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Review
. 2024 Jul;13(7):1461-1486.
doi: 10.1007/s40121-024-01002-4. Epub 2024 Jun 19.

The Incidence of Herpes Zoster Complications: A Systematic Literature Review

Nikolaos Giannelos  1 , Desmond Curran  2 , Chi Nguyen  3 , Carol Kagia  3 , Nikki Vroom  4 , Hilde Vroling  4
Affiliations
Review

The Incidence of Herpes Zoster Complications: A Systematic Literature Review

Nikolaos Giannelos et al. Infect Dis Ther. 2024 Jul.

Abstract

Introduction: The objective of this work was to summarize the incidence of herpes zoster (HZ) complications in different populations.

Methods: Systematic literature review of PubMed, Embase, and Virtual Health Library records between January 1, 2002 and October 20, 2022 using search strings for HZ, complications, and frequency measurements.

Results: The review included 124 studies, most conducted in the general population (n = 93) and on individuals with comorbidities (n = 41) ≥ 18 years of age. Most studies were conducted in Europe (n = 44), Asia (n = 40), and North America (n = 36). Postherpetic neuralgia (PHN) was the most studied neurological complication. Variable relative PHN incidence was found in the general population (2.6-46.7%) or based on diagnosis: immunocompromised (3.9-33.8%), depression (0-50%), and human immunodeficiency virus (HIV) (6.1-40.2%). High incidence rates were observed in hematological malignancies (HM) and solid organ malignancies (132.5 and 93.7 per 1000 person-years, respectively). Ocular complications were frequently reported with herpes zoster ophthalmicus (HZO). The relative incidence (incidence rate) of HZO in the general population was reported as 1.4-15.9% (0.31-0.35 per 1000 person-years). High relative incidence was observed in HIV (up to 10.1%) and HM (3.2-11.3%). Disseminated HZ was the most frequently reported cutaneous complication. The relative incidence of disseminated HZ was 0.3-8.2% in the general population, 0-0.5% in the immunocompetent, and 0-20.6% in patients with comorbidities. High relative incidence was reported in HM and solid organ transplant (up to 19.3% and 14.8%, respectively).

Discussion: Most reported complications were neurological (n = 110), ocular (n = 48), and cutaneous (n = 38). Few studies stratified complications by age or gender (or both). Incidence appeared higher in select immunocompromised populations. Higher incidence was associated with older age in several studies; the general association with gender was unclear.

Conclusions: Variable incidence of HZ complications was reported by population subgroup. Further research is required to quantitatively analyze incidence by age, gender, and location.

Keywords: Complications; Herpes zoster; Incidence; PHN; Systematic review; Varicella-zoster virus.

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Conflict of interest statement

Nikolaos Giannelos and Desmond Curran are employed by and hold financial equities in GSK. The authors declare no other financial or non-financial relationships and activities. Carol Kagia, Chi Nguyen, Hilde Vroling and Nikki Vroom are employees of P95/Pallas. P95/Pallas received funding from GSK for the submitted work. P95/Pallas holds/held contracts with AstraZeneca, CEPI, GSK, Pfizer, Sanofi, Seqirus, Orchard, Biomarin, Daiichi, Bavarian Nordic and Bayer. Authors declare no other financial and non-financial relationships and activities.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram. MA meta-analysis, PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses, SLR systematic literature review, VHL virtual health library
See this image and copyright information in PMC

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