Decline in hospitalization rates for herpes zoster in Italy (2003-2018): reduction in the burden of disease or changing of hospitalization criteria?

Publisher: Springer Country of Publication: Germany NLM ID: 101132995 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1720-8319 (Electronic) Linking ISSN: 15940667 NLM ISO Abbreviation: Aging Clin Exp Res Subsets: MEDLINE

Publication: <2013-> : Berlin : Springer
Original Publication: Milano, Italy : Editrice Kurtis, c2002-

Herpes Zoster*/epidemiology ; Herpesvirus 3, Human*; Aged ; Cost of Illness ; Hospitalization ; Humans ; Incidence ; Italy/epidemiology ; Retrospective Studies

Background: Herpes Zoster (HZ) is a very demanding disease caused by the reactivation of latent Varicella Zoster Virus. The main aim of this study was to estimate the burden of the HZ hospitalizations in Italy from 2003 to 2018 evaluating temporal trends.
Methods: Retrospective population-based study analyzing Hospital Discharge Records. Hospitalization records reporting the ICD-9 CM 053.X code in the principal diagnosis or in any of the five secondary diagnoses were considered as cases. Trends of hospitalization rates have been evaluated by Joinpoint analyses.
Results: Overall, 99,036 patients were hospitalized with HZ in the 16-year period of the study, and 83,720 (84.5%) of these patients were over 50 years. Hospitalization rate was 10.4 per 100,000 persons/year with a significant decreasing trend from 13.9 in 2003-2006 to 7.8 in 2015-2018 (p < 0.001). Hospitalization rates showed a 20-fold higher risk among subjects aged over 80 years and 11-fold higher risk among 70-79-year-old subjects with respect to those aged less than 50 years. Over time, a statistically significant increase was observed for the case fatality rate (from 1.2 to 1.7%; p < 0.001) and the median length of stay (from 7 to 8 days; p < 0.001).
Conclusions: Zoster is a disease that causes hospitalization as relatively frequent complication and the observed reduced trend over time could be due to a restriction in hospitalization criteria instead of a reduced burden of disease. The decreasing trend should be carefully interpreted, since it could have an impact on promoting herpes zoster vaccination.
(© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Johnson R, McElhaney J, Pedalino B et al (2007) Prevention of herpes zoster and its painful and debilitating complications. Int J Infect Dis Suppl 2:S43–S48. (PMID: 10.1016/S1201-9712(07)60021-6)
Johnson RW (2010) Herpes zoster and postherpetic neuralgia. Expert Rev Vaccine 9:21–26. (PMID: 10.1586/erv.10.30)
Opstelten W, Zaal MJ (2005) Managing ophthalmic herpes zoster in primary care. BMJ 331:147–151. (PMID: 10.1136/bmj.331.7509.147)
Cocchio S, Baldovin T, Furlan P et al (2019) Cross-sectional study on hospitalizations related to herpes zoster in an Italian region, 2008–2016. Aging Clin Exp Res 31:145–150. (PMID: 10.1007/s40520-018-0968-z)
Opstelten W, Mauritz JW, de Wit NJ et al (2002) Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Fam Pract 19:471–475. (PMID: 10.1093/fampra/19.5.471)
Centers for Disease Control and Prevention (2021) Available at https://www.cdc.gov/shingles/index.html . Accessed 3 Mar 2021.
White RR, Lenhart G, Singhal PK et al (2009) Incremental 1-year medical resource utilization and costs for patients with herpes zoster from a set of US health plans. Pharmacoeconomics 27:781–792. (PMID: 10.2165/11317560-000000000-00000)
Gnann JW Jr (2002) Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis 186:S91–S98. (PMID: 10.1086/342963)
Lydick E, Epstein RS, Himmelberger D et al (1995) Herpes zoster and quality of life: a self-limited disease with severe impact. Neurology 45:S52–S53. (PMID: 10.1212/WNL.45.12_Suppl_8.S52)
McElhaney JE (2010) Herpes zoster: a common disease that can have a devastating impact on patients’ quality of life. Expert Rev Vaccines 9:27–30. (PMID: 10.1586/erv.10.31)
Gabutti G, Franco E, Bonanni P et al (2015) Reducing the burden of Herpes Zoster in Italy. Hum Vaccin Immunother 11:101–107. (PMID: 10.4161/hv.34363)
Valente N, Cocchio S, Stefanati A et al (2017) Temporal trends in herpes zoster-related hospitalizations in Italy, 2001–2013: differences between regions that have or have not implemented varicella vaccination. Aging Clin Exp Res 29:771–779. (PMID: 10.1007/s40520-017-0782-z)
Stein AN, Britt H, Harrison C et al (2009) Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older. Vaccine 27:520–529. (PMID: 10.1016/j.vaccine.2008.11.012)
