Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb 25;15(2):e0229224.
doi: 10.1371/journal.pone.0229224. eCollection 2020.

Burden of disease from shingles and post-herpetic neuralgia in the over 80 year olds in the UK

Ian Matthews  1 , Mai Duong  2 , Victoria L Parsons  2 , Bayad Nozad  3 , Nawab Qizilbash  2   4 , Yash Patel  1 , Boriana Guimicheva  1
Affiliations

Burden of disease from shingles and post-herpetic neuralgia in the over 80 year olds in the UK

Ian Matthews et al. PLoS One. .

Abstract

Background: The current UK vaccination programme for herpes zoster (HZ) excludes people aged ≥80 years. This study aimed to quantify the number of individuals ≥80 years who missed HZ vaccination and the consequent epidemiological and economic burden of HZ and post-herpetic neuralgia (PHN).

Methods: Immunocompetent individuals aged ≥80 years between 1st September 2013 and 31st December 2017 in the Clinical Practice Research Datalink were selected and linked to Hospital Episodes Statistics, where available. Rates of HZ and PHN and healthcare resource utilisation were investigated for the overall study population and by age group (80-84, 85-89, ≥90 years old) and the burden of HZ and PHN was projected to the UK population.

Results: 4,858 HZ episodes and 464 PHN cases were identified in 255,165 individuals over 576,421 person-years (PY). Rates of HZ and PHN were 8.43 (95% confidence interval [CI] 8.19-8.66) and 0.80 (0.73-0.87) per 1,000 PY respectively and lowest in those aged ≥90 (HZ rate 7.37/1,000 PY; PHN rate 0.56/1,000 PY). Within HZ episodes, 10.27% of GP visits, 5.82% of prescribed medications and 21.65% of hospitalisations were related to HZ/PHN. Median length of hospitalisation increased from 7.0 days for all-cause to 10.5 days for HZ/PHN related hospitalisations. Individuals ≥90 stayed in hospital a median of 3-4 days longer than younger groups. Approximately 2.23 million individuals in the UK missed HZ vaccination since 2013 (1.86 million had never been eligible and 365,000 lost eligibility for HZ vaccination), resulting in an estimated 43,149 HZ episodes.

Conclusion: This study highlights the impact of the 80-year upper age limit policy on the health system. Our study estimates that 2.23 million individuals in the UK may have lost the opportunity to be vaccinated and that their burden of HZ and PHN remains high, especially among the very elderly.

PubMed Disclaimer

Conflict of interest statement

IM, BG and YP were all employees of Merck Sharp & Dohme Ltd and own shares in Merck & Co., Inc., Kenilworth, NJ, USA. MD, VP and NQ were employed by OXON Epidemiology Ltd at the time of the study, which received funding from Merck Sharp & Dohme Ltd to design and conduct the study and develop the manuscript. BN is an Honorary Clinical Senior Lecturer, Department of Primary Care and Public Health, Imperial College London. He has received consultancy fees from Merck Sharp & Dohme Ltd to assist with this study and has received consultancy fees from Sanofi Pasteur MSD for attending advisory panels and other consultancy projects. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Study population selection process.
Fig 2
Fig 2. Rates of HZ and PHN in overall study population and for each stratification.
Fig 3
Fig 3. Rate of hospitalisation and length of hospital stays in individuals with 1 or more HZ episodes, overall and in each age stratification.
Fig 4
Fig 4. Number and proportion of healthcare resource utilisation by age in individuals with 1 or more HZ episodes.
See this image and copyright information in PMC

References

    1. Hope-Simpson RE. The Nature of Herpes Zoster: A Long-Term Study and a New Hypothesis. Proc R Soc Med. 1965;58:9–20. Epub 1965/01/01. . - PMC - PubMed
    1. Weller TH. Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus. N Engl J Med. 1983;309(23):1434–40. Epub 1983/12/08. 10.1056/NEJM198312083092306 . - DOI - PubMed
    1. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the Management of Herpes Zoster. Clin Infect Dis. 2007;44(Suppl 1). - PubMed
    1. Harding DM. Shingles (Herpes Zoster) | Symptoms, Causes and Treatments: @patient; 2018. https://patient.info/health/shingles-herpes-zoster-leaflet.
    1. Gauthier A, Breuer J, Carrington D, Martin M, Remy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2009;137(1):38–47. Epub 2008/05/10. 10.1017/S0950268808000678 . - DOI - PubMed

Publication types

MeSH terms