Assessment of burden of illness due to herpes zoster and predictors of outcomes in Taiwan: a prospective observational study
Journal
International Journal of Infectious Diseases
Journal Volume
16
Date Issued
2012-06
Author(s)
Abstract
Background: Herpes zoster (HZ) is caused by the re-activation of latent varicella-zoster virus and is characterized by unilateral, vesicular cutaneous eruptions. Acute neuritis and post-herpetic neuralgia (PHN) are frequently debilitating, resulting in reduced quality of life (QoL). This study assesses the burden of illness associated with HZ in Taiwan in a real-life clinical setting. Methods: This was a prospective, observational, single-cohort study. Patients were enrolled at various time points during the course of a zoster episode and were followed for ≤6 months. HZ-associated pain (ZAP) was assessed with the Initial Zoster Impact Questionnaire and the Zoster Brief Pain Inventory. QoL was assessed with the EQ-5D instrument using the Japan preference weights. Results: The cohort comprised 150 HZ patients with a mean (SD) age of 64.9 (9.2) years and equal gender distribution. At baseline, mean (SD) time since rash onset was 18.8 (78.3) days. At the prodrome phase, a significant proportion (63.9%) of patients experienced a worst pain score of ≥5. ZAP was reported by 147 (98%) patients at baseline. Mean (SD) worst pain score decreased from 6.0 (3.1) at baseline to 2.7 (3.0) at 30 days and 0.3 (0.8) at 180 days. PHN (worst pain ≥3 after ≥90 days since rash onset) was experienced by 28 (18.7%) patients. The mean (SD) EQ-5D score significantly decreased (P<0.001) from 0.91 (0.16) before rash onset to 0.67 (0.18) after rash onset, increasing thereafter, showing significant (P<0.05) QoL deterioration up to 60 days post-rash onset. Acute pain severity (worst pain) and days of pain at rash onset were significant predictors (P<0.001) of poorer QoL at follow-up upon adjusting for QoL before rash onset. Furthermore, acute pain severity and duration interfered significantly (P<0.05) with all EQ-5D health domains –mobility, self-care, usual activities, pain/discomfort, anxiety/depression. Conclusion: HZ pain can significantly reduce QoL and ability to perform daily activities of people living in Taiwan. Severity and duration of acute pain at rash onset were identified as robust predictors of poor patient QoL. These findings are consistent with observational studies in other countries.
SDGs
Type
journal article