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Onizuka H, Fukuda H. Associations between income changes and the risk of herpes zoster: LIFE study. Soc Sci Med 2023; 328:115981. [PMID: 37269744 DOI: 10.1016/j.socscimed.2023.115981] [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: 08/12/2022] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
Economic stability is thought to be associated with health outcomes. Income changes may affect the occurrence of herpes zoster (HZ), which is a neurocutaneous disease caused by the varicella-zoster virus. This retrospective cohort study aimed to examine the associations between annual income changes and incident HZ in a Japanese population. The analysis was conducted using a database of public health insurance claims data linked with administrative data containing income levels. The study population comprised 48,317 middle-aged persons aged 45-64 years from five municipalities, and participants were followed-up from April 2016 until March 2020. Income changes were categorized as income unchanged (income in the year of interest remained within 50% of income in the previous year), income rise (income increased by more than 50% from the previous year to the year of interest), and income drop (income decreased by more than 50% from the previous year to the year of interest). Cox proportional hazards regression analyses were performed to calculate the hazard ratios of HZ for income drop and income rise (reference: income unchanged) as time-varying variables. Covariates included age, sex, and immune-related conditions. The results showed that income drop was significantly associated with a higher hazard ratio (1.15, 95% confidence interval: 1.00-1.31) for HZ. In contrast, income rise was not associated with HZ. A subgroup analysis revealed that the lowest baseline income group had a significantly higher risk of HZ when experiencing an income drop (HR: 1.56, 95% CI: 1.13-2.15). As zoster vaccination is voluntary and vaccination coverage in middle-aged persons is low in Japan, our findings indicate that it may be advantageous to promote and subsidize voluntary vaccinations for middle-aged people with low baseline income who have experienced substantial income reductions in order to reduce the risk of HZ.
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Affiliation(s)
- Hiroaki Onizuka
- Department of Interdisciplinary Science and Innovation, School of Interdisciplinary Science and Innovation, Kyushu University, Fukuoka, Japan; Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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2
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Armstrong D, Dregan A, Ashworth M, White P. Prior antibiotics and risk of subsequent Herpes zoster: A population-based case control study. PLoS One 2022; 17:e0276807. [PMID: 36301976 PMCID: PMC9612511 DOI: 10.1371/journal.pone.0276807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background The effect of antibiotics on the human microbiome is now well established, but their indirect effect on the related immune response is less clear. The possible association of Herpes zoster, which involves a reactivation of a previous varicella zoster virus infection, with prior antibiotic exposure might indicate a potential link with the immune response. Methods A case-control study was carried out using a clinical database, the UK’s Clinical Practice Research Datalink. A total of 163,754 patients with varicella zoster virus infection and 331,559 age/sex matched controls were identified and their antibiotic exposure over the previous 10 years, and longer when data permitted, was identified. Conditional logistic regression was used to identify the association between antibiotic exposure and subsequent infection in terms of volume and timing. Results The study found an association of antibiotic prescription and subsequent risk of varicella zoster virus infection (adjusted odds ratio of 1.50; 95%CIs: 1.42–1.58). The strongest association was with a first antibiotic over 10 years ago (aOR: 1.92; 95%CIs: 1.88–1.96) which was particularly pronounced in the younger age group of 18 to 50 (aOR 2.77; 95%CIs: 1.95–3.92). Conclusions By finding an association between prior antibiotics and Herpes zoster this study has shown that antibiotics may be involved in the reactivation of the varicella zoster virus. That effect, moreover, may be relatively long term. This indirect effect of antibiotics on viruses, possibly mediated through their effect on the microbiome and immune system, merits further study.
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Affiliation(s)
- David Armstrong
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- * E-mail: (DA); (AD)
| | - Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychological and Neurosciences, King’s College London, London, United Kingdom
- * E-mail: (DA); (AD)
| | - Mark Ashworth
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Patrick White
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
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3
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Ghosh B, Gajjar RA, Modi VK, Jadeja DM. A Rare Case of Herpes Zoster in an Adult Patient Recovered From Symptomatic Reinfection of COVID-19. Cureus 2021; 13:e16274. [PMID: 34377609 PMCID: PMC8349463 DOI: 10.7759/cureus.16274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 12/15/2022] Open
Abstract
In coronavirus disease 2019 (COVID-19) patients, various dermatological conditions have been observed. Varicella zoster virus (VZV) and herpes simplex virus must be ruled out before considering vesicular exanthems linked to COVID-19. The immunological status of the host has an impact on the natural history of herpes zoster (HZ). Age is a major risk factor for most of the cases of HZ. Reactivation of VZV can be triggered by iatrogenic immunosuppression or disease-related immunocompromised state or age-related immunosenescence. Rarely, dermatological symptoms have been reported in recovered COVID-19 patients. We hereby present a rare case of HZ in a recovered patient from symptomatic reinfection of COVID-19.
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Affiliation(s)
- Binita Ghosh
- Internal Medicine, Burdwan Medical College, Burdwan, IND
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4
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Schmidt SAJ, Sørensen HT, Langan SM, Vestergaard M. Perceived psychological stress and risk of herpes zoster: a nationwide population-based cohort study. Br J Dermatol 2021; 185:130-138. [PMID: 33511645 PMCID: PMC8360205 DOI: 10.1111/bjd.19832] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychological stress may reduce cellular immunity, but its role in triggering latent infections, including herpes zoster (HZ), is controversial. OBJECTIVES To examine the association between perceived psychological stress and risk of HZ. METHODS In a linked registry-based cohort study, we followed 77 310 persons aged 40 years or older who participated in the 2010 Danish National Health Survey from 1 May 2010 until HZ diagnosis, death, emigration or 1 July 2014, whichever occurred first. We computed hazard ratios (HRs) of HZ associated with Cohen's Perceived Stress Scale (PSS) score (range 0-40) using Cox regression with age as the timescale, adjusted for sex, immunosuppressive and selected chronic conditions, immunosuppressive drugs, and sociodemographic, lifestyle and anthropometric factors. The PSS measures chronic stress perceived by an individual in response to various demands of daily life. We modelled the PSS score using quintiles and a restricted cubic spline function. RESULTS The unadjusted rate of HZ varied from 5·53 to 7·20 per 1000 person-years from the lowest to the highest PSS score quintile. Compared with the lowest PSS score quintile, the adjusted HR for HZ was 1·00 [95% confidence interval (CI) 0·86-1·16], 1·08 (95% CI 0·92-1·26), 1·05 (95% CI 0·90-1·23) and 1·14 (95% CI 0·97-1·34) for the second to the fifth quintile, respectively. In cubic spline analyses, PSS scores < 20 were not associated with increased HR of HZ, but thereafter the HR increased linearly from 1·10 (95% CI 0·85-1·41) to 2·22 (95% CI 1·32-3·75). CONCLUSIONS Our study indicated that high levels of psychological stress are associated with increased risk of HZ.
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Affiliation(s)
- S A J Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - M Vestergaard
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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5
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Weidner-Glunde M, Kruminis-Kaszkiel E, Savanagouder M. Herpesviral Latency-Common Themes. Pathogens 2020; 9:E125. [PMID: 32075270 PMCID: PMC7167855 DOI: 10.3390/pathogens9020125] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022] Open
Abstract
Latency establishment is the hallmark feature of herpesviruses, a group of viruses, of which nine are known to infect humans. They have co-evolved alongside their hosts, and mastered manipulation of cellular pathways and tweaking various processes to their advantage. As a result, they are very well adapted to persistence. The members of the three subfamilies belonging to the family Herpesviridae differ with regard to cell tropism, target cells for the latent reservoir, and characteristics of the infection. The mechanisms governing the latent state also seem quite different. Our knowledge about latency is most complete for the gammaherpesviruses due to previously missing adequate latency models for the alpha and beta-herpesviruses. Nevertheless, with advances in cell biology and the availability of appropriate cell-culture and animal models, the common features of the latency in the different subfamilies began to emerge. Three criteria have been set forth to define latency and differentiate it from persistent or abortive infection: 1) persistence of the viral genome, 2) limited viral gene expression with no viral particle production, and 3) the ability to reactivate to a lytic cycle. This review discusses these criteria for each of the subfamilies and highlights the common strategies adopted by herpesviruses to establish latency.
