Shingles Science Image Shingles Science Image

Burden of disease and complications

Herpes zoster can have a significant impact on quality of life (QoL) of patients and healthcare costs.1-6

Herpes zoster can have a significant impact on QoL of patients and healthcare costs.1-3 As well as the initial impact reactivation of varicella zoster virus has on patient QoL (dermatological rash and pain), complications can arise from herpes zoster, which may add a further burden to patients and healthcare providers.1,2

icon depicting a dollar sign

US costs due to herpes zoster and its complications are estimated to be $2.4 billion annually (direct medical costs and productivity losses).5,6

icon depicting a person with a sad face in a speech bubble

57.9% of patients reported pain at levels that may indicate significant health-related QoL (HRQoL) burden in a QoL study of 229 patients.1

During an acute phase of herpes zoster, 70.7% of patients reported fatigue, 30.6% reported stomach upsets, 27.1% reported change in bowel movements and 27.1% reported muscle weakness.1

The natural course of herpes zoster consists of prodromal, acute and subacute phases, which can be followed by chronic complications

figure showing the natural course of herpes zoster. the prodromal phase lasts 4 days to 2 weeks. symptoms include: headache, photophobia, malaise, abnormal skin sensations, pain, and less commonly fever. the prodromal phase is followed by the acute phase, which lasts 2 to 4 weeks. .symptoms consist of unilateral, vesicular rash, and associated acute pain. the subacute phase can last up to three months. 5 to more than 30 percent of patients may experience the post herpetic neuralgia phase. PHN is defined as neuropathic pain that persists for greater than or equal to 90 days after the onset of herpes zoster rash

PHN is the most common complication of herpes zoster and can cause:2

figure showing icons that represent physical disability, interference with daily activities, interference with sleep and emotional distress

Physical disability

figure showing icons that represent physical disability, interference with daily activities, interference with sleep and emotional distress

Interference with daily activities

figure showing icons that represent physical disability, interference with daily activities, interference with sleep and emotional distress

Interference with sleep

figure showing icons that represent physical disability, interference with daily activities, interference with sleep and emotional distress

Emotional distress

For many patients, herpes zoster can lead to serious complications

Approximately 10% of patients with herpes zoster above 50 years of age experience one or more non-PHN complications.4 Symptoms and complications may be atypical or more severe in immunocompromised patients.11,12

icon depicting a person with a walking stick

Post-herpetic neuralgia

  • PHN is defined as pain that persists for ≥90 days after the diagnosis or onset of herpes zoster rash.7,8
  • The risk of developing PHN ranges from 5% to more than 30%.2
icon depicting an eye

Ophthalmic

Keratitis, scleritis, uveitis, and acute retinal necrosis occur in 10 to 15% of patients with herpes zoster.2

icon showing the profile of a head with a lightening rod to represent pain

Neurological

Neurological complications including aseptic meningitis, encephalitis, cerebral infarction associated with granulomatous vasculitis, myelitis, Guillain-Barré syndrome, Ramsay Hunt syndrome and Bell’s palsy have been reported.4,13-16

icon depicting a human heart

Cerebrovascular and cardiovascular

Cerebrovascular and cardiovascular complications may affect around 1% of people with HZ.17 These can include stroke, transient ischaemic attack, myocardial infarction and cardiovascular disease.17

Click on a section below to learn more:

Epidemiology and risk factors

Epidemiology and risk factors

Click here to learn about herpes zoster epidemiology and risk factors

LEARN MORE

Patient management teaser

Patient management

Click here to learn about herpes zoster patient management

LEARN MORE

The ZOE programme teaser

Prevention through vaccination: The ZOE programme

Click here to learn about the ZOE programme

LEARN MORE

Abbreviations

HRQoL, health-related quality of life; PHN, post-herpetic neuralgia; QoL, quality of life.

References

  1. Gater A, et al. BMC Infect Dis. 2014;14:402.
  2. Kawai K, et al. BMJ Open. 2014;4:e004833.
  3. Marra F, et al. Open Forum Infect Dis. 2020;7:ofaa005.
  4. Meyers JL, et al. Vaccine. 2019;37:1235-1244.
  5. Harvey M, et al. Pain. 2020;161:361-368.
  6. Pan CX, et al. Ther Adv Vaccines Immunother. 2022;10:25151355221084535.
  7. Weinberg JM. J Am Acad Dermatol. 2007;57:S130-135.
  8. Harpaz R, et al. MMWR Recomm Rep. 2008;57:1-30; quiz CE32-34.
  9. Johnson RW. Herpes. 2007;14 Suppl 2:30-34.
  10. Dworkin RH, et al. J Pain. 2008;9:S37-44.
  11. Dworkin RH, et al. Clin Infect Dis. 2007;44 Suppl 1:S1-26.
  12. Kennedy PGE, et al. Viruses. 2018;10:609.
  13. Cohen JI. N Engl J Med. 2013;369:255-263.
  14. Nakajima H et al. Neurological complications of varicella-zoster virus infection. In: Thomasini RL (ed). Human Herpesvirus Infection - Biological Features, Transmission, Symptoms, Diagnosis and Treatment. InTechOpen, 2019. doi: 10.5772/intechopen.83036.
  15. Kang JH, et al. Clin Infect Dis. 2010;51:525-530.
  16. Zandian A, et al. Med Sci Monit. 2014;20:83-90.
  17. Sundström K, et al. BMC Infect Dis. 2015;15:488.

Material supplied by the above-country business unit to LOCs for localisation must be subject to local Medical and/or Regulatory review and approval prior to use and/or external distribution.

LOCs to insert local adverse events reporting procedure.

© 2022 GSK group of companies or its licensor. GlaxoSmithKline Biologicals SA. Rixensart, Belgium.

NX-GBL-GVX-WCNT-220019 | September 2022