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Malherbe J, Godard P, Lacherade JC, Coirier V, Argaud L, Hyvernat H, Schneider F, Charpentier J, Wallet F, Pocquet J, Plantefeve G, Quenot JP, Bay P, Delbove A, Georges H, Urbina T, Schnell D, Le Moal C, Stanowski M, Muris C, Jonas M, Sauneuf B, Lesieur O, Lhermitte A, Calvet L, Gueguen I, du Cheyron D. Clinical description and outcome of overall varicella-zoster virus-related organ dysfunctions admitted in intensive care units: the VAZOREA cohort study. Ann Intensive Care 2024; 14:44. [PMID: 38548917 PMCID: PMC10978565 DOI: 10.1186/s13613-024-01270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Due to aging population and increasing part of immunocompromised patients, a raise in life-threatening organ damage related to VZV can be expected. Two retrospective studies were already conducted on VZV in ICU but focused on specific organ injury. Patients with high-risk of VZV disease still must be identified. The objective of this study was to report the clinical features and outcome of all life-threatening VZV manifestations requiring intensive care unit (ICU) admission. This retrospective cohort study was conducted in 26 French ICUs and included all adult patients with any life-threatening VZV-related event requiring ICU admission or occurring in ICU between 2010 and 2019. RESULTS One-hundred nineteen patients were included with a median SOFA score of 6. One hundred eight patients (90.8%) were admitted in ICU for VZV disease, leaving 11 (9.2%) with VZV disease occurring in ICU. Sixty-one patients (51.3%) were immunocompromised. Encephalitis was the most prominent organ involvement (55.5%), followed by pneumonia (44.5%) and hepatitis (9.2%). Fifty-four patients (45.4%) received norepinephrine, 72 (60.5% of the total cohort) needed invasive mechanical ventilation, and 31 (26.3%) received renal-replacement therapy. In-hospital mortality was 36.1% and was significantly associated with three independent risk factors by multivariable logistic regression: immunosuppression, VZV disease occurring in ICU and alcohol abuse. Hierarchical clustering on principal components revealed five phenotypically distinct clusters of patients: VZV-related pneumonia, mild encephalitis, severe encephalitis in solid organ transplant recipients, encephalitis in other immunocompromised hosts and VZV disease occurring in ICU. In-hospital mortality was highly different across phenotypes, ranging from zero to 75% (p < 0.001). CONCLUSION Overall, severe VZV manifestations are associated with high mortality in the ICU, which appears to be driven by immunosuppression status rather than any specific organ involvement. Deciphering the clinical phenotypes may help clinicians identify high-risk patients and assess prognosis.
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Affiliation(s)
- Jolan Malherbe
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Médecine Intensive - Réanimation, Caen, 14000, France.