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Affiliation(s)
- Magdalena Weidner-Glunde
- Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima Str. 10, 10-748 Olsztyn, Poland; (E.K.-K.); (M.S.)
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6
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Ischemia-modified albumin (IMA) and dynamic thiol-disulfide homeostasis in patients with postherpetic neuralgia. J LAB MED 2019. [DOI: 10.1515/labmed-2018-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Ischemia-modified albumin (IMA) is an isotype of albumin that increases under oxidative stress, and plasma thiols are main defense mechanisms against oxidative stress. The objective of this study was to investigate thiol-disulfide homeostasis and serum IMA levels in postherpetic neuralgia (PHN) patients.
Methods
A total of 29 PHN patients and 30 healthy controls were included in the study. Serum total and native thiol concentrations and serum disulfide concentration were measured using the method described by Erel and Neselioglu. The albumin cobalt binding test was used to measure serum IMA levels.
Results
Serum IMA levels were 1.21 ± 0.58 AU and 0.75 ± 0.09 AU in the PHN and control groups, respectively (p < 0.001). Serum total thiol concentrations were found to be 421.62 ± 90.28 μmol/L and 598.36 ± 73.63 μmol/L in the PHN and control groups, respectively (p < 0.001). Serum native thiol concentrations were found to be 365.75 ± 92.07 μmol/L and 531.90 ± 72.9 μmol/L in the PHN and control groups, respectively (p < 0.001). Serum disulfide concentrations were found to be 33.23 ± 5.33 μmol/L and 27.93 ± 7.81 μmol/L in the PHN and control groups, respectively (p = 0.003). The native thiol/total thiol ratio was significantly lower, and the disulfide/total thiol and disulfide/native thiol ratios were significantly higher in the PHN group compared to the controls.
Conclusions
IMA levels are high and dynamic thiol/disulfide homeostasis is disrupted in PHN patients.
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Hayward K, Cline A, Stephens A, Street L. Management of herpes zoster (shingles) during pregnancy. J OBSTET GYNAECOL 2018; 38:887-894. [DOI: 10.1080/01443615.2018.1446419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Khalea Hayward
- Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of General Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Abigail Cline
- Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Angela Stephens
- Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Linda Street
- Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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8
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Kim CK, Choi YM, Bae E, Jue MS, So HS, Hwang ES. Reduced NK cell IFN-γ secretion and psychological stress are independently associated with herpes zoster. PLoS One 2018; 13:e0193299. [PMID: 29466462 PMCID: PMC5821387 DOI: 10.1371/journal.pone.0193299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/08/2018] [Indexed: 11/17/2022] Open
Abstract
The pathogenesis of herpes zoster is closely linked to reduced varicella-zoster virus-specific cell-mediated immunity. However, little is known about the interplay between natural killer cells and psychological stress in the pathogenesis of herpes zoster. This study aimed to investigate possible associations among natural killer cells, T cells and psychological stress in herpes zoster. Interferon-gamma secretion from natural killer cell, psychological stress events, stress cognition scale scores and cytomegalovirus-specific cell-mediated immunity were compared between 44 patients with herpes zoster and 44 age- and gender-matched control subjects. A significantly lower median level of interferon-gamma secreted by natural killer cells was observed in patients with a recent diagnosis of herpes zoster than in control subjects (582.7 pg/ml vs. 1783 pg/ml; P = 0.004), whereas cytomegalovirus-specific cell-mediated immunity was not associated with herpes zoster. Psychological stress events and high stress cognition scale scores were significantly associated in patients with herpes zoster (P<0.001 and P = 0.037, respectively). However, reduced interferon-gamma secretion from natural killer cell and psychological stress were not associated. In conclusion, patients with a recent diagnosis of herpes zoster display reduced interferon-gamma secretion from natural killer cells and frequent previous psychological stress events compared with controls. However, reduced natural killer cell activity is not an immunological mediator between psychological stress and herpes zoster.
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Affiliation(s)
- Choon Kwan Kim
- Department of Internal Medicine, Division of Infectious Diseases, Veterans Health Service Medical Center, Seoul, Korea
| | - Youn Mi Choi
- Department of Laboratory Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Eunsin Bae
- Department of Laboratory Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Mihn Sook Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyung Seok So
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Korea
| | - Eung-Soo Hwang
- Department of Microbiology and Immunology, Seoul National University College of Medicine, and Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul, Korea
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9
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Takao Y, Okuno Y, Mori Y, Asada H, Yamanishi K, Iso H. Associations of Perceived Mental Stress, Sense of Purpose in Life, and Negative Life Events With the Risk of Incident Herpes Zoster and Postherpetic Neuralgia: The SHEZ Study. Am J Epidemiol 2018; 187:251-259. [PMID: 29036443 DOI: 10.1093/aje/kwx249] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/06/2017] [Indexed: 01/19/2023] Open
Abstract
In the present population-based prospective study, we examined the associations of psychosocial factors with the incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN). Data were collected from 12,359 participants (≥50 years of age) who answered a self-completed health questionnaire in the Shozu County of Kagawa Prefecture in Japan. During a 3-year follow-up between December 2008 and November 2012, HZ and PHN were diagnosed in 400 and 79 subjects, respectively. We used Cox regression analysis to estimate hazard ratios of incident HZ and PHN according to psychosocial factors, adjusting for age, sex, histories of HZ, cancer, and diabetes, smoking and drinking habits, and time from disease onset to treatment. Men with high levels of mental stress were twice as likely to be at risk for incident HZ. The risk of incident HZ was approximately 60% lower among men and women who reported a high sense of purpose in life. Women who experienced negative life events-particularly changes in their work, living environment, and relationships-had a 2- to 3-fold higher risk of incident PHN. Psychosocial factors such as perceived mental stress, sense of purpose in life, and negative life events may contribute to the development of HZ and PHN in the general population.
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Affiliation(s)
- Yukiko Takao
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshinobu Okuno
- The Research Foundation for Microbial Diseases of Osaka University, Kagawa, Japan
| | - Yasuko Mori
- Division of Clinical Virology, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hideo Asada
- Division of Clinical Virology, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Koichi Yamanishi
- The Research Foundation for Microbial Diseases of Osaka University, Kagawa, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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10
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Schmidt SAJ, Vestergaard M, Pedersen HS, Schønheyder HC, Thomas SL, Smeeth L, Mansfield KE, Sørensen HT, Forbes HJ, Langan SM. Partner Bereavement and Risk of Herpes Zoster: Results from Two Population-Based Case-Control Studies in Denmark and the United Kingdom. Clin Infect Dis 2017; 64:572-579. [PMID: 27986685 PMCID: PMC5850543 DOI: 10.1093/cid/ciw840] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background. Psychological stress is commonly thought to increase the risk of herpes zoster by causing immunosuppression. However, epidemiological studies on the topic are sparse and inconsistent. We conducted 2 parallel case-control studies of the association between partner bereavement and risk of zoster using electronic healthcare data covering the entire Danish population and general practices in the UK Clinical Practice Research Datalink. Methods. We included patients with a zoster diagnosis from the primary care or hospital-based setting in 1997–2013 in Denmark (n = 190671) and 2000–2013 in the United Kingdom (n = 150207). We matched up to 4 controls to each case patient by age, sex, and general practice (United Kingdom only) using risk-set sampling. The date of diagnosis was the index date for case patients and their controls. We computed adjusted odds ratios with 99% confidence intervals for previous bereavement among case patients versus controls using conditional logistic regression with results from the 2 settings pooled using random-effects meta-analysis. Results. Overall, the adjusted odds ratios for the association between partner bereavement and zoster were 1.05 (99% confidence interval, 1.03–1.07) in Denmark and 1.01 (.98–1.05) in the United Kingdom. The pooled estimates were 0.72, 0.90, 1.10, 1.08, 1.02, 1.04, and 1.03 for bereavement within 0–7, 8–14, 15–30, 31–90, 91–365, 366–1095, and >1095 days before the index date, respectively. Conclusions. We found no consistent evidence of an increased risk of zoster after partner death. Initial fluctuations in estimates may be explained by delayed healthcare contact due to the loss.
