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The burden of herpes zoster disease in Norway

Institution:	1. Department of Infectious Diseases Epidemiology and Modeling, Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway;2. Department of Infectious Diseases, Oslo University Hospital, Ullevaal and Institute of Clinical Medicine, University of Oslo, Norway;3. Department of Infectious Diseases and Department of Acute Medicine, Oslo University Hospital, PO Box 4956 Nydalen, N-0424 Oslo, Norway;4. MSD Norway, Associate Director Medical Affairs Vaccines;1. Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden;2. Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Medicinarergatan 18A, Box 463, 405 30 Göteborg, Sweden;3. Department of Communicable Disease and Control and Health Protection, Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden;4. Division of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska Institute, Karolinska Universitetssjukhuset Solna, Infektionskliniken, 171 76 Stockholm, Sweden;5. Department of Infectious Diseases, Karolinska University Hospital, Karolinska Universitetssjukhuset Solna, Infektionskliniken, B3:03, 171 76 Stockholm, Sweden;6. Institution for Translational Medicine, Lund University, J Waldenströms gata 35, 205 02 Malmö, Sweden;1. University Hospital, Hradec Kralove, Czech Republic;2. Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway;3. Pediatric Highly Intensive Care Unit, University of Milan, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy;4. Swedish Institute for Communicable Disease Control, Stockholm, Sweden;5. Department of Clinical Sciences Pediatrics, Umeå University, Umeå, Sweden;6. University of Medicine and Pharmacy Iuliu Ha?ieganu, Cluj-Napoca, Romania;7. Institute of Immunology, Moscow, Russia;8. Department of Epidemiology, Regional Office of Public Health, Trencín, Slovak Republic;9. Vilnius University, Clinic of Paediatrics, Vilnius, Lithuania;10. University School of Medical Sciences, Poznan, Poland;11. Regional Medical Center for Mother and Child, Poznan, Poland;12. GlaxoSmithKline Vaccines, King of Prussia, PA, USA;13. GlaxoSmithKline Vaccines, Wavre, Belgium;1. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States;2. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States;3. Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York City, NY, United States;1. GlaxoSmithKline, Wavre, Belgium;2. GlaxoSmithKline, Rockville, MD, USA;3. Division of Health Services, Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway;4. University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic;5. Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy;6. Department of Paediatrics, Skånes University Hospital, Malmo, Sweden;7. The Public Health Agency of Sweden and Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden;8. 3rd Pediatric Department, Iuliu Ha?ieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania;9. Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden;10. Faculty of Health Care, Alexander Dub?ek University of Tren?ín, Tren?ín, Slovakia;11. Clinic of Children''s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania;12. Department of Preventive Medicine, Poznan University of Medical Sciences, Poznan, Poland;13. Charles University, Faculty of Medicine in Hradec Kralove, Department of Social Medicine, Hradec Kralove, Czech Republic;1. Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;2. Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands;3. Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia;4. Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia;5. GSK, Wavre, Belgium;6. AC Health Consulting, Sciences Po, Paris, France;7. University of Melbourne, Melbourne, Australia;8. University of Malaga, Malaga, Spain;9. Creativ-Ceutical, London, United Kingdom;10. Creativ-Ceutical, Luxembourg, Luxembourg;11. University of Duisburg-Essen, Essen, Germany;12. Programme for Global Health, Royal Institute of International Affairs, Chatham House, London, United Kingdom

Abstract:	BackgroundNo national vaccination program against herpes zoster (HZ) is currently in place in Norway. We aimed to quantify the burden of medically attended HZ to assess the need for a vaccination program.MethodsWe linked data from several health registries to identify medically attended HZ cases during 2008–2014 and HZ-associated deaths during1996–2012 in the entire population of Norway. We calculated HZ incidences for primary and hospital care by age, sex, type of health encounter, vaccination status, and co-morbidities among hospital patients. We also estimated HZ-associated mortality and case-fatality.ResultsThe study included 82,064 HZ patients, of whom none were reported as vaccinated against HZ. The crude annual incidence of HZ was 227.1 cases per 100,000 in primary healthcare and 24.8 cases per 100,000 in hospitals. Incidence rates were higher in adults aged ≥50 years (461 per 100,000 in primary care and 57 per 100,000 in hospitals), and women than in men both in primary healthcare (267 vs 188 per 100,000), and hospitals (28 vs 22 per 100,000). Among hospital patients, 47% had complicated zoster and 25% had comorbidities, according to the Charlson comorbidity index. The duration of hospital stay (median 4 days) increased with the severity of comorbidities. The estimated mortality rate was 0.18 per 100,000; and in-hospital case-fatality rate was 1.04%.ConclusionsMedically attended HZ poses a substantial burden in the Norwegian healthcare sector. The majority of the zoster cases occurred among adults aged ≥50 years – the group eligible for zoster vaccination – and increased use of zoster vaccination may be warranted, especially among persons with co-morbidities.

Keywords:	Herpes zoster Shingles Postherpetic neuralgia Burden Registries Norway Primary healthcare Hospitalizations Deaths CCI"} {"#name":"keyword" "$":{"id":"k0055"} "$$":[{"#name":"text" "_":"the Charlson comorbidity index CDR"} {"#name":"keyword" "$":{"id":"k0065"} "$$":[{"#name":"text" "_":"the Cause of Death Registry CFR"} {"#name":"keyword" "$":{"id":"k0075"} "$$":[{"#name":"text" "_":"case-fatality-rate CI"} {"#name":"keyword" "$":{"id":"k0085"} "$$":[{"#name":"text" "_":"confidence interval CNS"} {"#name":"keyword" "$":{"id":"k0095"} "$$":[{"#name":"text" "_":"the central nervous system GP"} {"#name":"keyword" "$":{"id":"k0105"} "$$":[{"#name":"text" "_":"General Practitioner HIV/AIDS"} {"#name":"keyword" "$":{"id":"k0115"} "$$":[{"#name":"text" "_":"Human immunodeficiency virus infection and acquired immune deficiency syndrome HZ"} {"#name":"keyword" "$":{"id":"k0125"} "$$":[{"#name":"text" "_":"herpes zoster ICD-10"} {"#name":"keyword" "$":{"id":"k0135"} "$$":[{"#name":"text" "_":"the International Statistical Classification of Diseases and Related Health Problems 10th revision IQR"} {"#name":"keyword" "$":{"id":"k0145"} "$$":[{"#name":"text" "_":"interquartile range NPR"} {"#name":"keyword" "$":{"id":"k0155"} "$$":[{"#name":"text" "_":"the Norwegian Patient Registry p"} {"#name":"keyword" "$":{"id":"k0165"} "$$":[{"#name":"text" "_":"p-value PHN"} {"#name":"keyword" "$":{"id":"k0175"} "$$":[{"#name":"text" "_":"postherpetic neuralgia SD"} {"#name":"keyword" "$":{"id":"k0185"} "$$":[{"#name":"text" "_":"standard deviation US"} {"#name":"keyword" "$":{"id":"k0195"} "$$":[{"#name":"text" "_":"the United States of America VZV"} {"#name":"keyword" "$":{"id":"k0205"} "$$":[{"#name":"text" "_":"Varicella zoster virus
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