Journal reading

Incidence Rate of Herpes Zoster

Ophthalmicus
Christina L. Kong, BS, Ryan R. Thompson, MSPH, Travis C. Porco, PhD, MPH, Eric Kim,
MA,
Nisha R. Acharya, MD, MS

Presented By :
dr. Dita Permata Ayu
Medical Staff Group of Ophthalmology Sriwijaya University
Mohammad Hoesin General Hospital Palembang
2021
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 INTRODUCTION

Significant 20% HZO* 

50-70% HZO*
pain, chronic
 occular
morbidity  course 
involvement,
decreased ongoing
complications
quality of life treatment

The rates of Herpes Zoster (HZ) continued to rise Incidence of

HZO reported  ?
*: Herpes Zoster Ophthalmicus (HZO) 2
 OBJECTIVE
“
Examine
Examine thethe Incidence
Incidence Rate
Rate (IR)
(IR) of
of HZO
HZO inin American
American
Population
Population from
from 1994-2018
1994-2018 and
and assess
assess by
by age,
age, race,
race, gender,
gender,
and
and geographic
geographic region.
region.

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 METHODS
Time
January 1994 - December 31 2018

Place
OptumLabs Data Warehouse

Design
Retrospective, observational cohort study

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 METHODS
Enrolled continuously for
365 days or more.

Inclusion Criteria Exclusion Criteria

Have a history of HZ and

HZO
 METHODS
Cases of HZ and All statistical
Data between Jan 1 HZO identified by analyses were
1994 – Dec 31 2018 using ICD 9th conducted in R
were collected and 10th edition software version
codes 3.5

The time trend in the overall incidence was assessed through Huber robust
regression  10-year age-time intervals and broken-stick models of the time
 1994 to 2007 and 2008 to 2018  before and after the Advisory
Committee on Immunization Practices’ (ACIP) recommendation for the ZVL
vaccine in 2008.

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METHODS

The IR of HZO calculated by year, 10-year

age groups, 10-year birth cohorts,
gender, race, and geographic region.

Sensitivity analysis  standarized the IRs

by age, gender, and race or ethnicity
using the average of the years 2014
through 2018 in the database.

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Results

The IR of HZO increased from

1994 through 2018 by an
estimated 1.1 cases per
100.000 person-years annually
(95% CI, 1.0e1.3; P < 0.001).

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 Results

Broken-stick regression: this table shows that the slope of the HZO IR
shifted in individuals in the 0 to 10 years age group, 41 to 50 years age
group, and 61 to 70 years of age group.

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Results
This table shows that HZO IR increased by 10-
year age group from 1994 to 2018.
▧ Age 1-10 : 4.8 cases per 100.000 person-
years
▧ Age 81-90: 131.6 cases per 100.000 person-
years
Compared with white patients, Asians showed
an IRR of 0.70, black patients, of 0.75, and
Hispanics of 0.64

Compared with the Northeast, the Midwest

showed an IRR of 0.80, the West of 0.71, and the
of 0.77.

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 Results

Male had a lower overall HZO IR ratio compared to female

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 DISCUSSION

Before ACIP After ACIP

1994-2018 2008 2008

▧ HZO IRs were ▧ Stabilized in 21-30 years

▧ HZO IR increased
decreasing in of age.
3.6% per year,
using a large children between 0 ▧ Increased but less
United States to 10 years of age significant at 31-60
administrative real- and increasing in years of age
world data set. all older age
groups

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 DISCUSSION
Children <10 years Weinmann et al (2019)
▧ 1994-2007 : incidence ▧ HZ incidence declined by 72% in 0-
decreased 17 years of age, in a multi-database
▧ 2008-2018 : decreased study (2003-2014) in which
includes varicella vaccination.
more tremendously
Harpaz R, Leung JW (2019)
▧ It is reported by CDC among 60
years patients group there is
deceleration in HZ cases.
▧ Increase HZ rates in middle-aged
groups (35-55 years old)

Liesegang TJ (2008), Goldman

Chan et al (2015)
▧ HZO case increase in <50
years old from 16,2%
(1996-2004) to 29,6%
(2005-2012)
Reynolds et al (2008)
GS (2005), Civen et al (2009),
Donahue (2010) ▧ Incidence also increased in
▧ Intermittent exposure to wild- non vaccinated country 
there might be other
type varicella  escalate
factors
natural immunity
▧ Vaccination  when
immunity fades virus
reactivation

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 DISCUSSION
Dooling et al Borkar et al
Vaccination (2018), Policy
(2018)
statement (2018)

Is it still FDA approved RZV in Among non-Pacific

reccomended 2017, for adults without Islanders, occurrence
after continuous contraindications. of HZO is more
common, without
rising in the age AAO also approved the further
group of 31-60 vaccination along witth differentiation by
year old? FDA race and ethnicity..

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Kawai et al (2016), Johnson
et al (2015), Yawn et al
(2007)
The risk of HZO in women
and white patients are
higher.
DISCUSSION
Lu et al (2017) Reynolds et al (2008)
Hypothethical correlation Another hypothetical
between HZO and correlation between HZO
geographic region and geographic region
▧HZO rates were highest ▧ Possibly there is
in Northeastern US and association between
lowest in West  HZ risk and UV
possibly because ZVL exposure, but there is
coverage little information
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 Critical
Appraisal

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Is the background of the study clearly
stated?

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What is the main problem of this research?
Incidence Rate of Herpes Zoster Ophthalmicus is not reported in
the previous studies, meanwhile the reports from CDC shows
continous rising of Herpes Zoster cases in adults through 2016.
HZO may contribute to the reduction quality of life.

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What is the objective of this research?
To analyze incidence rate of Herpes Zoster Ophthalmicus and the
difference by age, gender, race, and region

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How is the study population selected?
All enrolled data in between 1st January 1994 through 31th
December 2018 using the codes from International Classification
of Diseases (ICD) 9th and 10th edition were taken in this study.

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Were objective and unbiased outcome criteria
used ?

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Are procedures for sampling within this
population clearly defined?

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 VALID

APPLICABL
E IMPORTANT

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THANK YOU

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