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Affiliation(s)
- Sigrun A J Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Mogens Vestergaard
- Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.,Section for General Practice, Department of Public Health, Aarhus University, Denmark
| | - Henrik S Pedersen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Kathryn E Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Harriet J Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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11
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Kawai K, Yawn BP. Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis. Mayo Clin Proc 2017; 92:1806-1821. [PMID: 29202939 DOI: 10.1016/j.mayocp.2017.10.009] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To systematically review studies examining risk factors for herpes zoster (HZ). METHODS We performed a literature search using PubMed, EMBASE, and Web of Science for articles published from January 1, 2003, to February 1, 2017. A random-effects model was used to summarize the risk ratio (RR) or odds ratio (OR) and 95% CI. RESULTS Of the 3450 studies screened, we included 84 studies in the systematic review and conducted meta-analysis in 62 studies. Women were at increased risk of HZ compared with men (pooled adjusted RR, 1.31; 95% CI, 1.27-1.34). Black individuals had almost half the risk of HZ as white individuals (pooled RR, 0.54; 95% CI, 0.47-0.63). Family history was found to be a risk factor for HZ (pooled OR, 3.59; 95% CI, 2.39-5.40). Autoimmune diseases, including rheumatoid arthritis (pooled RR, 1.67; 95% CI, 1.41-1.98) and systemic lupus erythematosus (pooled RR, 2.10; 95% CI, 1.40-3.15), were associated with an elevated risk of HZ. Other comorbidities were associated with an increased risk of HZ, with the pooled RRs ranging from 1.25 (95% CI, 1.13-1.39) for asthma to 1.30 (95% CI, 1.17-1.45) for diabetes mellitus and 1.31 (95% CI, 1.22-1.41) for chronic obstructive pulmonary disease. CONCLUSION Our review revealed that female sex, race/ethnicity, family history, and comorbidities are risk factors for HZ. Efforts are needed to increase the uptake of zoster vaccination.
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Affiliation(s)
- Kosuke Kawai
- Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA.
| | - Barbara P Yawn
- Department of Family Medicine and Community Health, University of Minnesota, Blaine, MN
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12
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Tseng HF, Chi M, Hung P, Harpaz R, Schmid DS, LaRussa P, Sy LS, Luo Y, Holmquist K, Takhar H, Jacobsen SJ. Family history of zoster and risk of developing herpes zoster. Int J Infect Dis 2017; 66:99-106. [PMID: 29146515 DOI: 10.1016/j.ijid.2017.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Studies have investigated a possible association between family history of HZ and the occurrence of HZ. However, the results were inconclusive and susceptible to bias. We evaluated this association in an elderly population. METHODS The matched case-control study conducted at Kaiser Permanente Southern California in 2012-2015 included 656 incident HZ patients ≥60 whose skin lesion tested positive for varicella zoster virus by polymerase chain reaction. Half of the HZ patients were vaccinated with zoster vaccine as achieved by stratified sampling. The controls were randomly selected and 1:1 matched to the cases on sex, age (±1year), and zoster vaccination (±3 months of the case's vaccination date). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). RESULTS Having any blood relative with a history of HZ was associated with a slightly increased risk of HZ (adjusted OR=1.37, 95% CI 1.05-1.79). The adjusted OR associated with having one and two categories of first-degree blood relatives with a history of HZ was 1.30 (95% CI: 0.97-1.73) and 2.53 (95% CI: 1.17-5.44), respectively. CONCLUSIONS Our results suggested a weak association between the development of HZ and a positive family history of HZ among the elderly population.
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Affiliation(s)
- Hung Fu Tseng
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
| | - Margaret Chi
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Peggy Hung
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rafael Harpaz
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Scott Schmid
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip LaRussa
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Lina S Sy
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Yi Luo
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kimberly Holmquist
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Harpreet Takhar
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Steven J Jacobsen
- Department of Research Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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13
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Robust gene expression changes in the ganglia following subclinical reactivation in rhesus macaques infected with simian varicella virus. J Neurovirol 2017; 23:520-538. [PMID: 28321697 DOI: 10.1007/s13365-017-0522-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/03/2017] [Accepted: 02/17/2017] [Indexed: 12/20/2022]
Abstract
Varicella zoster virus (VZV) causes varicella during acute infection and establishes latency in the sensory ganglia. Reactivation of VZV results in herpes zoster, a debilitating and painful disease. It is believed that VZV reactivates due to a decline in cell-mediated immunity; however, the roles that CD4 versus CD8 T cells play in the prevention of herpes zoster remain poorly understood. To address this question, we used a well-characterized model of VZV infection where rhesus macaques are intrabronchially infected with the homologous simian varicella virus (SVV). Latently infected rhesus macaques were thymectomized and depleted of either CD4 or CD8 T cells to induce selective senescence of each T cell subset. After T cell depletion, the animals were transferred to a new housing room to induce stress. SVV reactivation (viremia in the absence of rash) was detected in three out of six CD8-depleted and two out of six CD4-depleted animals suggesting that both CD4 and CD8 T cells play a critical role in preventing SVV reactivation. Viral loads in multiple ganglia were higher in reactivated animals compared to non-reactivated animals. In addition, reactivation results in sustained transcriptional changes in the ganglia that enriched to gene ontology and diseases terms associated with neuronal function and inflammation indicative of potential damage as a result of viral reactivation. These studies support the critical role of cellular immunity in preventing varicella virus reactivation and indicate that reactivation results in long-lasting remodeling of the ganglia transcriptome.
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Gabutti G, Bonanni P, Conversano M, Fanelli G, Franco E, Greco D, Icardi G, Lazzari M, Rossi A, Scotti S, Volpi A. Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience. Hum Vaccin Immunother 2017; 13:391-398. [PMID: 27925894 PMCID: PMC5328234 DOI: 10.1080/21645515.2017.1264831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Herpes zoster (HZ) is an acute viral illness characterized by a vesicular rash with unilateral distribution, which can also result in severe complications such as post-herpetic neuralgia (PHN), ophthalmic zoster, stroke or other neurological complications. The estimate incidence in Europe ranges between 2.0 and 4.6 cases per 1,000 person-years, with a sharp increase in >50 year-old subjects. Currently, treatment options for HZ are only partially effective in limiting the acute phase, while the management of complications is complex and often unsatisfactory. The total burden of the disease and the high costs related to its diagnostic and therapeutic management led researchers to develop a new preventive approach through a live attenuated virus vaccine. The currently available vaccine, with a high antigen content, is safe, well tolerated and reduces the incidence of HZ, PHN and the burden of illness. Several countries have introduced this vaccination, albeit with different recommendations and methods of financing. Taking into account the barriers to this immunization registered in some areas (difficulty of vaccine distribution, lack of physician recommendations, the cost of vaccine for patients, etc.), this group of Italian experts advocate that a common strategy able to guarantee a good compliance with this vaccination should be implemented. The same group addresses some practical questions concerning the use of zoster vaccine.