| | - Pierre Godard
- Service de Médecine Intensive - Réanimation, CHU Bordeaux site Pellegrin, Bordeaux, France
| | | | - Valentin Coirier
- Service de Médecine Intensive - Réanimation, CHU de Rennes, Rennes, 35000, France
| | - Laurent Argaud
- Service de Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, Lyon, France
| | - Hervé Hyvernat
- Service de Médecine Intensive - Réanimation, Université Côte d'Azur (UCA), CHU de Nice, 151 route Saint Antoine de Ginestière, Nice, 06200, France
| | - Francis Schneider
- Médecine Intensive - Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg et Unistra, Strasbourg, France
| | - Julien Charpentier
- Service de Médecine Intensive - Réanimation, Centre-Université Paris Cité, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, 75014, France
| | - Florent Wallet
- Médecine Intensive - Réanimation, CHU Lyon Sud, Pierre Benite, France
- RESHAPE Research on healthcare performance, U1290, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, Dijon, France
| | - Pierre Bay
- Service de Médecine Intensive - Réanimation, AP-HP Assistance Publique Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, DMU Médecine, Créteil, 94010, France
- UPEC Université Paris-Est Créteil, INSERM, Unité U955, Equipe 18, Créteil, 94010, France
| | - Agathe Delbove
- Service de réanimation polyvalente, CHBA Vannes, Vannes, France
| | - Hugues Georges
- Service de réanimation polyvalente, Centre hospitalier de Tourcoing, Tourcoing, 59200, France
| | - Tomas Urbina
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, Assistance Publique- Hôpitaux de Paris, Paris, 75012, France
| | - David Schnell
- Réanimation Polyvalente et USC, CH Angoulême, Angoulême Cedex 9, Angoulême, 19959, France
| | - Charlène Le Moal
- Service Réanimation/USC, Centre Hospitalier du Mans, Le Mans, 72037, France
| | | | - Corentin Muris
- Université de Poitiers, CHU de Poitiers, Médecine intensive Réanimation, 2 rue de la miletrie, Poitiers, 86000, France
| | - Maud Jonas
- Service Médecine Intensive - Réanimation/USC, Centre hospitalier de Saint-Nazaire, Saint-Nazaire, 44600, France
| | - Bertrand Sauneuf
- Service de Réanimation polyvalente, Centre Hospitalier Public du Cotentin, Cherbourg en Cotentin, 50100, France
| | - Olivier Lesieur
- Centre Hospitalier Saint-Louis, Réanimation polyvalente, La Rochelle, 17019, France
| | - Amaury Lhermitte
- Hôpital Universitaire Félix Guyon, Réanimation polyvalente, Allée des Topazes, Saint-Denis, La Réunion, 97400, France
| | - Laure Calvet
- Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont- Ferrand, France
| | - Ines Gueguen
- Service de réanimation médicale, CHRU de Lille, Lille, France
| | - Damien du Cheyron
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Médecine Intensive - Réanimation, Caen, 14000, France
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Dauby N, Motet C, Libois A, Martin C. The value of herpes zoster prevention in people aging with HIV: A narrative review. HIV Med 2023; 24:1190-1197. [PMID: 37772682 DOI: 10.1111/hiv.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Review the evidence on the incidence and impact of herpes zoster among people living with HIV and the potential impact of recombinant zoster vaccine for people aging with HIV. METHODS Narrative review. RESULTS Although antiretroviral therapy has substantially reduced the risk of herpes zoster among people living with HIV, they remain at an increased risk compared with the general population. Among people aging with HIV, aging per se is now the main risk factor for herpes zoster. Beyond pain, herpes zoster is also associated with a risk of sight-threatening complications in case of trigeminal involvement, disseminated diseases and stroke. Post-herpetic neuralgia is also a potential threat to the quality of life of people aging with HIV. The recombinant zoster vaccine has demonstrated high and sustained efficacy in the prevention of herpes zoster, post-herpetic neuralgia, and other herpes zoster complications in the general population. Immunogenicity data among people living with HIV with high CD4+ T-cell count and controlled viral load are comparable to those among the general population. Real-life effectiveness data indicate high vaccine efficacy among immunocompromised patients other than people living with HIV. High vaccine price, vaccine hesitancy, and limited disease and vaccine awareness represent potential hurdles for high vaccine uptake among people aging with HIV in Europe. CONCLUSIONS Herpes zoster, and its complications, is a vaccine-preventable disease of aging people. Given its impact on quality of life, herpes zoster prevention using recombinant zoster vaccine is a safe strategy to be considered in every person aging with HIV.
