Herpes Zoster–Related Hospitalizations and Expenditures Before and After Introduction of the Varicella Vaccine in the United States

Herpes Zoster–Related Hospitalizations and Expenditures Before and After Introduction of the Varicella Vaccine in the United States

Opportunistic and other infections have declined since the introduction of highly active antiretroviral therapy (HAART) in developed countries but few studies have addressed the impact of HAART in HIV-infected children from developing countries. This study examines the prevalence and incidence of opportunistic and other infections in Latin America during the HAART era. We investigated the incidence of VZV complications in the Dutch general practitioner (GP) practices and pharmacies in a retrospective population-based cohort study (2004-2008) based on longitudinal GP data including free text fields, hospital referral and discharge letters from approximately 165,000 patients. When non-reactive in one assay, the final visit samples were tested to determine the incidence rate. We searched for diagnoses of herpes zoster (using the International Classification of Diseases, Ninth Revison, Clinical Modification codes starting with 053) in all 15 diagnostic-code fields included for hospital discharges in the Nationwide Inpatient Sample during 1993–2004. Several studies have been performed in some Middle Eastern countries. The high variability of HSV-2 shedding in infected individuals and the complex dynamics of prolonged shedding episodes are poorly understood, though such knowledge is needed to refine therapeutic approaches for treating HSV-2 infection and to eventually develop an effective HSV-2 vaccine.
Herpes Zoster–Related Hospitalizations and Expenditures Before and After Introduction of the Varicella Vaccine in the United States

Secondary outcomes included mean charges for HZHDs and the distribution of total charges for HZHDs by expected primary payer. After enrollment, the overall incidence was 23.5 per 100 person-years; the most common infections (per 100 person-years) were bacterial pneumonia (7.8), varicella (3.0), dermatophyte infections (2.9), herpes simplex (2.5), and herpes zoster (1.8). All of these incidence rates were higher than those reported in PACTG 219C. The incidence increased with age; 32.8 per 10,000 for 65 year olds. After lowering the cut-off for the Kalon assay to 0.66 early infections were detected without impairing its specificity. Hospital charges for HZHDs overall increased by more than $700 million annually by 2004; in particular, we found that the herpes zoster vaccine–eligible population (ie, persons aged 60 years or older) accounted for 74% of the total annual hospital charges in 2004. Only 50, 44, and 61 KS cases were reported in the National Cancer Registry in 2004 [27, 28], 2005 [27] and 2006 [27, 28] respectively, and 101 new cases have been registered in Tehran Population Based Cancer Registry from 1998-2002 [27, 29].

To help them gain insights into the biology of the highly heterogeneous shedding episodes that define chronic, untreated genital herpes, Schiffer et al. AS the rates of VRHDs and the associated charges have decreased, there has been a significant increase in HZHDs and associated charges, disproportionately among older adults. Eligibility for this analysis was limited to vertically infected participants in the NISDI pediatric study.

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