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Initial Presentation Sites as Predictors of Herpes Zoster Complications: A Nationwide Cohort Study. PLoS One 2016; 11:e0164019. [PMID: 27711168 PMCID: PMC5053470 DOI: 10.1371/journal.pone.0164019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022] Open
Abstract
Herpes zoster (HZ) is associated with complications such as postherpetic neuralgia (PHN) and HZ ophthalmicus (HZO). However, few studies have focused on identifying patients having a high risk of PHN and HZO according to the initial presentation sites. The current study investigated these factors in a nationwide population-based cohort derived from Taiwan’s Longitudinal Health Insurance Database. The results indicate that the initial presentation sites can predict the complication site of HZ. In this study, elderly patients were found to be more susceptible to HZ and were the first to present with neurological signs (HZN). Furthermore, compared with patients with HZO and other signs (HZT), those with HZN had a higher comorbidity risk. Patients with HZN showed a significantly higher visceral complication risk than did those with HZO (adjusted hazard ratio [HR] = 1.47, 95% confidence interval [CI] = 1.27–1.71). In addition, patients with HZT showed lower risks of ocular and neurological complications than did those with HZN after stratification by age and sex (adjusted HR = 0.46, 95% CI = 0.31–0.68 and HR = 0.73, 95% CI = 0.59–0.91, respectively).
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Marin M, Harpaz R, Zhang J, Wollan PC, Bialek SR, Yawn BP. Risk Factors for Herpes Zoster Among Adults. Open Forum Infect Dis 2016; 3:ofw119. [PMID: 27382600 PMCID: PMC4929487 DOI: 10.1093/ofid/ofw119] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022] Open
Abstract
Background. The causes of varicella-zoster virus reactivation and herpes zoster (HZ) are largely unknown. We assessed potential risk factors for HZ, the data for which cannot be obtained from the medical sector. Methods. We conducted a matched case-control study. We established active surveillance in Olmsted County, Minnesota to identify HZ occurring among persons age ≥50 years during 2010–2011. Cases were confirmed by medical record review. Herpes zoster-free controls were age- and sex-matched to cases. Risk factor data were obtained by telephone interview. Results. We enrolled 389 HZ case patients and 511 matched controls; the median age was 65 and 66 years, respectively. Herpes zoster was associated with family history of HZ (adjusted odds ratio [aOR] = 1.65); association was highest with first-degree or multiple relatives (aOR = 1.87 and 3.08, respectively). Herpes zoster was also associated with prior HZ episodes (aOR = 1.82), sleep disturbance (aOR = 2.52), depression (aOR = 3.81), and recent weight loss (aOR = 1.95). Stress was a risk factor for HZ (aOR = 2.80), whereas a dose-response relationship was not noted. All associations indicated were statistically significant (P < .05). Herpes zoster was not associated with trauma, smoking, tonsillectomy, diet, or reported exposure to pesticides or herbicides (P > .1). Conclusions. We identified several important risk factors for HZ; however, the key attributable causes of HZ remain unknown.
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Affiliation(s)
- Mona Marin
- National Center for Immunization and Respiratory Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Rafael Harpaz
- National Center for Immunization and Respiratory Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - John Zhang
- National Center for Immunization and Respiratory Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Peter C Wollan
- Department of Research , Olmsted Medical Center , Rochester , Minnesota
| | - Stephanie R Bialek
- National Center for Immunization and Respiratory Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Barbara P Yawn
- Department of Research , Olmsted Medical Center , Rochester , Minnesota
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Liu Y. Advances in Epidemiological Studies of Herpes Zoster. INFECTION INTERNATIONAL 2015. [DOI: 10.1515/ii-2017-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractHerpes zoster (HZ) is a varicella zoster virus (VZV) that attacks locality of nerves and skin, resulting information of clusters of blisters on the skin connected unilateral facial nerve and accompanying apparent nerve pain. Incidence ranges from 3.2 to 4.2 per 1000 populations per year in the United States. Influence factors of HZ include age, infection history with VZV, vaccination history of varicella vaccine, reduced immunocompetence, and other diseases. Current domestic studies on HZ mainly focus on clinical reports of case treatment. This study reviews advances in foreign epidemiological studies of HZ.
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Functional decline and herpes zoster in older people: an interplay of multiple factors. Aging Clin Exp Res 2015; 27:757-65. [PMID: 26440662 DOI: 10.1007/s40520-015-0450-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/09/2015] [Indexed: 12/17/2022]
Abstract
Herpes zoster is a frequent painful infectious disease whose incidence and severity increase with age. In older people, there is a strong bidirectional link between herpes zoster and functional decline, which refers to a decrement in ability to perform activities of daily living due to ageing and disabilities. However, the exact nature of such link remains poorly established. Based on the opinion from a multidisciplinary group of experts, we here propose a new model to account for the interplay between infection, somatic/psychiatric comorbidity, coping skills, polypharmacy, and age, which may account for the functional decline related to herpes zoster in older patients. This model integrates the risk of decompensation of underlying disease; the risk of pain becoming chronic (e.g. postherpetic neuralgia); the risk of herpes zoster non-pain complications; the detrimental impact of herpes zoster on quality of life, functioning, and mood; the therapeutic difficulties due to multimorbidity, polypharmacy, and ageing; and the role of stressful life events in the infection itself and comorbid depression. This model underlines the importance of early treatment, strengthening coping, and vaccine prevention.
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Hunter HJA, Momen SE, Kleyn CE. The impact of psychosocial stress on healthy skin. Clin Exp Dermatol 2015; 40:540-6. [DOI: 10.1111/ced.12582] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 12/01/2022]
Affiliation(s)
- H. J. A. Hunter
- Dermatological Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - S. E. Momen
- St John's Institute of Dermatology; Guys and St Thomas; London UK
| | - C. E. Kleyn
- Dermatological Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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Sinayobye JD, Hoover DR, Shi Q, Mutimura E, Cohen HW, Anastos K. Prevalence of shingles and its association with PTSD among HIV-infected women in Rwanda. BMJ Open 2015; 5:e005506. [PMID: 25748413 PMCID: PMC4360726 DOI: 10.1136/bmjopen-2014-005506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To examine the prevalence of reported shingles in the last 6 months and its association with post-traumatic stress disorder (PTSD), depression and severity of HIV disease in Rwandan women with HIV. SETTINGS This cross-sectional study was conducted as part of the Rwanda Women's Interassociation Study and Assessment (RWISA), an observational cohort study designed to assess the impact of HIV and residual factors from experiencing rape in the 1994 genocide in Rwandan women. Participants were recruited through grassroots women's associations of people living with HIV infection and clinical care sites for HIV infection. Most participants (58.5%, n=405/692) had PTSD. PARTICIPANTS This cross-sectional analysis was conducted in 710 HIV-infected women enrolled in RWISA. Inclusion criteria were: age >15 years, informed consent, HIV test, ability to complete the interview in the local language, travel to and from the research site and participate in a baseline outpatient visit, and being naive to antiretroviral therapy at enrolment. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of interest was self-reported shingles in the past 6 months. The exposure was PTSD defined using the cross-culturally validated Harvard Trauma Questionnaire. RESULTS Overall prevalence of reported shingles in the past 6 months was 12.5% (n=89/710). There was an inverse relationship between shingles prevalence and immunological status: 7.6%, 12.3% and 16.7% of women with CD4 >350, 200-350 and <200 cells/µL, respectively, reported singles (p=0.01). In multivariate analysis, PTSD (aOR 1.7; 95% CI 1.02 to 2.89) and low CD4 (aOR 2.4; 95% CI 1.23 to 4.81) were independently associated with reported shingles in the past 6 months. CONCLUSIONS Our study found a significant independent relationship between PTSD and reported shingles, suggesting that PTSD may be associated with immune compromise that can result in herpes zoster reactivation. Further study is needed. It also confirmed previous findings of a strong relationship between shingles and greater immunosuppression in women with HIV infection.