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Affiliation(s)
- Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
- School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- U-CRI, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christian Motet
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Agnès Libois
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Charlotte Martin
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Kendzerska T, Povitz M, Gershon AS, Ryan CM, Talarico R, Franco Avecilla DA, Robillard R, Ayas NT, Pendharkar SR. Association of clinically significant obstructive sleep apnoea with risks of contracting COVID-19 and serious COVID-19 complications: a retrospective population-based study of health administrative data. Thorax 2023; 78:933-941. [PMID: 36717242 DOI: 10.1136/thorax-2022-219574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
RATIONALE/OBJECTIVES Despite plausible pathophysiological mechanisms, more research is needed to confirm the relationship between obstructive sleep apnoea (OSA) and the risk of COVID-19 infection or COVID-19-related serious complications. METHODS We conducted a retrospective population-based cohort study using provincial health administrative data (Ontario, Canada). Adults with physician-diagnosed OSA who received positive airway pressure therapy in the 5 years prepandemic (OSA group) were propensity score matched by baseline characteristics to individuals in the general population at low risk of OSA (non-OSA group) using inverse probability of treatment weighting. Weighted HRs of (1) a positive COVID-19 test and (2) COVID-19-related emergency department (ED) visits, hospitalisations, intensive care unit (ICU) admissions and mortality, within 12 months of pandemic onset, were compared between groups. We also evaluated the impact of comorbid cardiometabolic or chronic airways disease. RESULTS We identified and matched 324 029 individuals in the OSA group to 4 588 200 individuals in the non-OSA group. Compared with the non-OSA group, those in the OSA group were at a greater hazard of testing positive for COVID-19 (HR=1.17, 95% CI 1.13 to 1.21), having a COVID-19-related ED visit (HR=1.62, 95% CI 1.51 to 1.73), hospitalisation (HR=1.50, 95% CI 1.37 to 1.65) or ICU admission (HR=1.53, 95% CI 1.27 to 1.84). COVID-19-related 30-day mortality was not different (HR=0.98, 95% CI 0.82 to 1.16).We found that for the OSA group, comorbid airways disease but not cardiometabolic conditions increased the hazards of COVID-19-related outcomes, including mortality. CONCLUSION In this large population-based study, we demonstrated that a recent diagnosis of OSA requiring treatment was associated with an increased hazard of testing positive for COVID-19 and serious COVID-19-related complications, particularly in those with co-existing chronic airways disease.
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Affiliation(s)
- Tetyana Kendzerska
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea S Gershon
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sleep Research Laboratory, Toronto Rehabilitation Institute University Health Network, Toronto, Ontario, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | | | | | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Leidner AJ, Anderson TC, Hong K, Ortega-Sanchez IR, Guo A, Pike J, Prosser LA, Dooling KL. Cost-Effectiveness Analysis of Vaccination With Recombinant Zoster Vaccine Among Hematopoietic Cell Transplant Recipients and Persons With Other Immunocompromising Conditions Aged 19 to 49 Years. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:204-215. [PMID: 36243666 DOI: 10.1016/j.jval.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/12/2022] [Accepted: 08/05/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to estimate the cost-effectiveness of the use of recombinant zoster vaccine (RZV) (Shingrix), which protects against herpes zoster (HZ), among immunocompromised adults aged 19 to 49 years, as a contribution to deliberations of the Advisory Committee on Immunization Practices. METHODS Hematopoietic cell transplant (HCT) recipients experience a high incidence of HZ, and the efficacy of RZV in preventing HZ has been studied in clinical trials. The cost-effectiveness model calculated incremental cost-effectiveness ratios that compared vaccination with RZV with a no vaccination strategy among adults aged 19 to 49 years. Costs and outcomes were calculated until age 50 years using the healthcare sector perspective and summarized as cost per quality-adjusted life-year (QALY) gained. The base case represents HCT recipients, with scenario analyses representing persons with other immunocompromising conditions, including hematologic malignancies, human immunodeficiency virus, and autoimmune and inflammatory conditions. Uncertainty was investigated using univariate, multivariate, and probabilistic sensitivity analyses. RESULTS Base-case results indicated vaccination with RZV would avert approximately 35% of HZ episodes and complications, while saving approximately 11% of net costs. Compared with no vaccination, vaccination of HCT recipients with RZV generated cost-savings (ie, lower costs and improved health) in the base case and in 81% of simulations in the probabilistic analysis. In scenario analyses, vaccination cost US dollar ($) 9500/QALY among patients with hematologic malignancies, $79 000/QALY among persons living with human immunodeficiency virus, and $208 000/QALY among persons with selected autoimmune and inflammatory conditions. CONCLUSIONS Generally favorable economic estimates supported recommendations for vaccination of immunocompromised adults with RZV to prevent episodes of HZ and related complications.
