Herpes zoster is characterized by unilateral grouped vesicles along the distribution of a dermatome. A global recurrence rate as low as 0.5%∼6.2% has been reported for herpes zoster. The recurrence of herpes zoster is higher in immunocompromised patients and older patients.
The purpose of this study is to assess the frequency of herpes zoster recurrence and factors that can influence its recurrence.
From January 2005 to December 2015, 14,343 patients with herpes zoster were enrolled in this study. The patients were diagnosed at Hallym University Medical Centers and Kangwon National University Hospital in Seoul, Gyeonggi, and Gangwon. Herpes zoster recurrence and patient characteristics were surveyed by medical record review and a telephonic survey.
The overall frequency of herpes zoster recurrence was 1.18%. The frequency of recurrence was higher in women than in men. It was also higher in patients aged 50∼70 years than in patients who were younger or older than this. Additionally, we assessed that the frequency of recurrence was statistically higher in patients with a compromised immune system and in patients who experienced longer lasting pain during their first episode.
The frequency of herpes zoster recurrence is more common in women, older age, patient with longer pain duration and immunocompromised patients.
Herpes zoster is a disease caused by the varicella-zoster virus of the herpes virus group. It occurs because of reactivation of the dormant virus in the nerves, such as the cranial nerve ganglia and the dorsal root ganglia, following varicella infection
The global recurrence rate of herpes zoster is low, but recent studies have reported a rate ranging from 0.5% to 6.2%, which is higher than that reported earlier
The current study was conducted to investigate the frequency of herpes zoster recurrence in Korean patients and to identify factors that influence the probability of recurrence by surveying patients who had herpes zoster at some point during the last 10 years and who lived in Seoul, Gyeonggi, and Gangwon. We also aimed to identify the differences in recurrence propensity according to sex, age, immunocompetence status, and duration of pain during the first episode.
To assess the frequency of herpes zoster recurrence, we surveyed a total of 14,343 inpatients and outpatients diagnosed with herpes zoster between January 2005 and December 2015 at six hospitals including five Hallym University Medical Centers (Kangnam Sacred Heart Hospital, Kangdong Sacred Heart Hospital, Hallym University Sacred Heart Hospital, Dongtan Sacred Heart Hospital, and Chuncheon Sacred Heart Hospital) and Kangwon National University Hospital. Of the total number of patients, 6,704 were surveyed in Seoul (from Kangnam Sacred Heart Hospital located in Yeongdeungpo-gu, Seoul, and Kangdong Sacred Heart Hospital located in Gangdong-gu, Seoul); 5,834 were surveyed in the Gyeonggi province (from Hallym University Sacred Heart Hospital located in Anyang, Gyeonggi, and Dongtan Sacred Heart Hospital located in Hwaseong, Gyeonggi); and 1,805 patients were surveyed in the Gangwon province (from Chuncheon Sacred Heart Hospital and Kangwon National University Hospital, both located in Chuncheon, Gangwon) (
Data on herpes zoster recurrences were collected from a review of the patients' medical records and a telephonic survey. The clustered vesicles, papules, and pustules along the dermatome, and the accompanying pain were used in the clinical diagnosis in both the first and recurrent herpes zoster episodes. The clinical diagnosis was based on the patient's clinical history and findings on visual inspection by a dermatologist. In cases which were difficult to make a diagnosis or necessary to make a differential diagnosis, we reviewed the result records of Tzanck test and polymerase chain reaction test.
We assessed several affecting factors, including patient's sex, age, immunocompetence at the time of recurrence and duration of pain during the first episode. Age and duration of pain were categorized into three groups each: <50 years, 50~70 years, and ≥70 years for age; and <30 days, 30~90 days, and ≥90 days for duration of pain. To assess the effect of immunocompetence on recurrence, patients with the following characteristics were investigated: antirheumatic drug use, immunosuppressive drug use after organ transplantation, ongoing treatment for hematologic cancers such as leukemia and lymphoma, anticancer drug use, acquired immunodeficiency syndrome, diabetes mellitus and chronic kidney disease. In addition, we reviewed the interval between the first episode and the recurrence of herpes zoster, and the anatomical location of the recurrence (trigeminal, cervical, thoracic, lumbar, or sacral nerves).
Statistical analyses were performed using SPSS ver. 12.0 for Windows Statistical Package (SPSS Inc., Chicago, IL, USA), and
This study was approved by the Institutional Review Board of Hallym University Medical Center (IRB no. 2016-09-002).
Total 14,343 patients were reviewed in this study, including 5,834 men (40.7%) and 8,509 women (59.3%). The patient with aged <50 years were 4,960, aged 50~70 were 6,148 and ≥70 years were 3,235. Patients that had immunocompetent status were 12,680 and immunocompromised patients were 1,663. Patients with duration of pain <30 days were 11,265, 30~90 days were 1,839 and duration ≥90 days were 1,239.
