA had a 2.85-fold higher risk than non-RA, and CIC RA had a 1.78-fold higher risk than non-CIC RA. Moreover, in CIC RA patients, prednisolone use was associated with incident HZ risk compared with prednisolone nonuse (adjusted odds ratio 1.48, 1.08-2.03); prolonged prednisolone use (approximately 5 years) increased the risk (adjusted odds ratio 2.16, 1.46-3.19). Our results suggested that RA was positively associated with HZ risk, particularly in RA patients with prednisolone use.

Herpes zoster and postherpetic neuralgia cause substantial pain in patients. Persons with type 2 diabetes (T2D) are prone to zoster infection and postherpetic neuralgia due to compromised immunity. We conducted this study to evaluate the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers. Propensity score matching was utilized to select 47 472 pairs of metformin users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers in patients with T2D. Compared with no-use of metformin, the adjusted hazard ratios (95% confidence interval) for metformin use in herpes zoster and postherpetic neuralgia were 0.70 (0.66, 0.75) and 0.510 (0.39, 0.68), respectively. A higher cumulative dose of metformin had further lower risks of herpes zoster and postherpetic neuralgia than metformin no-use. This nationwide cohort study demonstrated that metformin use was associated with a significantly lower risk of herpes zoster and postherpetic neuralgia than metformin no-use. Moreover, a higher cumulative dose of metformin was associated with further lower risks of these outcomes.

The varicella zoster virus as an aetiological agent for endodontic disease is not a well-recognised entity despite several published case reports. While advances in DNA molecular analysis techniques (PCR) have contributed to the current understanding of the potential role of the varicella zoster virus in the initiation and progression of endodontic disease, a review indicates a need for ongoing research. Case reports are presented of two female patients with a history of herpes zoster who developed pulp necrosis, with one patient progressing to apical periodontitis. Both patients received non-surgical endodontic therapy, followed by intra-coronal bleaching in one of the patients due to tooth discolouration which developed during the prodromal and acute phases of the herpes zoster infection. Clinical and radiographic examinations at 23 and 22 years, respectively, showed the affected teeth to be retained in an asymptomatic and aesthetically satisfactory state with no radiographic evidence of apical pathosis.

Herpes Zoster (HZ) is the reactivation of a previous infection with varicella-zoster virus (VZV) which shares the same mode of transmission as HZ. It presents with painful erythematous vesicles in a dermatome which is characterized by a burning sensation before and after the rash. Any conditions with suppressed cellular immunity example diabetes mellitus, chronic obstructive pulmonary disease, asthma, cardiovascular diseases, chronic steroid uses, malignancy, etc. causes reactivation of the virus. Impaired immune responses in asthma patients either in any age group may increase their susceptibility to HZ infection owing to skewed Th1/Th2 immunity, resulting in predominant Th2 conditions and an unwarranted Th2 cell response against respiratory allergens. Similarly, many studies have delineated the association of asthma with HZ. However, the relation between steroid use in asthma and HZ is uncertain, its immunosuppressive effect might be responsible for increased susceptibility to the infection. As HZ increases the economic burden and morbidity, its prevention should use vaccines. There are two types of Food and Drug Administration (FDA)-approved vaccine available against HSV one of which is given as a single dose vaccine called Zostavax, for people 50-59 years but its efficacy falls after 3rd dose and on the subsequent 4th dose and is also contraindicated in human immunodeficiency virus/acquired immunodeficiency syndrome, pregnancy and people taking immunosuppressive drugs. Shingrix is preferred by FDA which is a two doses vaccine that is given 6 months apart for people above 50 years and to immunocompromised people. Hence, proper counseling and education about the risks of herpes should be informed to the patients with timely utilization of the vaccine.