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Affiliation(s)
- Andrew J Leidner
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Tara C Anderson
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kai Hong
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela Guo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jamison Pike
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen L Dooling
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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5
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Zou J, Krentz HB, Lang R, Beckthold B, Fonseca K, John Gill M. Sero-positivity, risks, and morbidity from Varicella-Zoster Virus (VZV) infections in an adult PWH (people with HIV) cohort from 2000-2020. Open Forum Infect Dis 2022; 9:ofac395. [PMID: 36004318 PMCID: PMC9394766 DOI: 10.1093/ofid/ofac395] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Varicella-zoster virus (VZV) infection disproportionately affects people with HIV (PWH), primarily presenting as herpes zoster. However, VZV seroprevalence, its association with zoster, and clinical outcomes remain understudied in era of modern antiretroviral therapy (ART). We assessed VZV seroprevalence, rates of VZV illness, and associated health care costs in a large cohort of PWH over 20 years. Methods We performed retrospective chart reviews of patients followed at a regional HIV clinic from January 1, 2000, to December 31, 2020. Serological, immunization, clinical, and costing data were extracted from in-house databases. VZV-related inpatient admissions, emergency department (ED), and urgent care (UC) visits were identified using relevant International Classification of Disease (ICD-10) codes and validated where possible by 2 physicians. Health care utilization costs were adjusted to 2020 Canadian dollars. Results Of 3006 PWH, VZV serology was available for 2628; of these, 2503 (95.2%) were seropositive. Only 39% of known seronegative patients were subsequently immunized for varicella. During 29 768 years of patient follow-up, 38 hospitalizations and 138 ED/UC visits due to VZV infection were identified. Most occurred in VZV-seropositive PWH <50 years of age (82%) who were unimmunized (99.2%) and not on ART (64.8%). Nearly 25% of hospitalizations were due to laboratory-confirmed VZV meningitis/encephalitis. The average admission cost was CDN$33 001; the total measured cost of VZV illness was CDN$1 258 718. Conclusions Despite ART and vaccines for chickenpox and shingles, VZV still caused significant costs and morbidity for PWH, occurring at younger ages and often as encephalitis/meningitis. Supporting ART adherence may reduce VZV illness and hospitalization costs in PWH, and the cost-effectiveness of expanding shingles vaccine use warrants further study.
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Affiliation(s)
- Jason Zou
- Department of Medicine, University of Calgary , Calgary, Alberta , Canada
| | - Hartmut B Krentz
- Department of Medicine, University of Calgary , Calgary, Alberta , Canada
- Southern Alberta Clinic, Alberta Health Services , Calgary, Alberta , Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary , Calgary, Alberta , Canada
- Southern Alberta Clinic, Alberta Health Services , Calgary, Alberta , Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, Alberta Canada
| | - Brenda Beckthold
- Southern Alberta Clinic, Alberta Health Services , Calgary, Alberta , Canada
| | - Kevin Fonseca
- Alberta Precision Labs, ProvLab Calgary , Alberta , Canada
- Department of Microbiology, Immunology &Infectious Diseases, University of Calgary , Calgary, Alberta , Canada
| | - M John Gill
- Department of Medicine, University of Calgary , Calgary, Alberta , Canada
- Southern Alberta Clinic, Alberta Health Services , Calgary, Alberta , Canada
- Department of Microbiology, Immunology &Infectious Diseases, University of Calgary , Calgary, Alberta , Canada
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6
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Kobayashi H, Yoshida Y, Komoshita T, Suma H, Hosokawa Y, Hirose Y, Sugimoto T, Mokuda S, Hirata S, Sugiyama E. The Efficacy of Amenamevir for the Treatment of Disseminated Herpes Zoster Complicated with Probable Varicella-zoster Pneumonia in an Immunocompromised Patient. Intern Med 2022; 61:1785-1788. [PMID: 34776482 PMCID: PMC9259304 DOI: 10.2169/internalmedicine.8104-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We herein report the case of a 78-year-old woman who was diagnosed as having disseminated herpes zoster (DHZ) complicated with probable varicella-zoster pneumonia during maintenance therapy for microscopic polyangiitis. Because the patient had severe renal dysfunction, amenamevir administration was started to avoid any neurotoxicity of acyclovir, which is suggested to be optimal for treatment. It ameliorated her symptoms without any adverse events. This is the first report suggesting the efficacy of amenamevir in the treatment of severe herpes zoster infection with coexisting DHZ and probable varicella-zoster pneumonia. Amenamevir could thus be a treatment option for severe varicella zoster virus infections.
