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. 2015 May 5:15:466.
doi: 10.1186/s12889-015-1753-y.

Herpes zoster-associated mortality in Europe: a systematic review

Hélène Bricout  1 , Margaret Haugh  2 , Olugbenga Olatunde  3 , Ruth Gil Prieto  4
Affiliations

Herpes zoster-associated mortality in Europe: a systematic review

Hélène Bricout et al. BMC Public Health. .

Abstract

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.

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Figures

Figure 1
Figure 1
PRISMA diagram - summary of search results.
Figure 2
Figure 2
Mortality data from published studies: A) HZ mortality rate by age (years); B) HZ case fatality rate by age (years); C) HZ hospital fatality rate by age (years).
Figure 3
Figure 3
Age-standardized HZ mortality rate per 100 000 in all adults aged ≥50 years [15].
Figure 4
Figure 4
Age-standardized HZ mortality rate per 100 000 in females (left) and males (right) aged ≥50 years [15].
Figure 5
Figure 5
Age-standardized HZ mortality rate per 100 000 in adults by age group in the European countries [15].
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