Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

  • Liang-Kung Chen1, 2Email author,
  • Hidenori Arai3,
  • Liang-Yu Chen1,
  • Ming-Yueh Chou2, 4,
  • Samsuridjal Djauzi5,
  • Birong Dong6,
  • Taro Kojima7,
  • Ki Tae Kwon8,
  • Hoe Nam Leong9,
  • Edward M. F. Leung10,
  • Chih-Kuang Liang2, 4, 11,
  • Xiaohong Liu12,
  • Dilip Mathai13,
  • Jiun Yit Pan14,
  • Li-Ning Peng1, 2,
  • Eduardo Rommel S. Poblete15,
  • Philip J. H. Poi16,
  • Stewart Reid17,
  • Terapong Tantawichien18 and
  • Chang Won Won19
BMC Infectious DiseasesBMC series – open, inclusive and trusted201717:213

DOI: 10.1186/s12879-017-2198-y

Received: 5 March 2016

Accepted: 9 January 2017

Published: 15 March 2017

Abstract

Background

Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.

Methods

We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.

Results

From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand.

HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation.

Conclusions

Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.

Keywords

Asia-Pacific Complications Epidemiology Healthcare burden Herpes zoster Immunisation Management Post-herpetic neuralgia Prevention Vaccine

Background

Herpes zoster (HZ) is a prevalent and debilitating viral disease that often causes serious complications and proves challenging to treat. Consequently, HZ results in substantial morbidity, healthcare expenditure, loss of productivity, and diminished quality of life (QoL). Older people bear the greatest burden of disease, which is increasing as populations age. Despite a strong rationale for prevention, availability of an effective vaccine, and guidelines recommending HZ immunisation, vaccination has not become routine practice. One reason was limited availability of HZ vaccine after its launch in 2006 [1, 2]. Although an ample supply was restored, a fundamental barrier in Asia is long-standing neglect of preventive adult healthcare. Since Ilina Isahak highlighted this issue in 2000 [3], progress been limited and adult immunisation is still not given the priority that it merits [4, 5, 6]. Moreover, existing HZ immunisation guidelines are based on evidence from Western populations, which creates a perceptual barrier to changing management practices in Asia. Conversely, more locally-relevant data may promote guideline implementation; however, many Asian countries lack such data [7]. To address these concerns, we systematically reviewed literature on HZ from the Asia-Pacific region. Our objectives were: 1) To provide a comprehensive overview of the epidemiology, burden, and current management of HZ; 2) To disseminate best practice in HZ immunisation; and 3) To provide an up-to-date source of reference and information for stakeholders concerned with reducing the burden of HZ in Asia-Pacific. This review summarises our key findings and recommendations.

Methodology

Literature search strategy

We reviewed literature on HZ published over 21 years by authors from 14 Asia-Pacific countries. We searched three databases: PubMed (United States [US] National Library of Medicine National Institutes of Health), Scopus (Elsevier), and the World Health Organization (WHO) Global Health Library Regional Indexes. PubMed and Scopus searches used the search term ‘zoster’ in title, abstract, and author keywords fields, AND the term ‘country name’ in the affiliation field. The countries/regions were: Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam OR Viet Nam. WHO searches used the terms ‘country name’ AND ‘zoster’. Searches were limited to articles with abstracts in English published electronically since 1 January 1994 and before 31 December 2014; alerts were set to capture eligible articles added to PubMed and Scopus after the initial search dates.

We performed separate internet searches for guidelines on HZ immunisation. These used the country names and also vernacular terms for their inhabitants, eg, Thai, Filipino, Malay, combined with the terms herpes zoster, guidelines, recommendations, adult immunisation, vaccine, vaccination.

Data management

PubMed and Scopus results were downloaded in Comma Separated Value format then saved to Microsoft Excel files. WHO Global Health Library searches were exported as text files then imported into Microsoft Excel. Results from each database were screened to remove duplicates before entering the results for each country into a Microsoft Excel workbook. Duplicates between databases were identified by using conditional formatting to highlight entries with the same title. Duplicates between countries were identified similarly, by highlighting entries with the same database identity codes.