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Affiliation(s)
- Hiroki Kobayashi
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, Medical Corporation JR Hiroshima Hospital, Japan
| | - Yusuke Yoshida
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Tomoki Komoshita
- Postgraduate Clinical Training Center, Hiroshima University Hospital, Japan
| | - Harumichi Suma
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Japan
| | - Yohei Hosokawa
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, Hiroshima Prefectural Hospital, Japan
| | - Yoshikazu Hirose
- Department of Dermatology, Hiroshima University Hospital, Japan
- Department of Dermatology, Hiroshima Prefectural Hospital, Japan
| | - Tomohiro Sugimoto
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, Medical Corporation JR Hiroshima Hospital, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
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ACAR A, YOLDAŞ AH, KARAARSLAN I, ERTAM SAĞDUYU İ, CEYLAN C, UNAL İ, ÖZTÜRK G. Retrospective evaluation of clinical features in hospitalized herpes zoster patients. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1085700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Raza S, Acharya S, Howard G, Pattanaik D. Safety of Recombinant Zoster Vaccine in Rheumatology Patients. South Med J 2022; 115:125-128. [PMID: 35118501 DOI: 10.14423/smj.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Recombinant zoster vaccine (RZV) is Food and Drug Administration approved for the prevention of herpes zoster (shingles) in adults 50 years old and older. Immunocompromised subjects were excluded from the pivotal vaccine trials. We studied the safety of this vaccine in our university-affiliated rheumatology practice. METHODS This was a single-center, retrospective study focusing on subjects who received RZV during 2018. We collected the demographic data, any self-reported adverse events after vaccination, C-reactive protein, Routine Assessment of Patient Index Data 3 (RAPID3) scores for subjects with rheumatoid arthritis, and available RAPID3 scores for all study subjects before and after the vaccination. RESULTS Comparision of C-reactive protein (n = 40), RAPID3 scores for subjects with rheumatoid arthritis (n = 16), and available RAPID3 scores for all subjects (n = 21) using the paired t test, did not show significant differences before and after the administration of RZV. A total of 6.4% of patients reported adverse events after vaccination. The adverse events were mild and did not lead to hospitalization, end organ damage, or change in treatment plan. CONCLUSIONS The RZV was safe and well tolerated among our study population.
