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Review
. 2023 Aug 1;19(2):2228169.
doi: 10.1080/21645515.2023.2228169. Epub 2023 Jul 9.

The incidence of herpes zoster in China: A meta-analysis and evidence quality assessment

Zhujiazi Zhang  1 , Xinnong Liu  2 , Luodan Suo  1 , Dan Zhao  1 , Jingbin Pan  1 , Li Lu  1
Affiliations
Review

The incidence of herpes zoster in China: A meta-analysis and evidence quality assessment

Zhujiazi Zhang et al. Hum Vaccin Immunother. .

Abstract

This review aimed to estimate the disease burden of herpes zoster (HZ) in China and explore the application of the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach in studies of disease burden. We searched for the literature of observational studies analyzing HZ incidence in populations of all ages in China. Meta-analysis models were constructed to calculate the pooled incidence of HZ and pooled risks of postherpetic neuralgia (PHN), HZ recurrence, and hospitalization. Subgroup analysis was performed according to gender, age, and quality assessment score. The quality of evidence for incidence was rated using the GRADE system. Twelve studies with a total of 25,928,408 participants were included in this review. The pooled incidence for all ages was 4.28/1000 person years (95% CI 1.22-7.35). It increased with the increasing in age especially for individuals aged ≥60 y, which was 11.69/1000 person years (95% CI 6.56-16.81). The pooled risks of PHN, recurrence, and hospitalization were 12.6% (95% CI 10.1-15.1), 9.7% (95% CI 3.2-16.2), and 6.0/100,000 population (95% CI 2.3-14.2), respectively. The quality of the evidence assessment of the pooled incidence by the GRADE for all ages was 'low'; however, it was 'moderate' for the ≥60 yold subgroup. HZ is a serious public health problem in China and is more significant in individuals older than 60 y. Therefore, an immunization strategy for the zoster vaccine should be considered. The evidence quality assessment by the GRADE approach indicated that we had more confidence in the estimation of aged population.

Keywords: GRADE; Herpes zoster; disease burden; incidence; meta-analysis.

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Figures

Figure 1.
Figure 1.
Flow diagram of the study selection: two reviewers independently selected the studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Disagreements were resolved by consulting with a third person.
Figure 2.
Figure 2.
Random effects model for the incidence of herpes zoster.
Figure 3.
Figure 3.
Funnel plot of the incidence of herpes zoster.
See this image and copyright information in PMC

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