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Meta-Analysis
. 2025 Dec;21(1):2496048.
doi: 10.1080/21645515.2025.2496048. Epub 2025 Apr 29.

A systematic review and meta-analysis of herpes zoster risk in adults with immunocompromised conditions and autoimmune diseases in Asia-Pacific

Jing Chen  1 , Chin-Yen Ho  2   3 , Yu-Kang Tu  2   3 , Yi-Chih Lin  3   4 , Yun Hsia  3   5 , Ying-Chun Lin  3   6 , Sumitra Shantakumar  1
Affiliations
Meta-Analysis

A systematic review and meta-analysis of herpes zoster risk in adults with immunocompromised conditions and autoimmune diseases in Asia-Pacific

Jing Chen et al. Hum Vaccin Immunother. 2025 Dec.

Abstract

Asia-Pacific (APAC) faces an increasing burden of herpes zoster (HZ) over time. The risk of HZ and its complications are increased in immunocompromised (IC) patients and those with autoimmune diseases (AID). Our study aimed to synthesize evidence on the epidemiological burden of HZ and its complications among the general adult population and patients with IC/AID conditions in APAC. Following a systematic literature review, we performed meta-analyses for outcomes where ≥3 studies met the inclusion criteria. Of the 271 articles identified, 75 were included for meta-analysis. We found a high burden of HZ and its complications (i.e., postherpetic neuralgia, HZ ophthalmicus), particularly among individuals with IC/AID conditions in APAC. Patients with IC/AID conditions had significantly increased HZ risk and a higher proportion of HZ recurrence than the general adult population. These findings may inform clinical practice and public health decisions regarding HZ prevention, including HZ vaccination strategies, among the IC/AID population in APAC.

Keywords: Asia-Pacific; Herpes zoster; autoimmune diseases; epidemiology; immunocompromised; meta-analysis.

PubMed Disclaimer

Conflict of interest statement

JC and SS are employed by and hold financial equities in GSK. CYH, YKT, YCL, YH, and YCL received payments to their institution for this study from GSK.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flowchart detailing the meta-analysis article selection process. SLR: systematic literature review.
Figure 2.
Figure 2.
HZ incidence in patients with IC/AID conditions. (a) Forest plot of HZ IRs reported in studies included in the meta-analysis, in ascending order. Articles included:. (b) Pooled HZ IR by IC/AID condition, in descending order. Articles included: hematological malignancies,,, SLE,,, solid organ tumor,,,, liver transplantation,,, RA,,,,,,, and psoriasis.,, (c) IC/AID condition-specific HZ IRs by age. Articles included: Chen et al. 2011, Chang et al. 2018, Min et al. 2021, Kao et al. 2021, and Tanaka et al. 2021. *Age-stratified HZ incidences rates for psoriasis have been calculated manually based on values reported in Min et al. 2021. AID: autoimmune diseases; CI: confidence interval; HSCT: hematopoietic stem cell transplantation; HZ: herpes zoster; IBD: inflammatory bowel disease; IC: immunocompromised; IR: incidence rate; PY: person-years; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus; SOM: solid organ malignancies.
Figure 3.
Figure 3.
Forest plots of HZ IRs in the general adult population for all studies included in the meta-analysis (a) in ascending order of IR, (b) by age group <50 YOA and ≥50 YOA, and (c) by country/territory. Articles included in all three graphs: Australia,,,,,, China,,,, Japan,,,,, Korea,,,, New Zealand, and Taiwan.,,,,,,, CI: confidence interval; HZ: herpes zoster; IR: incidence rate; YOA: years of age.
Figure 3.
Figure 3.
(Continued).
Figure 4.
Figure 4.
Forest plot of IRRs for the IC/AID population versus the non-IC/AID population reported in studies included in the meta-analysis, in ascending order. Articles included: Chen at al. 2011, Imafuku et al. 2019, Kao et al. 2021, Liao et al. 2017, Min et al. 2021, Sakai et al. 2018, Sun et al. 2021, Tsai et al. 2015, and Tsai et al. 2017. AID: autoimmune diseases; CI: confidence interval; IBD: inflammatory bowel disease; IC: immunocompromised; IRR: incidence rate ratio; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus.
Figure 5.
Figure 5.
Forest plots of the proportion of patients with HZ-related complications reported in studies included in the meta-analysis. (a) Proportion of PHN in HZ patients with IC/AID conditions and (b) the general adult population. (c) Proportion of HZO in HZ patients with IC/AID conditions and (d) the general adult population. (e) Proportion of disseminated HZ in patients with IC/AID conditions. Articles included: PHN (IC/AID population),,,,,, PHN (general adult population),,,,,,,,, HZO (IC/AID population),,,, HZO (general adult population),,, and disseminated HZ (IC/AID population).,, AID: autoimmune diseases; CI: confidence interval; HZ: herpes zoster; HZO: herpes zoster ophthalmicus; IC: immunocompromised; PHN: postherpetic neuralgia; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus.
Figure 5.
Figure 5.
(Continued).
Figure 6.
Figure 6.
Forest plots of proportion of HZ recurrence reported in studies included in the meta-analysis, in ascending order among (a) patients with IC/AID conditions, and (b) the general adult population. Articles included: IC/AID population,,, general adult population.,, AID: autoimmune diseases; CI: confidence interval; HZ: herpes zoster; IC: immunocompromised; SLE: systemic lupus erythematosus.
See this image and copyright information in PMC

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