Abstract
Purpose :
The incidence of herpes zoster ophthalmicus (HZO) may be increasing, however the impact of the SARS-CoV2 pandemic (COVID) on HZO epidemiology is unclear. This study seeks to determine the variation in the incidence of HZO over the past 6 years with a special focus on its correlation with overall systemic herpes zoster (SHZ) incidence and HZO monthly and seasonal changes before and after the onset of COVID.
Methods :
This is a hospital-based epidemiology study of patients attending Duke University Hospital System (DUHS) between 01/2016 and 10/2021 via Duke Enterprise Data Unified Content Explorer (DEDUCE) data with corresponding ICD codes for HZO and SHZ diagnosis. The analysis calculated monthly incidence of novel consults of HZO and SHZ with emphasis on demographics, seasonal variation, and the changes in rates with the COVID pandemic (estimated to impact DUHS population starting in 03/2020).
Results :
24896 patients presented with SHZ at DUHS in the study period, of whom 2921 (11.7%) suffered from HZO. The mean age at the incident episode of HZO was 62.8±15.6 years. Most patients were white (78%), female (63.5%), above 50 years old (79.5%) and non-smokers (61.5%). Over the study period SHZ experienced an overall decline in its incidence, however HZO incident cases have been slightly increasing with a mean of 37/month in 2016, 47/month in 2019, and 50/month in 2021. The ratio of monthly incidence HZO/SHZ demonstrates a steady increase from an annual 9% in 2016 to 13.4% in 2019 and 15.5% in 2021. Interestingly, HZO annual peak incidence steadily emerged in the months of November and February throughout all the years. Since COVID onset, the mean monthly incidence of SHZ decreased significantly (373.1 +/- 35 vs 312.1 ± 28, p<0.0001). However, the mean monthly incidence of HZO exhibited a statistically significant increase (39.5 ± 10 vs 46.7 ± 16; p=0.025). Likewise, the trendlines of HZO/SHZ exhibited a significant increase since COVID (10.6% ± 4.6 to 15.1% ± 2.7; p<0.0001).
Conclusions :
These study findings point that HZO incidence may be increasing, despite an overall lower SHZ incidence, which may suggest a distinct mechanism for HZO appearance despite vaccination efforts. A specific seasonal variation with winter peaks was observed, which should guide physicians towards early recognition of HZO. COVID, directly or indirectly, may have accelerated the already increasing HZO incidence.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.