Inclusion and inclusion criteria

We included articles about four topics: epidemiology and burden; complications and comorbidities; management and prevention; and recommendations/guidelines. We excluded articles about: subjects only younger than 18, or from another country; primary varicella zoster virus (VZV) infection or not specifying that VZV infection was reactivated; negative disease associations, cases of coincidental HZ, or diseases other than HZ; extraneous research topics, eg, basic/molecular/experimental, diagnosis, technology; or reviews without country-specific information. Miscellaneous exclusions were editorials, correspondence or errata concerning included articles; study protocols, and articles on terminology, hypotheses, non-human subjects, or knowledge, attitudes and behaviour relating to HZ and its treatment.

Literature search results

The database searches returned 4007 articles (Fig. 1a). Having excluded 1493 duplicates and 1264 non-relevant articles, 1250 were assigned to four categories: epidemiology and burden (421); complications and comorbidities (538); management and prevention (287); and guidelines (4) (Fig. 1b). The separate search for guidelines found recommendations on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, Taiwan, and Thailand.
Fig. 1

a Literature search and selection; b) Included articles by country and topic. WHO-GHL, World Health Organization Global Health Library

‘Grey literature’ included other key studies/data cited in retrieved articles or not stored in the searched databases, eg, national statistics or reports published locally; 16 such sources were added.

Clinicopathology

Herpes zoster is caused by reactivation of VZV dormant in nerve root ganglia since a primary varicella infection (Chickenpox). The cardinal symptom is neuropathic pain, often accompanied by a self-limiting vesicular rash and/or inflammation disclosing the source nerve [810]. In Asia, as elsewhere, the classic presentation is unilateral HZ affecting a single thoracic dermatome, although HZ frequently involves the trigeminal, cranial, or cervical nerves; lumbosacral HZ is less common (Fig. 2) [1131]. The presentations and course of HZ also vary depending on patients’ age, health, and immune status. Older people are more likely to have trigeminal VZV reactivation and worse and longer-lasting rash and pain [20, 32], whereas immunocompromised patients tend to have relatively more thoracic HZ [14, 33]. All physicians should therefore beware that HZ assumes an array of guises.
Fig. 2

Nerve branches affected by herpes zoster. HIV+, human immunodeficiency virus positive; HSCT, haematopoietic stem cell transplant

Atypical HZ

Reactivated VZV can affect any part of the body. Ocular symptoms due to involvement of the ophthalmic division of the trigeminal nerve are common [34]; however, the maxillary and mandibular branches may occasionally be affected, resulting in oro-cutaneous manifestations [35, 36]. Atypical presentations usually reflect underlying immunocompromise, and other unusual locations have included the eardrum [37], genitalia [38, 39], papilla [40], and finger [41].

Zoster sine herpete

VZV reactivation does not always manifest cutaneously. Zoster “sine herpete” causes unexplained pathologies, including neuralgia [42], ocular [43], facial [44], or neuromotor palsy or paralysis [45, 46], and cerebral or ocular inflammations [47, 48].

Multidermatomal, disseminated and visceral HZ

Rarely, especially in patients who are elderly or otherwise immunocompromised, HZ involves two or more distinct dermatomes [49, 50], spreads across multiple sites [51, 52], appears as a generalised rash [53, 54], or worse, affects internal organs [9, 10]. Although occasionally seen in immunocompetent individuals [5564], such unusual presentations constitute fewer than 1% of total cases, being particularly characteristic of iatrogenic immunosuppression in transplant recipients [65, 66] or cancer patients [6771], or human immunodeficiency virus (HIV) infection, in which bilateral [72, 73], multidermatomal [74], disseminated [75], or recurrent [73, 76, 77] HZ are often the presenting symptom [72, 7880].

