Acute Non-PHN Complications of Herpes Zoster

Pavankumar Kamat

November 25, 2020

Acute complications of herpes zoster (HZ) other than post-herpetic neuralgia (PHN) are relatively common, a new study suggests.

Researchers conducted a cohort study of unvaccinated immunocompetent adults with incident HZ (n=178,964) and matched to zoster-free control participants (n=1,799,380), using data from the UK Clinical Practice Research Datalink.

In total, 0.48 per cent, 1.33 per cent, 0.29 per cent and 0.78 per cent of HZ patients developed neurological, ocular, cutaneous and visceral complications, respectively. The absolute risks of acute HZ-specific complications within three months of diagnosis were 0.37 per cent (95% CI, 0.34-0.39) for Ramsay Hunt syndrome, 0.01 per cent (95% CI, 0.0-0.01) for disseminated HZ, 0.04 per cent (95% CI, 0.03-0.04) for HZ death and 0.97 per cent (95% CI, 0.92-1.00) for HZ hospitalisation.

Individuals with zoster aged ≥50 years were more likely to develop HZ-specific complications than younger patients, with the exception of Ramsay Hunt syndrome. Antiviral treatment during acute illness appeared to protect against Ramsay Hunt syndrome, neurological complications and hospitalisation.

Writing in the  British Journal of Dermatology , the authors commented: "Including non-PHN complications in cost-effectiveness models of the zoster vaccine may alter the recommendations, as some complications would have significant cost implications for the healthcare system, as well as important impacts on quality of life."

Forbes HJ, Bhaskaran K, Grint D, Hu VH, Langan SM, McDonald HI, Morton C, Smeeth L, Walker JL, Warren-Gash C. Incidence of acute complications of herpes zoster among immunocompetent adults in England: a matched cohort study using routine health data. Br J Dermatol. 2020 Nov 20 [Epub ahead of print]. doi: 10.1111/bjd.19687. PMID: 33216946 View abstract

This article originally appeared on Univadis, part of the Medscape Professional Network.

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