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Affiliation(s)
| | | | - Qiuhu Shi
- New York Medical College, Valhalla, New York, USA
| | - Eugene Mutimura
- Regional Alliance for Sustainable Development, Kigali, Rwanda
| | - Hillel W Cohen
- Albert Einstein College of Medicine, Bronx, New York, USA
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Balanitis is a risk factor for herpes zoster. Eur J Clin Microbiol Infect Dis 2015; 34:985-90. [DOI: 10.1007/s10096-015-2314-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
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Harpaz R, Leung JW, Brown CJ, Zhou FJ. Psychological Stress as a Trigger for Herpes Zoster: Might the Conventional Wisdom Be Wrong? Clin Infect Dis 2014; 60:781-5. [DOI: 10.1093/cid/ciu889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ogunjimi B, Buntinx F, Bartholomeeusen S, Terpstra I, De Haes I, Willem L, Elli S, Bilcke J, Van Damme P, Coenen S, Beutels P. Herpes zoster is associated with herpes simplex and other infections in under 60 year-olds. J Infect 2014; 70:171-7. [PMID: 25218425 DOI: 10.1016/j.jinf.2014.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/18/2014] [Accepted: 08/05/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We assessed the association between herpes zoster (HZ) and herpes simplex (HS) occurrence whilst controlling for risk factors of HZ. METHODS Using a Belgian general practitioner network, a retrospective cohort study with 3736 HZ patients and 14,076 age-gender-practice matched controls was performed, covering over 1.5 million patient-years. Multiple logistic regression was used with HZ as outcome and several diagnoses (malignancy, depression, diabetes mellitus, auto-immune diseases, asthma, multiple sclerosis, HIV, fractures), medications (systemic corticosteroids, biologicals, vaccination), HS and other infections as variables. RESULTS HS was significantly associated with HZ for all analysed time intervals (up to five years) post HZ (OR of 3.51 [2.09 5.88] 95%CI one year post HZ) and to a lesser extent for time ranges pre HZ. Registration of other infections was significantly associated with HZ in all time intervals pre and post HZ (OR up to 1.37). Malignancy up to five years pre HZ, depression up to one year pre or post HZ, fractures up to two years pre HZ, asthma, auto-immune diseases, and immunosuppressive medication one year pre or post HZ were also associated with HZ. CONCLUSIONS HZ and HS occurrences are significantly associated and potentially share a common susceptibility beyond the known risk factors.
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Affiliation(s)
- Benson Ogunjimi
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium.
| | - Frank Buntinx
- Department of General Practice and Intego Registry, Catholic University of Leuven, Kapucijnenvoer 33, Blok J, Bus 7001, 3000 Leuven, Belgium; Research Institute Caphri, University of Maastricht, Universiteitssingel 40, 6229 Maastricht, The Netherlands.
| | - Stephaan Bartholomeeusen
- Department of General Practice and Intego Registry, Catholic University of Leuven, Kapucijnenvoer 33, Blok J, Bus 7001, 3000 Leuven, Belgium.
| | - Ita Terpstra
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Inke De Haes
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Lander Willem
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Steven Elli
- Department of General Practice and Intego Registry, Catholic University of Leuven, Kapucijnenvoer 33, Blok J, Bus 7001, 3000 Leuven, Belgium.
| | - Joke Bilcke
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Centre for General Practice, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Philippe Beutels
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Level 3, Samuels Building Gate 11, Botany Street, 2052 Sydney, Australia.
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Nerve-derived transmitters including peptides influence cutaneous immunology. Brain Behav Immun 2013; 34:1-10. [PMID: 23517710 PMCID: PMC3750093 DOI: 10.1016/j.bbi.2013.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/27/2013] [Accepted: 03/10/2013] [Indexed: 01/01/2023] Open
Abstract
Clinical observations suggest that the nervous and immune systems are closely related. For example, inflammatory skin disorders; such as psoriasis, atopic dermatitis, rosacea and acne; are widely believed to be exacerbated by stress. A growing body of research now suggests that neuropeptides and neurotransmitters serve as a link between these two systems. Neuropeptides and neurotransmitters are released by nerves innervating the skin to influence important actors of the immune system, such as Langerhans cells and mast cells, which are located within close anatomic proximity. Catecholamines and other sympathetic transmitters that are released in response to activation of the sympathetic nervous system are also able to reach the skin and affect immune cells. Neuropeptides appear to direct the outcome of Langerhans cell antigen presentation with regard to the subtypes of Th cells generated and neuropeptides induce the degranulation of mast cells, among other effects. Additionally, endothelial cells, which release many inflammatory mediators and express cell surface molecules that allow leukocytes to exit the bloodstream, appear to be regulated by certain neuropeptides and transmitters. This review focuses on the evidence that products of nerves have important regulatory activities on antigen presentation, mast cell function and endothelial cell biology. These activities are highly likely to have clinical and therapeutic relevance.
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Gershon AA, Gershon MD. Pathogenesis and current approaches to control of varicella-zoster virus infections. Clin Microbiol Rev 2013; 26:728-43. [PMID: 24092852 PMCID: PMC3811230 DOI: 10.1128/cmr.00052-13] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Varicella-zoster virus (VZV) was once thought to be a fairly innocuous pathogen. That view is no longer tenable. The morbidity and mortality due to the primary and secondary diseases that VZV causes, varicella and herpes zoster (HZ), are significant. Fortunately, modern advances, including an available vaccine to prevent varicella, a therapeutic vaccine to diminish the incidence and ameliorate sequelae of HZ, effective antiviral drugs, a better understanding of VZV pathogenesis, and advances in diagnostic virology have made it possible to control VZV in the United States. Occult forms of VZV-induced disease have been recognized, including zoster sine herpete and enteric zoster, which have expanded the field. Future progress should include development of more effective vaccines to prevent HZ and a more complete understanding of the consequences of VZV latency in the enteric nervous system.
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Martin GM. “Orphan” phenotypes in gerontological research. Aging Clin Exp Res 2013. [DOI: 10.1007/bf03324182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Irwin MR, Levin MJ, Laudenslager ML, Olmstead R, Lucko A, Lang N, Carrillo C, Stanley HA, Caulfield MJ, Weinberg A, Chan ISF, Clair J, Smith JG, Marchese RD, Williams HM, Beck DJ, McCook PT, Zhang JH, Johnson G, Oxman MN. Varicella zoster virus-specific immune responses to a herpes zoster vaccine in elderly recipients with major depression and the impact of antidepressant medications. Clin Infect Dis 2013; 56:1085-93. [PMID: 23413415 DOI: 10.1093/cid/cis1208] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes zoster (HZ). The Depression Substudy was a 2-year longitudinal cohort study in 92 community-dwelling adults≥60 years of age who were enrolled in the SPS, a large, double-blind, placebo-controlled Veterans Affairs Cooperative zoster vaccine efficacy study. METHODS Forty subjects with major depressive disorder, stratified by use of antidepressant medications, and 52 age- and sex-matched controls with no history of depression or other mental illness had their VZV-CMI measured prior to vaccination with zoster vaccine or placebo and at 6 weeks, 1 year, and 2 years postvaccination. RESULTS Depressed subjects who were not treated with antidepressant medications had lower levels of VZV-CMI following administration of zoster vaccine than nondepressed controls or depressed subjects receiving antidepressants even when antidepressant medications failed to alter depressive symptom severity (P<.005). Similar results were obtained taking into account the time-varying status of depression and use of antidepressant medications, as well as changes in depressive symptoms, during the postvaccination period. CONCLUSIONS Depressed patients have diminished VZV-CMI responses to zoster vaccine, and treatment with antidepressant medication is associated with normalization of these responses. Because higher levels of VZV-CMI correlate with lower risk and severity of HZ, untreated depression may increase the risk and severity of HZ and reduce the efficacy of zoster vaccine.
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Affiliation(s)
- Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, University of California, Los Angeles, Los Angeles, CA 90095-7057, USA.