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Affiliation(s)
- Syed Raza
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Saurav Acharya
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Gabrielle Howard
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Debendra Pattanaik
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
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9
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Rutstein BH, Gmuca S, Gerber JS, Lim T, Argraves M, Ogdie A. Validation of coding algorithms for the identification of herpes zoster among children. Pharmacoepidemiol Drug Saf 2021; 30:1162-1167. [PMID: 33960541 DOI: 10.1002/pds.5264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To examine the validity of International Classification of Diseases, 10th Revision, (ICD-10) code-based algorithms for herpes zoster (HZ) in the electronic medical record (EMR) of a large, integrated pediatric healthcare network and to examine baseline demographics and chronic comorbidities associated with HZ in a representative pediatric population. METHODS We reviewed the electronic charts of all patients with a single ICD-10 for HZ (B02.xx) as their primary or secondary diagnosis in the EMR of the Children's Hospital of Philadelphia (CHOP) healthcare network from January 2010-March 2019. The positive predictive value (PPV) for a single code for HZ was calculated and alternative algorithms were examined to determine which method resulted in the highest PPV. RESULTS The PPV for a single ICD-10 code was 91.7% (95% CI 80.8-95.4) for definitive and/or probable cases of HZ and 63.9% (95% CI 53.4%-75.5%) for definitive cases alone. Adding a prescription for an antiviral did not improve the PPV. However, adding a new code for rash entered within 1 week of the HZ code increased the PPV to 100% for definitive and/or probable cases but with substantial loss of sensitivity. A high proportion of children with HZ who required inpatient hospitalization had chronic disease (70%) and were on systemic immunomodulatory therapy (50%). CONCLUSIONS HZ can be identified with a high PPV in electronic medical records of children using ICD-10 code alone. These findings lay the foundation for future pharmacoepidemiologic research to better understand risk factors for HZ infection.
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Affiliation(s)
- Beth H Rutstein
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tristan Lim
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa Argraves
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexis Ogdie
- Department of Medicine, Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Buchan SA, Daneman N, Wang J, Wilson SE, Garber G, Wormsbecker AE, Antoniou T, Deeks SL. Herpes zoster in older adults in Ontario, 2002-2016: Investigating incidence and exploring equity. PLoS One 2021; 16:e0246086. [PMID: 33571224 PMCID: PMC7877748 DOI: 10.1371/journal.pone.0246086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/12/2021] [Indexed: 11/18/2022] Open
Abstract
Older adults are at increased risk of herpes zoster (HZ) and post-herpetic neuralgia (PHN) and HZ vaccines are available to help prevent infection. The objective of our study was to provide updated data on incidence of HZ and PHN related to clinical and demographic factors in older adults to inform immunization practices. We conducted a population-based, retrospective cohort study and included all cases of HZ seen in outpatient, emergency department, and hospital settings for adults aged 65 years and over between April 1, 2002 to August 31, 2016 in Ontario, Canada. We calculated the incidence of HZ and PHN, and estimated the proportion within each subgroup that developed PHN. We also assessed incidence by neighbourhood-level income quintile before and after the availability of vaccine for private purchase. The average annual incidence of HZ in any setting was 59.0 per 10,000 older adults, with higher incidence in outpatient as opposed to hospital settings. Incidence was higher in the oldest age groups, females, and those classified as immunocompromised or frail. Relative to the pre-vaccine era, the disparities in incidence of HZ by neighbourhood-level income increased, with higher rates of HZ and PHN seen in those residing in lower income quintiles. Additional prevention efforts should be targeted toward adults who are immunocompromised, frail, and those living in lower socioeconomic quintiles. Future work should assess the impact of the zoster vaccine program with a particular focus on equity in the publicly-funded era.