Chidiac C, Bruxelle J, Daures JP et al (2001) Characteristics of patients with herpes zoster on presentation to practitioners in France. Clin Infect Dis 33:62–69. (PMID: 10.1086/320884)
Brisson M, Edmunds WJ (2003) Epidemiology of Varicella-Zoster Virus in England and Wales. J Med Virol 70:S9–S14. (PMID: 10.1002/jmv.10313)
de Melker H, Berbers G, Hahné S et al (2006) The epidemiology of varicella and herpes zoster in The Netherlands: implications for varicella zoster virus vaccination. Vaccine 24:3946–3952. (PMID: 10.1016/j.vaccine.2006.02.017)
Paul E, Thiel T (1996) Zur Epidemiologie der Varizella-Zoster-Infektion Ergebnisse einer prospektiven Erhebung im Landkreis Ansbach [Epidemiology of varicella zoster infection. Results of a prospective study in the Ansbach area]. Hautarzt 47:604–609. (PMID: 10.1007/s001050050476)
Gialloreti LE, Merito M, Pezzotti P et al (2010) Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: a retrospective, population-based study. BMC Infect Dis 10:230. (PMID: 10.1186/1471-2334-10-230)
La scheda di dimissione ospedaliera (SDO). www.salute.gov.it . [Online] http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=1232&area=ricoveriOspedalieri&menu=vuoto . Accessed 3 Nov 2020.
ISTAT. Available at http://demo.istat.it/ . Accessed 03 Nov 2019.
Hobbelen PH, Stowe J, Amirthalingam G et al (2016) The Burden of Hospitalisation for Varicella and Herpes Zoster in England from 2004 to 2013. J Infect 73:241–253. (PMID: 10.1016/j.jinf.2016.05.008)
Ultsch B, Siedler A, Rieck T et al (2011) Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis 11:173. (PMID: 10.1186/1471-2334-11-173)
Schmidt SAJ, Kahlert J, Vestergaard M et al (2016) Hospital-based herpes zoster diagnoses in Denmark: rate, patient characteristics, and all-cause mortality. BMC Infect Dis 16:99. (PMID: 10.1186/s12879-016-1369-6)
Gil A, Gil R, Alvaro A et al (2009) Burden of Herpes Zoster Requiring Hospitalization in Spain during a Seven-Year Period (1998–2004). BMC Infect Dis 9:55. https://doi.org/10.1186/1471. (PMID: 10.1186/1471194226872685386)
Kawai K, Gebremeskel BG, Acosta CJ (2014) systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 4:e004833. https://doi.org/10.1136/bmjopen-2014-004833. (PMID: 10.1136/bmjopen-2014-004833249160884067812)
Di Legami V, Gianino MM, Ciofi degli Atti M et al (2007) Epidemiology and costs of herpes zoster: background data to estimate the impact of vaccination. Vaccine 25:7598–7604. https://doi.org/10.1016/j.vaccine.2007.07.049. (PMID: 10.1016/j.vaccine.2007.07.04917889410)
Salleras L, Salleras M, Salvador P et al (2015) Herpes zoster and postherpetic neuralgia in Catalonia (Spain). Hum Vaccin Immunother 11:178–184. (PMID: 10.4161/hv.34421)
Mesquita M, Froes F (2013) Hospital Admissions for Herpes Zoster in Portugal between 2000 and 2010. Acta Med Port 26:531–536. (PMID: 10.20344/amp.312)
Italian Health Ministry. Available at http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=5458&area=ricoveriOspedalieri&menu=vuoto . Accessed 20 Feb 2020. Last Accessed 21 Jan 2021.
Pecoraro F, Clemente F, Luzi D (2020) The efficiency in the ordinary hospital bed management in Italy: an in-depth analysis of intensive care unit in the areas affected by COVID-19 before the outbreak. PLoS ONE 15:e0239249. (PMID: 10.1371/journal.pone.0239249)
Marino D, Quattrone G (2019) A proposal for a new index to evaluate hospital resource allocation: the case of Italian NHS rationalisation. Eur Res Manag Bus Econ 25:23–29. https://doi.org/10.1016/j.iedeen.2018.10.001. (PMID: 10.1016/j.iedeen.2018.10.001)
Brisson M, Edmunds WJ, Gay NJ et al (2000) Modelling the impact of immunization on the epidemiology of varicella zoster virus. Epidemiol Infect 125:651–669. (PMID: 10.1017/S0950268800004714)
Amodio E, Casuccio A, Tramuto F et al (2020) Varicella vaccination as useful strategy for reducing the risk of varicella-related hospitalizations in both vaccinated and unvaccinated cohorts (Italy, 2003–2018). Vaccine 38:5601–5606. (PMID: 10.1016/j.vaccine.2020.06.076)
Holl K, Sauboin C, Amodio E et al (2016) Coverage, efficacy or dosing interval: Which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy. BMC Public Health 16:1103. (PMID: 10.1186/s12889-016-3738-x)
Amodio E, Tramuto F, Cracchiolo M et al (2015) The impact of ten years of infant universal Varicella vaccination in Sicily, Italy (2003–2012). Hum Vaccin Immunother 11:236–239. (PMID: 10.4161/hv.36157)

Keywords: Herpes zoster; Hospitalization; Italy

Date Created: 20220119 Date Completed: 20220510 Latest Revision: 20220510

20240105

10.1007/s40520-021-02014-7

35043279