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Gershon AA. Varicella zoster vaccines and their implications for development of HSV vaccines. Virology 2013; 435:29-36. [PMID: 23217613 DOI: 10.1016/j.virol.2012.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 09/29/2012] [Accepted: 10/01/2012] [Indexed: 02/01/2023]
Abstract
Live attenuated vaccines to prevent varicella and zoster have been available in the US for the past 17 years, with a resultant dramatic decrease in varicella incidence and a predicted future decrease in the incidence of zoster. The pathogenesis and immune responses to varicella zoster virus (VZV) as well as the safety and effectiveness of VZV vaccines are reviewed. The lack of sterilizing immunity provided by VZV vaccines has not prevented them from being safe and effective. Virological and pathological information concerning parallels and differences between VZV and herpes simplex virus (HSV) are highlighted. Although VZV and HSV are distinct pathogens, they appear to have similarities in target organs and immunity that provide an expectation of a high likelihood for the success of vaccination against HSV, and predicted to be similar to that of VZV.
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Affiliation(s)
- Anne A Gershon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, NY, NY 10032, USA.
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Lasserre A, Blaizeau F, Gorwood P, Bloch K, Chauvin P, Liard F, Blanchon T, Hanslik T. Herpes zoster: family history and psychological stress-case-control study. J Clin Virol 2012; 55:153-7. [PMID: 22824229 DOI: 10.1016/j.jcv.2012.06.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/22/2012] [Accepted: 06/28/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have reported risk factors for herpes zoster (HZ), but their results remain controversial and difficult to compare because of their limitations regarding sampling and design. OBJECTIVES This study was aimed to determine risk factors in ambulatory patients aged 50 years or more, by consulting general practitioners (GPs) in France. STUDY DESIGN A prospective, national, matched case-control study was conducted. It involved 121 GPs who recruited 250 cases of HZ and 500 controls (matched by age and sex), aged 50 years and older, between April 2009 and September 2010. GP and patient questionnaires explored the following risk factors: family history of HZ, comorbidities, depression, anxiety, negative life events, physical trauma, alcohol and tobacco consumption, level of education, and various protective factors (such as exposure to children). Odds ratios were estimated using conditional logistic regression. RESULTS In multivariate adjusted analysis, a family history of HZ (OR 3.69, 95% CI 1.81-7.51), a HAD depressive score≥8 (OR 4.15, 95% CI 1.88-9.16), and a recent negative life event (OR 3.40, 95% CI 1.67-6.93) were all significantly associated with HZ. CONCLUSIONS This case-control study conducted in ambulatory patients in general practice reinforced the hypothesis that, in addition to the age-related decline in VZV-specific T-cell-mediated immunity, depression negative life event and familiar history of zoster increase the risk of occurrence of herpes zoster. In people with familiar history, this risk could be prevented by vaccination.
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Affiliation(s)
- Andrea Lasserre
- UPMC Univ Paris 06, 27, Rue de Chaligny, 75571 Paris Cedex 12, France.
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Şahin Ş, Çınar N, Okluoğlu T, Batum K, Karşıdağ S. Is Herpes Zoster Merely A Simple Neuralgia
Syndrome? ELECTRONIC JOURNAL OF GENERAL MEDICINE 2011. [DOI: 10.29333/ejgm/82741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Yang YW, Chen YH, Lin HW. Risk of herpes zoster among patients with psychiatric diseases: a population-based study. J Eur Acad Dermatol Venereol 2011; 25:447-53. [PMID: 20666877 DOI: 10.1111/j.1468-3083.2010.03811.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychiatric disorders have been shown to be associated with impaired immune response, including decreased cellular immunity to varicella-zoster virus. However, the risk of herpes zoster (HZ) in psychiatric patients is, to date, unknown. OBJECTIVE The aim of this study was to determine the risk of herpes zoster (HZ) in psychiatric patients compared with the general population. METHODS We used data from the Taiwan Longitudinal Health Insurance Database from 2004 to 2006. Our study cohort consisted of patients aged 18 years and older diagnosed with psychiatric disorders in 2004 (N=42 340). The comparison cohort (N=169 360) consisted of four age- and gender-matched controls randomly selected for every patient in the study cohort. All subjects were followed from the date of cohort entry until they developed HZ or the end of 2006, whichever was earliest. Stratified Cox proportional hazard regressions were performed to compute the 2-year HZ-free survival rates. RESULTS After adjusting for potential confounders, we found patients with psychiatric disorders were more likely to have an episode of HZ than the control population [adjusted hazard ratio (HR), 1.29; 95% confidence interval (CI), 1.18-1.38]. When stratified by age and psychiatric diagnostic categories, in patients aged ≤60 years, the adjusted HRs for HZ were 1.34 (P=0.026) for patients with affective psychoses, 1.42 (P<0.001) for those with neurotic illness or personality disorders and 1.53 (P<0.001) for patients with other mental disorders. However, in patients aged >60years, only neurotic illness or personality disorders were significantly associated with an increased risk of HZ (adjusted HR, 1.26; P=0.003). CONCLUSIONS Our analysis suggests that patients with psychiatric disorders are at increased risk of HZ, especially those aged ≤60 years. Further study is required to elucidate the nature of this association.
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Affiliation(s)
- Y-W Yang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
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Irwin MR, Levin MJ, Carrillo C, Olmstead R, Lucko A, Lang N, Caulfield MJ, Weinberg A, Chan ISF, Clair J, Smith JG, Marchese RD, Williams HM, Beck DJ, McCook PT, Johnson G, Oxman MN. Major depressive disorder and immunity to varicella-zoster virus in the elderly. Brain Behav Immun 2011; 25:759-66. [PMID: 21329753 PMCID: PMC3081366 DOI: 10.1016/j.bbi.2011.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 01/20/2023] Open
Abstract
Major depressive disorder has been associated with activation of inflammatory processes as well as with reductions in innate, adaptive and non-specific immune responses. The objective of this study was to evaluate the association between major depression and a disease-relevant immunologic response, namely varicella-zoster virus (VZV)-specific immunity, in elderly adults. A cross-sectional cohort study was conducted in 104 elderly community dwelling adults ≥ 60years of age who were enrolled in the depression substudy of the shingles prevention study, a double blind, placebo-controlled vaccine efficacy trial. Fifty-two subjects had a current major depressive disorder, and 52 age- and sex-matched controls had no history of depression or any mental illness. VZV-specific cell-mediated immunity (VZV-CMI) was measured by VZV responder cell frequency (VZV-RCF) and interferon-γ enzyme-linked immunospot (ELISPOT) assays, and antibody to VZV was measured by an enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA). VZV-CMI, measured by VZV-RCF, was significantly lower in the depressed group than in the controls (p<0.001), and VZV-RCF was inversely correlated with the severity of depressive symptoms in the depressed patients. In addition, an age-related reduction in VZV-RCF was observed in the depressed patients, but not in the controls. Furthermore, there was a trend for depressive symptom severity to be associated with lower ELISPOT counts. Finally, VZV-RCF was higher in depressed patients treated with antidepressant medications as compared to untreated depressed patients. Since lower levels of VZV-RCF appear to explain the increased risk and severity of herpes zoster observed in older adults, these findings suggest that, in addition to increasing age, depression may increase the risk and severity of herpes zoster.
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Affiliation(s)
- Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095-7057, USA.