A total of 169 herpes zoster recurrences were assessed in a total of 14,343 patients and the overall frequency of recurrence was 1.18%. Of 169 patients, 134 were confirmed by medical record review and 35 were confirmed by telephonic survey. Herpes zoster recurred in 41 of the 5,834 male patients (0.70%), and in 128 of the 8,509 female patients (1.50%). Of the 4,960 patients aged <50 years, 38 patients (0.77%) experienced recurrent herpes zoster, while 94 of the 6,148 patients aged 50~70 years (1.53%), and 37 of the 3,235 patients aged ≥70 years (1.14%), experienced a recurrence. Of 12,680 immunocompetent patients 129 (1.02%) experienced a recurrence, while 40 of 1,663 immunocompromised patients (2.41%) had a recurrence. Among the immunocompromised patients who experienced recurrence, 6 patients were taking antirheumatic drugs, 3 were taking anticancer drugs and 3 were taking immunosuppressive agent due to organ transplantation. Two of forty patients were diagnosed as hematologic malignancy and 1 of 40 had acquired immune deficiency syndrome. Twenty-one patients had diabetes mellitus as an underlying disease and 4 were status of chronic kidney disease. Lastly, herpes zoster recurred in 106 of 11,265 patients (0.94%) with duration of pain <30 days, in 41 of 1,839 patients (2.23%) with duration of 30~ 90 days, and in 22 of 1,239 patients (1.78%) with duration ≥90 days (
Herpes zoster, a disease caused by the varicella-zoster virus, is characterized by clustered vesicles and pain along a dermatome
It is interesting that the recurrence was significantly different between sexes and between different age groups, whereas previous research in 2012 did not identify these factors to be significant
The logistic regression analysis conducted in the present study showed that the risk of recurrence was higher in the patients aged 50~70 years old than in patients <50 years old. This difference was statistically significant (
Herpes zoster is becoming an important disease as the size of the aging population and the number of people with a compromised immune system increase along with an increased lifespan
We expect that the current study will motivate many researchers to study more general factors associated with herpes zoster as well as the recurrence. In particular, we expect that the findings of this study will be useful in future research on morbidity and the recurrence of herpes zoster following the recent introduction of the herpes zoster vaccine
In conclusion, the overall frequency of herpes zoster recurrence was 1.18%. The frequency of recurrence was higher in women than in men. It was also higher in patients aged 50~70 years of age than in younger or older patients. Additionally, we confirmed that the frequency of recurrence was statistically higher in patients with a compromised immune system, and in patients who had longer duration of pain during their first episode.
Factor | Number of patients with recurrence (n=169) | Total number of Patients (n=14,343) | Percentage of patients with recurrence (%) |
---|---|---|---|
Sex | |||
Male | 41 | 5,834 | 0.70 |
Female | 128 | 8,509 | 1.50 |
Age (yr) | |||
<50 | 38 | 4,960 | 0.77 |
50~70 | 94 | 6,148 | 1.53 |
≥70 | 37 | 3,235 | 1.14 |
Immunity | |||
Immunocompetent | 129 | 12,680 | 1.02 |
Immunocompromised | 40 | 1,663 | 2.41 |
Duration of pain (d) | |||
<30 | 106 | 11,265 | 0.94 |
30~90 | 41 | 1,839 | 2.23 |
≥90 | 22 | 1,239 | 1.78 |
Factor | Cross-tabulation ( | Logistic regression analysis ( | Exp(B) |
---|---|---|---|
Sex | <0.001 | <0.001 | 2.123 |
Age (yr) | 0.045 | ||
<50 | |||
50∼70 | 0.014 | 1.621 | |
≥70 | 0.732 | 1.085 | |
Immunity | <0.001 | <0.001 | 2.402 |
Duration of pain (d) | <0.001 | ||
<30 | |||
30∼90 | <0.001 | 2.268 | |
≥90 | 0.019 | 1.752 |
*Cross-tabulation analysis by the chi-squared test.
Province | Seoul | Gyeonggi | Gangwon | ||||||
---|---|---|---|---|---|---|---|---|---|
Recurremce | Total | % | Recurremce | Total | % | Recurremce | Total | % | |
Sex | |||||||||
Male | 18 | 2,618 | 0.69 | 22 | 2,398 | 0.92 | 1 | 0819 | 0.12 |
Female | 62 | 4,086 | 1.52 | 54 | 3,436 | 1.57 | 12 | 0986 | 1.22 |
Age (yr) | |||||||||
<50 | 14 | 2,207 | 0.63 | 22 | 2,297 | 0.96 | 2 | 0456 | 0.44 |
50∼70 | 46 | 3,066 | 1.50 | 43 | 2,363 | 1.82 | 5 | 0723 | 0.69 |
≥70 | 20 | 1,431 | 1.40 | 11 | 1,174 | 0.94 | 6 | 0626 | 0.96 |
Immunity | |||||||||
Immunocompetent | 57 | 5,989 | 0.95 | 62 | 5,125 | 1.21 | 10 | 1,566 | 0.64 |
Immunocompromised | 23 | 0715 | 3.22 | 14 | 0709 | 1.97 | 3 | 0239 | 1.26 |
Duration of pain (d) | |||||||||
<30 | 52 | 5,167 | 1.01 | 47 | 4,492 | 1.05 | 7 | 1,606 | 0.44 |
30∼90 | 20 | 946 | 2.11 | 18 | 765 | 2.35 | 3 | 128 | 2.34 |
≥90 | 8 | 591 | 1.35 | 11 | 577 | 1.91 | 3 | 71 | 4.23 |
Total | 80 | 6,704 | 1.93 | 76 | 5,834 | 1.30 | 13 | 1,805 | 0.72 |
Dermatomes | Number of patients with 1st episode | Number of patients with 2nd episode | Number of concurrence patients |
---|---|---|---|
Trigeminal nerves | 8 | 15 | 3 |
Cervical nerves | 31 | 52 | 15 |
Thoracic nerves | 56 | 79 | 30 |
Lumbar nerves | 15 | 14 | 2 |
Sacral nerves | 6 | 9 | 2 |
None* | 53 |
*Data were unavailable or patients did not remember the location.