Disseminated HZ predicts higher risk of complications [81] and may portend abdominal HZ, which has high mortality despite antiviral therapy, especially in profoundly immunocompromised patients [9, 10, 82]. For example, haematopoietic stem cell transplant (HSCT) recipients have died of fulminant VZV hepatitis [83, 84]. Such patients may present with severe abdominal pain [82, 8587] either sine herpete or before lesions appear [9, 10]. Besides hepatitis, viscerally disseminated HZ may also cause pancreatitis [88, 89], colitis [90], pneumonitis [91, 92], or pneumonia [69, 93], which causes most fatalities [10].

Pain

Irrespective of its outward appearance, pain is the hallmark of HZ in adulthood. Acute pain and post-herpetic neuralgia (PHN) are its most unbearable and debilitating symptoms and severely impair QoL and everyday activities [15, 18, 20, 30]. Pain is notoriously challenging to manage, especially once established, making this the most compelling reason for early intervention [9, 25, 94, 95].

Almost all adult HZ patients suffer pain, which can be excruciating and is often described as the worst ever experienced [10, 96]. Many cases are presaged by prodromal neuralgia or malaise, with abnormal sensations such as itching, paraesthesia and hyperaesthesia [10, 18]. In India, Korea, Singapore and Taiwan, around two-thirds of patients reported prodromal pain, which more than 90% rated moderate-to-severe [18, 20, 25, 31]. Among 150 Taiwanese patients, 98% had acute pain at enrolment (87% moderate-to-severe) [20]; similarly, 95% of Indian and Singaporean patients experienced pain during the course of disease [12, 18]. Pain is more frequent and severe in older patients and can have devastating impacts; patients feel anxious and miserable, have disturbed sleep and cannot work normally or enjoy life [10, 12, 15, 18, 20, 25, 30]. Besides age, the severity and duration of acute herpetic pain correlates with the degree of prodromal pain, the severity of skin lesions, trigeminal/ophthalmic involvement, anxiety or depression, and comorbid disease [23, 32, 33, 97100].

Epidemiology and risk factors

Seroepidemiology

The aetiologic prerequisite of HZ is prior VZV infection, which most people contract in childhood, unless vaccinated preemptively [2, 7, 101, 102]. Although acquisition may be delayed in tropical climes, around 90% of adults age 30–39 in Asia-Pacific countries/regions have seroconverted, with almost all aged ≥40 years VZV seropositive and therefore at risk of HZ (Fig. 3) [7, 103135].
Fig. 3

Ages of varicella zoster virus seroconversion among adultsa in tropical, subtropical and temperate Asia-Pacific countries. NIID, National Institute of Infectious Diseases, Japan. a Reported seroprevalence in age-groups including individuals ≥18 years old

Incidence

HZ is very common in the Asia-Pacific region. Alike Western populations, estimated lifetime risk is approximately one-third [10, 136], and incidence of 3–10/1000 person-years (PY) rises steeply above age 40 and peaks between 70–80 years (Table 1, Fig. 4); there is female predominance in diverse Asia-Pacific populations, especially between ages 50–70 [11, 17, 26, 104, 126, 132, 133, 136144]. Authors ascribe higher age-specific incidence rates in Korea than other countries, to heavy use of state-insured healthcare by patients with mild HZ symptoms, besides being based on data from recent years during which HZ incidence has risen steeply [138, 140]; on the other hand, much lower incidence in Thailand [30, 144] probably reflects under-reporting.
Table 1

Herpes zoster incidence rates in Asia-Pacific

Country (source)

Study year(s)

HZ cases

Age range (years)

Incidence (cases/1000 person years)

Overall

By sex

Age-range (years)

 

Male

Female

<10

10–19

20–29

30–39

40–49

50–59

60–69

70–79

>80

Australia (MacIntyre 2003) [102]

1999

59200

All ages

8.3a

           

Australia (Stein 2009) [104](MacIntyre 2015) [807]