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Failla V, Nikkels A. Ustekinumab and Herpes Zoster. Dermatology 2011; 222:119-22. [DOI: 10.1159/000323736] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 12/21/2010] [Indexed: 12/14/2022] Open
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Gatti A, Pica F, Boccia MTY, De Antoni F, Sabato AF, Volpi A. No evidence of family history as a risk factor for herpes zoster in patients with post-herpetic neuralgia. J Med Virol 2010; 82:1007-11. [PMID: 20419815 DOI: 10.1002/jmv.21748] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Little is known about reactivation of latent varicella zoster virus as herpes zoster in individuals with no underlying immunosuppression. Risk factors include age, sex, ethnicity, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. An association between herpes zoster and family history of zoster has been proposed. A case-control study involving patients affected by post-herpetic neuralgia, which usually follows more severe acute herpes zoster, was performed. The patients with post-herpetic neuralgia were enrolled at the Pain Clinic of the Policlinico Tor Vergata in Rome, Italy, within 1 year from the onset of acute zoster. The controls matched for sex and age were chosen among healthy subjects without a history of herpes zoster presenting at the Internal Medicine Outpatient Clinic for hypertension in the same time period. All the participants in the study gave informed consent and were interviewed by medically trained and blinded investigators using a questionnaire. Similar proportions of the patients and the controls reported a family history of herpes zoster irrespective of the degree of relationship, i.e., 17.4% and 18.2%, respectively, by analyzing only the first-degree relatives [RR 1.03 (CI 95%: 0.78-1.37)], and 28.4% and 29.6%, respectively, by analyzing the total number of relatives [RR 1.03 (CI 95%: 0.81-1.31)]. Further and larger prospective cohort studies are needed to ascertain whether a family history of herpes zoster is really an independent predictor of zoster in different geographical settings.
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Affiliation(s)
- A Gatti
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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Arnould B, Benmedjahed K, Gallais JL, Giniès P, Baron R. The impact of herpes zoster and subsequent chronic pain on patients’ daily lives. J Public Health (Oxf) 2010. [DOI: 10.1007/s10389-010-0346-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Gershon AA, Gershon MD, Breuer J, Levin MJ, Oaklander AL, Griffiths PD. Advances in the understanding of the pathogenesis and epidemiology of herpes zoster. J Clin Virol 2010; 48 Suppl 1:S2-7. [PMID: 20510263 PMCID: PMC5391040 DOI: 10.1016/s1386-6532(10)70002-0] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The primary varicella zoster virus (VZV) infection results in chickenpox (varicella), which is transmitted via the airborne route. VZV is highly infectious, but in the USA the incidence of varicella has been reduced by 76-87% as a result of the varicella vaccine. The virus establishes latency in the dorsal root ganglia during varicella and, when reactivated, travels along the sensory nerve axons to cause shingles (herpes zoster [HZ]). There are over 1 million cases of HZ in the USA each year, with an estimated lifetime attack rate of 30%. The incidence of HZ, which causes significant morbidity, increases with age and reaches approximately 10 cases per 1,000 patient-years by age 80. Cell-mediated immunity (CMI) is known to decline with age as part of immunosenescence, and decreased CMI is associated with reactivation of VZV. This article provides an overview of our emerging understanding of the epidemiology and pathogenesis of varicella and HZ, in addition to exploring the current theories on latency and reactivation. Understanding the risk factors for developing HZ and the complications associated with infection, particularly in older people, is important for prompt diagnosis and management of HZ in primary care, and they are therefore also reviewed.
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Affiliation(s)
- Anne A. Gershon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Michael D. Gershon
- Department of Pathology and Cell Biology, Columbia University, P&S, 630 West 168th Street, New York, NY 10032, USA
| | - Judith Breuer
- Centre for Infectious Disease, 4 Newark St, London E1 2AT, UK
| | - Myron J. Levin
- Pediatric Infectious Diseases, University of Colorado Denver, Mail Stop C227, Building 401, 1784 Racine Street, Room R09–108, Aurora, CO 80045, USA
| | - Anne Louise Oaklander
- Harvard Medical School, Nerve Injury Unit, Massachusetts General Hospital, 275 Charles Street, Boston, MA 02214, USA
| | - Paul D. Griffiths
- Centre for Virology, University College Medical School, Rowland Hill St, London NW3 2PF, UK
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Risk factors of herpes zoster among children immunized with varicella vaccine: results from a nested case-control study. Pediatr Infect Dis J 2010; 29:205-8. [PMID: 19952977 DOI: 10.1097/inf.0b013e3181bc379b] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies of varicella-zoster virus reactivation in children have provided little information on potential risk factors. The aim of this study was to investigate the effects of race, chronic medical conditions and treatments, and recent vaccination, on the risk of herpes zoster (HZ) in children vaccinated with one dose of varicella vaccine. METHODS Case subjects were identified from a cohort of subjects who were members of the Southern California Kaiser Permanente Health Plan and received primary immunization with a single-antigen live varicella vaccine at age < or = 12 years from 2002 to 2008. Control subjects free of HZ during the study period were matched at a 5:1 ratio to each case subject on date of birth and sex. Race information was obtained from membership files, health records, and phone interview. Immunization history, medical history, and health care utilization were identified from Southern California Kaiser Permanente Health Plan electronic records. RESULTS During this time, 122 children were diagnosed with HZ. With adjustment for the number of hospitalizations, outpatient visits, and length of time between vaccination with varicella vaccine and the onset of HZ, Black children were at lower risk of developing HZ than were White (OR=0.41, 95% CI=0.17-0.98) and Asian children (OR=0.30, 95% CI=0.11-0.84). CONCLUSIONS These data suggest that the racial differences in the risk of developing HZ seen in adults are manifest in children as well. As children are not subject to the majority of factors hypothesized to underlie HZ in adults and as this study was conducted in a setting which affords equal access to health care, it is possible that genetic variation may explain some portion of varicella-zoster virus reactivation.
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Bailey MT, Glaser R. Immune Measures in Behavioral Medicine Research: Procedures and Implications. HANDBOOK OF BEHAVIORAL MEDICINE 2010. [PMCID: PMC7122467 DOI: 10.1007/978-0-387-09488-5_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Immune system activity is heavily influenced by the central nervous system. These interactions provide us the means to study mind–body interactions and how they affect health. In general, measures of immune system activity can be divided into two categories: those that are evident in the circulation and those that need to be elicited. For example, leukocytes can be collected from the circulation, counted, and their function accessed in cell culture. To test the ability of the immune system to respond to an experimental challenge more directly, studies involving wound healing, or involving the response to an infectious agent, can be performed. The purpose of this chapter is briefly to describe immune assays that are commonly employed in behavioral medicine research, including a rationale for their use as well as a brief description of the methodology. This chapter also describes previous studies in which circulatory and elicited immune measures have been studied in human subjects experiencing different psychological stressors, with an emphasis on studies involving medical students experiencing academic stress and caregivers of a spouse with Alzheimer’s disease. Finally, the chapter discusses the important role that the employment of animal models can play in studies of stress and health and in defining how nervous system activity can influence the immune response.
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Incidence of herpes zoster among children vaccinated with varicella vaccine in a prepaid health care plan in the United States, 2002-2008. Pediatr Infect Dis J 2009; 28:1069-72. [PMID: 19773676 DOI: 10.1097/inf.0b013e3181acf84f] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Herpes zoster (HZ), or shingles, is caused by reactivation of latent varicella-zoster virus after a primary infection with either wild-type or vaccine-type varicella-zoster virus, the latter having been introduced in 1995 for children. Since then, few population-based data about the incidence of childhood HZ are available. METHODS We identified children aged < or = 12 years who were vaccinated with 1 dose of varicella vaccine between 2002 and 2008 in a prepaid health plan and followed them through their electronic health records for a diagnosis of HZ. The medical records of these children were reviewed. Persistent and chronic conditions for these children before HZ were identified. RESULTS There were 172,163 children vaccinated, with overall follow-up of 446,027 person-years (Incidence rate = 27.4 per 100,000 person-years, 95% confidence interval: 22.7-32.7). Children vaccinated after age 5 years had a higher but not statistically significant different rate than children vaccinated between 12 and 18 months (34.3 vs. 28.5 per 100,000 person-years). Among children vaccinated between 12 and 18 months, incidence rates gradually increased each year in the first 4 years after vaccination (P < 0.001). Among the HZ cases, there were 1 (0.7%) case of lymphoid leukemia, 1 (0.7%) case of drug abuse, 16 (11.1%) cases of asthma with 3 or more acute exacerbations, 12 (8.3%) cases of developmental disorders, and 3 (2.1%) cases of psychological or mental disorders. CONCLUSIONS These data demonstrate that diagnosed HZ is rare among children following varicella vaccine. Despite the small numbers, the roles of delayed vaccination, severe asthma, and development disorders warrant further investigation. In the future, analyses of HZ isolates will be needed to identify the virus strains causing reactivation.
