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. 2024 Dec;30(12):2476-2482.
doi: 10.3201/eid3012.240538.

Increase in Adult Patients with Varicella Zoster Virus-Related Central Nervous System Infections, Japan

Ayami Yoshikane, Hiroki Miura, Sayuri Shima, Masaaki Matsunaga, Soichiro Ishimaru, Yuki Higashimoto, Yoshiki Kawamura, Kei Kozawa, Akiko Yoshikawa, Akihiro Ueda, Atsuhiko Ota, Hirohisa Watanabe, Tatsuro Mutoh, Tetsushi Yoshikawa

Increase in Adult Patients with Varicella Zoster Virus-Related Central Nervous System Infections, Japan

Ayami Yoshikane et al. Emerg Infect Dis. 2024 Dec.

Abstract

An increase in the number of herpes zoster patients has been reported since universal varicella immunization was introduced, perhaps because of reduced opportunities for varicella patients to experience the natural booster effect caused by reexposure. We investigated recent trends of varicella zoster virus (VZV)-related central nervous system (CNS) infections at a university hospital in Japan. We enrolled patients with suspected CNS infection during 2013-2022 and tested cerebrospinal fluid samples by real-time PCR for DNA from 7 human herpesviruses. VZV DNA was the most commonly detected in 62 (10.2%) of 615 patients. Kulldorff's circular spatial scan statistics demonstrated a significant temporal cluster of patients with VZV-related CNS infections during 2019-2022 (p = 0.008). Among persons with such infections, the percentage with aseptic meningitis was significantly higher during 2019-2022 (86.8%), when the temporal cluster of cases occurred, than during 2013-2018 (50.0%) (p = 0.0029).

Keywords: Japan; VZV; central nervous system infection; meningitis/encephalitis; real-time PCR; varicella zoster virus; viruses.

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Figures

Figure 1
Figure 1
Flowchart of virologic examinations of cerebrospinal fluid samples from 615 patients with suspected CNS infection increase in adult patients with VZV-related CNS infections, Japan. Real-time PCR was carried out to detect DNA of 7 human herpesviruses: HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, and HHV-7. Statistical analyses of VZV DNA–positive patients were performed to determine the trends and clinical features of VZV-related CNS infections. CMV, cytomegalovirus; CNS, central nervous system; EBV, Epstein‐Barr virus; HHV, human herpesvirus; HSV, herpes simplex virus; VZV, varicella-zoster virus.
Figure 2
Figure 2
Trends of VZV-related central nervous system infections at Fujita Health University School of Medicine during 2013–2022 in study of increase in adult patients with VZV-related central nervous system infections, Japan. Vertical bars show percentages of patients with (black) and without (white) VZV infection each year. Numbers above bars indicate no. patients positive/no. analyzed. VZV, varicella-zoster virus.
See this image and copyright information in PMC

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