1998–2005

379

≥50

9.7a

  

1.4 (<25)

3.4 (25–49)

6.5

8.6

14.5

15.6

Japan (Toyama 2009) [139]

1997–2006

48388

0– ≥ 90

4.2

3.7

4.6*

2.5

2.9

2.3

2.0

2.5

5.2

7.0

7.8

6.9b

New Zealand (Reid 2014) [17]

2009–2013

339

All ages

3.0

5.8c

6.4c

1.3 (≤50)

   

13.9

Korea (Kim YJ 2014) [138]

2011

529690

0– ≥ 80

10.4

8.3

12.6

2.0

3.3

6.3

7.8

10.2

17.4

22.4

21.8

16.5

Korea (Kang 2008) [129]

2004–2005

705

19–24

1.4

   

1.4 (19–24)

      

Korea (Choi 2010) [130]

2003–2007

2431744

All ages

10.0d

           

Korea (Park SY 2004) [26]

1994–2003

1089

All ages

3.0

           

Thailand (Aunhachoke 2011) [30]

2008

180

≥50

0.3e

           

Taiwan (Wu PY 2013) [141]

2000–2009

 

All ages

6.2

           

Taiwan (Wu CY 2010) [142]

2000–2005

24527

20– ≥ 60

7.0

           

Taiwan (Chao DY 2012) [143]

2004–2008

7574

All ages

5.7

           

Taiwan (Jih 2009) [137]

2000–2006

34280

1– > 80

4.9

4.7

5.1

2.1

      

13.7

Taiwan (Lin 2010) [136]

2000–2005

672782

≤1– ≥ 80

5.0

4.7

5.2*

1.6

  

3.5

5.2

8.4

11.1

12.3

10.2

Median (range)

5.0f (0.3–10.4)

4.7 (3.7–8.3)

5.2 (4.6–12.6)

2.0 (1.6–2.5)

3.1 (2.9–3.3)

4.3 (2.3–6.3)

3.5 (2.0–7.8)

5.2 (2.5–10.2)

7.4 (5.2–17.4)

9.8 (7.0–22.4)

13.4 (7.8–21.8)

13.8 (6.9–16.5)

Quartile range (IQR)

3.6–7.3 (3.7)

4.7–5.8 (1.0)

5.1–6.4 (1.3)

1.9–2.2 (0.3)

3.0–3.2 (0.2)

3.3–5.3 (2.0)

2.7–5.7 (2.9)

3.9–7.7 (3.8)

6.8–12.9 (6.1)

9.0–16.8 (7.7)

10.1–17.1 (7.0)

10.2–13.9 (3.7)

HZ Herpes zoster, IQR Interquartile range

aNational estimate extrapolated from sample

b80–89

cAge >50 years

dClinic visits for herpes zoster

e Based on reported cases per 100000 population

fSubjects of all ages

*P < 0.001

Bold data values signify significant difference between incidence rate in females vs. males

Fig. 4

Age-specific incidence of herpes zoster in Asia-Pacific countries. NZ, New Zealand; ♀, female; ♂, male

As in other populations, HZ incidence rates are increasing in countries across Asia-Pacific (Table 2, Fig. 5) [2, 102, 139150]; the principal cause is most likely rising incidence in ageing populations, especially among women, together with growing prevalence of chronic diseases and use of immunosuppressive medications [2, 102, 139141, 143, 147]. HZ incidence in Taiwan rose by 20% from 2004–05 to 2006–08 despite remaining stable in 10–49 year-olds, with a significant increase in older people [143]. Hypothetically, mass varicella immunisation might also contribute to this trend; if natural exposure to VZV strengthens immunity to HZ – exogenous boosting – HZ incidence in countries that institute routine childhood varicella immunisation (Table 3) would be expected to rise subsequently among the unvaccinated population, due to declining prevalence of varicella [2, 141, 146, 151, 152]. Although there is some evidence that exogenous boosting does occur [151], there is very little for a substantive contribution to HZ, and its role, if any, in HZ epidemiology remains obscure [2, 141, 143, 146, 147, 151, 152]. Rising HZ rates predating mass varicella immunization (Fig. 5) suggest that other factors are more important; besides those already mentioned, these may also include changes in health-seeking behaviour and more comprehensive and accurate disease surveillance [151, 152].
Table 2