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Volpi A, Gatti A, Pica F, Bellino S, Marsella L, Sabato A. Clinical and psychosocial correlates of post-herpetic neuralgia. J Med Virol 2008; 80:1646-52. [DOI: 10.1002/jmv.21254] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Reynolds MA, Chaves SS, Harpaz R, Lopez AS, Seward JF. The impact of the varicella vaccination program on herpes zoster epidemiology in the United States: a review. J Infect Dis 2008; 197 Suppl 2:S224-7. [PMID: 18419401 DOI: 10.1086/522162] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Speculation that a universal varicella vaccination program might lead to an increase in herpes zoster (HZ) incidence has been supported by modeling studies that assume that exposure to varicella boosts immunity and protects against reactivation of varicella-zoster virus (VZV) as HZ. Such studies predict an increase in HZ incidence until the adult population becomes predominantly composed of individuals with vaccine-induced immunity who do not harbor wild-type VZV. In the United States, a varicella vaccination program was implemented in 1995. Since then, studies monitoring HZ incidence have shown inconsistent findings: 2 studies have shown no increase in overall incidence, whereas 1 study has shown an increase. Studies from Canada and the United Kingdom have shown increasing rates of HZ incidence in the absence of a varicella vaccination program. Data suggest that heretofore unidentified risk factors for HZ also are changing over time. Further studies are needed to identify these factors, to isolate possible additional effects from a varicella vaccination program. Untangling the contribution of these different factors on HZ epidemiology will be challenging.
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Affiliation(s)
- Meredith A Reynolds
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Schmader K, Gnann JW, Watson CP. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. J Infect Dis 2008; 197 Suppl 2:S207-15. [PMID: 18419399 DOI: 10.1086/522152] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Worldwide, herpes zoster (HZ) affects millions of patients (particularly older adults) annually and causes significant suffering due to acute and chronic pain, or postherpetic neuralgia (PHN). The objective of this article is to explain the rationale for the HZ vaccine by summarizing data on the epidemiology of HZ in the immunocompetent host, with a focus on recent incidence and risk factor studies; to review information on the burden of HZ; and to discuss the challenges of lessening the morbidity of the disease. The incidence and severity of HZ and PHN are highest in older adults. Given the central nervous system damage caused by HZ, the difficulty of adequately treating HZ to prevent PHN, and the intractability of PHN, the advent of the HZ vaccine appears to be a crucial innovation for preventing HZ and PHN.
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Affiliation(s)
- Kenneth Schmader
- Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, North Carolina, USA.
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Abourazzak F, Couchouron T, Meadeb J, Perdriger A, Tattevin P, Moutel A, Le Goff B, Hajjaj-Hassouni N, Chalès G. [Sciatica with motor loss revealing meningoradiculitis due to varicella-zoster virus]. Rev Med Interne 2008; 29:932-5. [PMID: 18406019 DOI: 10.1016/j.revmed.2008.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Revised: 12/14/2007] [Accepted: 01/28/2008] [Indexed: 12/28/2022]
Abstract
Herpes zoster is a disease which occurs secondary to the reactivation of varicella-zoster virus. Motor involvement in acute herpes zoster is rare. We report a case of sciatica L5 due to herpes zoster infection with motor loss. Typical skin lesions occurred one week before the sciatica. Radiological finding did not explain the paresis. The diagnosis of zoster sciatica with motor involvement was suspected. Serological tests and cerebrospinal fluid examination established the diagnosis. The antiviral and physical treatment was conducted in order to improve functional outcome.
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Affiliation(s)
- F Abourazzak
- Service de rhumatologie, CHU de Rabat-Salé, hôpital El-Ayachi, Maroc.
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Schmader KE, Dworkin RH. Natural history and treatment of herpes zoster. THE JOURNAL OF PAIN 2008; 9:S3-9. [PMID: 18166460 DOI: 10.1016/j.jpain.2007.10.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The objective of this article is to provide an overview of the natural history and treatment of herpes zoster, with a focus on pain management. Herpes zoster has the highest incidence of all neurological diseases, occurring annually in approximately 1 million people in the United States. A basic feature of herpes zoster is a marked increase in incidence with aging and with diseases and drugs that impair cellular immunity. Herpes zoster begins with reactivation of varicella zoster virus in dorsal root or cranial nerve ganglia, which is often accompanied by a prodrome of dermatomal pain or abnormal sensations. Varicella zoster virus spreads in the affected primary afferent nerve to the skin and produces a characteristic dermatomal maculopapular and vesicular rash and pain. Herpes zoster acute pain lowers quality of life and interferes with activities of daily living. Antiviral therapy and scheduled analgesics form the pharmacotherapeutic foundation for herpes zoster acute pain reduction. If moderate to severe herpes zoster pain is not adequately relieved by antiviral agents in combination with oral analgesic medications, then corticosteroids, anticonvulsants (eg, gabapentin or pregabalin), tricyclic antidepressants (eg, nortriptyline or desipramine), or neural blockade can be considered. PERSPECTIVE This article presents information on the clinical features and treatment of herpes zoster. This information will help clinicians diagnose and manage herpes zoster pain.
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Affiliation(s)
- Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University Medical Center and Geriatric Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC 27705, USA.
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Levin MJ, Oxman MN, Zhang JH, Johnson GR, Stanley H, Hayward AR, Caulfield MJ, Irwin MR, Smith JG, Clair J, Chan ISF, Williams H, Harbecke R, Marchese R, Straus SE, Gershon A, Weinberg A. Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine. J Infect Dis 2008; 197:825-35. [PMID: 18419349 PMCID: PMC4014857 DOI: 10.1086/528696] [Citation(s) in RCA: 254] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/10/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND A double-blind, placebo-controlled trial that involved 38,546 subjects > or =60 years old demonstrated efficacy of a high-potency live-attenuated Oka/Merck varicella-zoster virus (VZV) vaccine. The trial included an immunology substudy to determine the relationship of VZV-specific immune responses to vaccination and clinical outcome. METHODS The immunology substudy enrolled 1395 subjects at 2 sites where blood samples obtained prior to vaccination, at 6 weeks after vaccination, and at 1, 2, and 3 years thereafter were tested for VZV-specific cell-mediated immunity (VZV-CMI) by gamma-interferon ELISPOT and responder cell frequency assays and for VZV antibody by glycoprotein ELISA. RESULTS VZV-CMI and VZV antibodies were significantly increased in vaccine recipients at 6 weeks after vaccination. The vaccine-induced increases in VZV-CMI persisted during the 3 years of follow-up, although their magnitude decreased over time. The magnitude of these VZV-specific immune responses was greater in subjects 60-69 years old than in subjects > or =70 years old. CONCLUSIONS The zoster vaccine induced a significant increase in VZV-CMI and VZV antibody. The magnitude and duration of the boost in VZV-CMI in vaccine recipients and the relationship of this boost to age paralleled the clinical effects of the vaccine observed during the efficacy trial. These findings support the hypothesis that boosting VZV-CMI protects older adults against herpes zoster and postherpetic neuralgia.
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Affiliation(s)
- M J Levin
- University of Colorado Health Sciences Center, Denver, Colorado, USA.
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Weinberg JM. Herpes zoster: Epidemiology, natural history, and common complications. J Am Acad Dermatol 2007; 57:S130-5. [DOI: 10.1016/j.jaad.2007.08.046] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 07/09/2007] [Accepted: 08/11/2007] [Indexed: 11/25/2022]
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