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Affiliation(s)
- Sarah A. Buchan
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Nick Daneman
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jun Wang
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
| | - Sarah E. Wilson
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gary Garber
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne E. Wormsbecker
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tony Antoniou
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Agger WA, Deviley JA, Borgert AJ, Rasmussen CM. Increased Incidence of Giant Cell Arteritis After Introduction of a Live Varicella Zoster Virus Vaccine. Open Forum Infect Dis 2021; 8:ofaa647. [PMID: 33598502 PMCID: PMC7875324 DOI: 10.1093/ofid/ofaa647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/28/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) has been associated with giant cell arteritis (GCA). The introduction of a live attenuated vaccine against this virus (ZVL) might have changed the incidence of GCA. METHODS The incidence of GCA was retrospectively measured using 2 matched cohorts seen in a regional health system located in the Midwestern United States: ZVL recipients from the years 2007 through 2015 following the introduction of the vaccine and nonrecipients from the years 2000 through 2015. RESULTS In the ZVL cohort, a significant increase of GCA was associated with clinical criteria alone for the diagnosis of GCA (hazard ratio [HR], 2.70; 95% CI, 1.48-4.45; P = .004). In addition, using only pathologically confirmed GCA, the same matched cohort comparison analysis also found that ZVL recipients were at significantly higher risk than those who did not receive ZVL (HR, 2.70; 95% CI, 1.48-4.95; P = .001). CONCLUSION Using a matched cohort, retrospective comparison, ZVL was associated with an increased incidence of GCA.
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Affiliation(s)
- William A Agger
- Department of Infectious Disease, Gundersen Health System, La Crosse, Wisconsin, USA
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Jake A Deviley
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Andrew J Borgert
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Cary M Rasmussen
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
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12
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Racine É, Gilca V, Amini R, Tunis M, Ismail S, Sauvageau C. A systematic literature review of the recombinant subunit herpes zoster vaccine use in immunocompromised 18-49 year old patients. Vaccine 2020; 38:6205-6214. [PMID: 32788132 DOI: 10.1016/j.vaccine.2020.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/29/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The adjuvanted recombinant zoster vaccine (RZV) is indicated for prevention of herpes zoster (HZ) in adults aged ≥50 years. Questions regarding the use of RZV in immunocompromised patients < 50-year-old, who are at increased risk for HZ, were raised. OBJECTIVES The objective of this systematic review was to consolidate existing evidences on safety, immunogenicity and efficacy of RZV in immunocompromised adults aged 18-49 years. METHODS Four databases were searched. Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines were followed. Screening and classification of search items was performed using the web-based platform DistillerSR. RESULTS The search identified 1389 potentially relevant records. Six studies fulfilled inclusion criteria. The proportion of patients aged 18-49 varied between 23 and 62%. Pain at injection site (98.6%) and fatigue (75.3%) were the most common adverse events. The proportion of patients reporting serious adverse events (SAEs) ranged between 8.1 and 30.8% in RZV and between 4.1 and 36.5% in placebo groups. SAEs deemed related to vaccination were reported in < 1% of patients in both RZV and placebo groups. The proportion of patients that experienced clinically significant underlying disease-related events ranged between 0.0 and 20.0% in RZV and 0.0 and 26.7% in placebo groups. The humoral and cell-mediated immune response rate ranged between 65.4 and 96.2% and 50.0-93.0%, respectively. Vaccine efficacy in hematopoietic stem cell transplant patients was 72% (95%CI, 39-88%) in 18-49-year-olds and 67% (95%CI, 53-78%) in ≥ 50-year-olds (median follow-up 21 months). Vaccine efficacy in ≥ 18-year-old patients with hematologic malignancies was estimated at 87.2% (95%CI, 44.3-98.6%) up to 13 months post-vaccination. CONCLUSIONS Results suggest that RZV has an acceptable safety profile and induces immunity in an important proportion of ≥ 18-year-old immunocompromised patients. Longer follow-up studies are warranted to assess the duration of RZV induced immunity in immunocompromised patients.
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Affiliation(s)
- Étienne Racine
- Department of Public Health and Social Medicine, Laval University, Québec, Canada
| | - Vladimir Gilca
- Department of Biological Risks' and Occupational Health, Québec Public Health Institute, Laval University Research, Hospital Center, Québec, Canada.
| | - Rachid Amini
- Department of Biological Risks' and Occupational Health, Québec Public Health Institute, Québec, Canada
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Shainoor Ismail
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Canada
| | - Chantal Sauvageau
- Department of Biological Risks' and Occupational Health, Québec Public Health Institute, Laval University Research, Hospital Center, Québec, Canada.
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