Trends in herpes zoster incidence, hospitalisation and healthcare costs in Asia-Pacific countries

Country (source)

Metric

Years compared

Herpes zoster rate

Annual increase (%)

Australia (Kelly 2014) [146]

Cases/1000 consultations

1998

2006–12

1.03

1.81

6.3

Australia (Nelson 2010) [145]

Management/1000 GP consultations

1998

2008

1.71

2.35

3.4

Australia (MacIntyre 2003) [102]

Hospitalisations/100000 population

1993

1998

20

25

4.2

Australia (Carville 2010) [147]

Hospitalisations/100000 populationa

1995–99

2006–07

6.3

9.1

3.1

Australia (Heywood 2014) [2]

Hospitalisations/100000 population

1998

2004

2006–10

9.2

10.6

10.4

2.2

−0.4

Korea (Choi 2010) [130]

Hospitalisations/1000 population

2003

2007

0.22

0.32

9.1

Consultations/1000 population

2003

2007

7.93

12.54

11.6

Total socioeconomic cost (US$)

2003

2007

75,921,348

143,774,888

17.9

Japan (Toyama 2009) [139]

Incidence/1000 person-years

1997

2006

3.61

4.55

2.6

Taiwan (Lin 2010) [136]

Healthcare cost (NT$)

2000

2004

250,000,000

319,000,000

5.5

Taiwan (Wu CY 2010) [142]

Incidence/1000 population

2000

2005

4.94

7.00

7.0

Taiwan (Chao DY 2012) [143]

Incidence/1000 population

2000

2008

4.45

6.89

6.1

Taiwan (Wu PY 2013) [141]

Incidence/1000 person-years

2000

2009

4.40

6.24

5.5

Thailand (Bureau of Epidemiology)

Reported cases/100000 population

2001

2010

2014

6.44

40.49

7.65

52.9

−8.1

Median (range)

5.5 (−8.1–17.9)

Quartile range (IQR)

3.0–7.5 (4.6)

GP General practitioner, IQR Interquartile range

aPrincipal diagnosis of herpes zoster

Fig. 5

Trends in herpes zoster rates in Asia-Pacific countries. a Consultations. b Reported cases

Table 3

Asia-Pacific countries with national varicella immunisation programmes

Country

Varicella vaccine schedule

Planned extent of coverage

Programme commenced (month, year)

Dose(s)

Age

Australia

1

18 months, with catch-up at 10–13 yearsa

Entire population

November 2005

Hong Kong

2

12 months & 6 yearsb

Entire population

November 2005

Japan

2

12–36 months

Entire population (voluntary category)c

October 2014

New Zealand

1

15 months, with catch-up at 11 yearsd

Entire population

July 2017

South Korea

1

12–15 months

Entire population

January 2005

Taiwan

1

12–18 months

Entire population

January 2004

aSchools programme

bPrimary 1 school age

cNot covered under the Preventive Vaccinations Act for Routine Vaccination against Category A Diseases

dFor non-vaccinated children who have not already had a varicella infection

Recurrence

Reported HZ recurrence rates range from 2.3% to 8.0% overall [13, 153, 154] and are higher in women, immunocompromised patients, and individuals aged 50–70 or with PHN [153].

