Seasonality of herpes zoster and herpes zoster ophthalmicus

Abstract

Background: Herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) are common and debilitating diseases. There is no consensus in the literature whether HZ and HZO exhibit seasonal patterns.

Objectives: To determine whether HZ and HZO are seasonal.

Study design: All patients in the OptumLabs® Data Warehouse (OLDW), a longitudinal, insurance claims database with de-identified lives between January 1, 2006 and December 31, 2017 with 365 days or more of continuous enrollment were considered in the study. The database was queried for patients reporting a new ICD-9/ICD-10 code for HZ or HZO and monthly counts of each administrative code were modeled using Morelet wavelets and analyzed for annual periodicity using Fisher's g test.

Results: There were a total of 513,911 new cases of HZ during this time period; 40,166 cases (7.8 %) were reported as HZO. Administrative coding for new cases of HZ exhibited annual periodicity (P < .001) with a peak in the summer. No periodicity was evident for HZO.

Conclusions: These results contribute to a growing body of evidence suggesting that HZ may be seasonal and help characterize the epidemiology of this common, painful disease.

Keywords: Epidemiology; Herpes zoster; Herpes zoster ophthalmicus; Seasonality; Shingles; Wavelets.

Figure 1 -. Aggregate Time Series of HZ and HZO Codes, Normalized Time Series of Average Monthly Incidence Rate of HZ Codes from 2006–2017 by Region, Normalized to Total Patient Encounters

a.) Time series of normalized relative incidence for incident administrative codes for herpes zoster (ICD-9: 053.X and ICD-10: B02X) in the OLDW aggregated from 2006–2017. b.) Time series of normalized relative incidence for incident administrative codes for herpes zoster ophthalmicus (ICD-9: 053.2 and ICD-10: B023.X) in the OLDW aggregated from 2006–2017. For both a.) and b.) nationwide rates are shown in black and normalized to national total monthly patient encounters and scaled to normalized relative incidence as described in the text. Regional rates are shown as colored (MW = Midwest, NE = Northeast, SO = South, WE = West) and each is normalized to its regional total monthly patient.