Risk factors and comorbidities

The constitutional cause of HZ is failing cell-mediated immunity (CMI) that becomes too weakened to suppress latent VZV [155]. CMI wanes naturally with age [156], explaining why advanced age is the preeminent risk factor for HZ and PHN among all populations [10, 95]. Besides immune senescence, other conditions that diminish CMI likewise increase the risk of HZ. The principal predisposing factors are iatrogenic or pathologic immunosuppression (Fig. 6) [137, 157167]. Inpatients with severe illnesses or recovering from surgery develop HZ more frequently than others [168].
Fig. 6

Relative risk of herpes zoster in different predisposing conditions. PD, peritoneal dialysis; HD, haemodialysis; CKD, chronic kidney disease; SLE, systemic lupus erythematosus; RA, rheumatoid arthritis; IBD, inflammatory bowel disease; COPD, chronic obstructive pulmonary disease; HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome

Immunosuppressant therapies

Transplantation

Organ, tissue or cell transplant recipients require immunosuppressive therapy with cyclosporine and/or other drugs that prevent transplant rejection. Consequently, they often develop HZ or other opportunistic infections, especially within the first year following transplantation [16, 66, 169180]. HZ rates of up to >80% have been reported [170, 181], and transplant recipients are especially prone to disseminated and visceral HZ with potentially fatal inflammatory complications [70, 82, 181186].

Anti-inflammatory and cytotoxic agents

Corticosteroids

Systemic glucocorticosteroids are immunosuppressant and have been associated with HZ rates above 30% in long-term use [187189].

Cyclophosphamide and others

Cyclophosphamide-based and other chemotherapeutic regimens substantially increase the risk of HZ in patients with lymphoma [190192]. High rates have also been reported in leukaemia patients treated with arsenic trioxide [193196]. Systemic lupus erythematosus (SLE) and lupus nephritis are also treated with cyclophosphamide, often combined sequentially with azathioprine and prednisolone or mycophenolate mofetil. HZ is the most common drug-related infection, with rates of up to 40% [166, 197201].

HZ is also an adverse effect of azathioprine and mycophenolate mofetil in SLE and other therapeutic settings [202214]. Cases of disseminated HZ have occurred in rheumatoid arthritis patients treated with leflunomide, with increased risk in those taking concomitant methotrexate and corticosteroids [215, 216]. HZ was the most common infection in leflunomide-treated lupus nephritis [217]. The multiple sclerosis drug cladribine is associated with an increased rate of HZ versus placebo [218].

Biologic agents

Antibody therapies for cancer, transplant rejection and other conditions are associated with elevated rates of VZV reactivation, both alone and combined with other biologics or chemotherapies. These include alemtuzumab [219], rituximab [220224], and abatacept [225]. Tofacitinib is associated with significantly higher rates HZ in Asians than other races [226, 227]. Increased relative risk of HZ has also been reported with ustekinumab, adalimumab and infliximab [165, 228230].

Bortezomib Bortezomib directly impairs CMI and is an independent risk factor for HZ [166], with incidence of up to 40% in some Asia-Pacific studies [231250]. HZ prophylaxis is advisable before commencing such therapy [251].

Other iatrogenic risk factors

Trauma

Accidental or iatrogenic trauma can trigger HZ [252258]. This is particularly associated with ocular, facial or dental surgeries [259268], and heightened vigilance is warranted following such procedures, particularly in elderly or immunocompromised patients. Ironically, neurosurgical treatment of PHN occasionally causes HZ [269271].

Anaesthesia

General anaesthesia may compromise immune function, and mothers anaesthetised for caesarean delivery have a small increased risk of HZ during the following year [272].

Statin therapy

Statin users have slightly increased risk of HZ, likely due to statin-mediated immunosuppression [273, 274].

Drug-induced hypersensitivity syndrome

Drug-induced hypersensitivity is a severe reaction to certain drugs that involves the reactivation of herpes viruses, including VZV. Systemic corticosteroids may contribute to this risk, and like immune restoration syndrome, withdrawal of corticosteroid may trigger HZ [275].

Infections

HIV/AIDS

HIV/Acquired Immunodeficiency Syndrome (AIDS) is a major healthcare problem in Asia. With prevalence of up to 30% and incidence as high as 40–50/1000 PY [276303], HZ is so common in HIV-infected individuals that it may be a pragmatic prognostic marker [14, 27, 28, 76], especially among younger individuals [304309]. AIDS patients may have recurrent [73, 76, 77, 80], disseminated [27, 78], or cerebral HZ infections [310, 311]. HZ incidence correlates with low CD4+ cell count [310, 312314] and may be significantly reduced by highly-active antiretroviral therapy (HAART); however rates in the post-HAART era remain double-digit [281, 303].

Immune reconstitution syndrome Paradoxically, patients regaining immunocompetence following HAART are at higher risk of HZ than when immunodeficient, probably due to increasing CD8 cell count, a phenomenon termed immune reconstitution inflammatory syndrome [315318].

Varicella zoster virus

Counterintuitively, Taiwanese healthcare workers frequently exposed to VZV did not gain enhanced immunological protection, and had higher incidence of HZ than the general population; however, this may be because their very stressful working environment dampened CMI, overriding any protective effect [142]. Epidemiology data from Japan [319] and elsewhere suggests that varicella exposure boosts immunity to HZ [102, 151]. Nevertheless, rare localised HZ clusters suggest that VZV re-exposure might occasionally provoke recrudescent HZ; the mechanism is unknown, but may involve disruption of CMI by the humoral response to VZV reinfection [320]. Although VZV transmission from patients with HZ is rare, due to less and more localised viremia, exudate from open HZ lesions may potentially infect close contacts who have not had varicella or been immunised [10, 320324].

Other pathogens

Rare cases of HZ associated with tuberculosis or malaria have been reported in China and India [325328].

Intrinsic risk factors

Pregnancy

Pregnancy is another immunosuppressed state that may potentiate HZ [120]. Although this seldom occurs, HZ is the most common skin infection that dermatologists encounter in pregnant women, accounting for up to 30% of cases [329]. While challenging to treat, unlike congenital varicella, HZ poses minimal risk to the foetus [330, 331].

Good’s syndrome

Good’s syndrome is a very rare immunodeficiency disease predisposing to HZ [332].

Nutritional deficiency

Micronutrient deficiencies that diminish CMI may increase susceptibility to HZ and PHN; supplements, particularly vitamin D, can boost VZV immunity [333335].

Genetic predisposition

Asians have genetic predispositions to HZ; specifically, human leukocyte antigen gene polymorphisms have been linked to VZV reactivation in East Asian populations [336338].

Associated diseases

Unsurprisingly, many HZ patients have common diseases of older age (Table 4), most frequently hyper-tension, diabetes, malignancies, and pulmonary disorders [11, 12, 15, 23, 26, 28, 137, 154, 166, 339]; however, since comorbidities and/or complications account for high proportion of hospitalised HZ cases [11, 12, 15, 23, 26, 28, 102, 104, 136, 137, 154, 166, 340], these may be more prevalent among such patients than in the general population.
Table 4

Common comorbidities of herpes zoster in Asia-Pacific patient populations

Country (source)

Setting (patient number)

Age profile (years)

Proportions with comorbidities (%)

Any

Hypertension

Diabetes

Malignancy

Pulmonary

Cardiovascular

Korea (Park SY 2004) [26]

Dermatology (1089)

NA

36.5

12.6

7.9

0.6

1.7a

1.6c

Korea (Kim YM 2008) [11]

Dermatology (297)

NA

56.2

32.1

17.5

10.4

7.5a

NA

China (Yuan LL 2014) [339]

Hospitals (2960)

Median 60

 

22.2

11.7

 

6.2b

10.7

Philippines (Jara 2010) [15]

Hospital (221)

Mean 43

28.0

13.6

 

1.8

8.1

2.7

Japan (Kurokawa 2002) [23]

Hospitals (263)

Mean 59

41.1

 

9.6

13.7

  

Thailand (Tunsuriyawong 2005) [154]

Hospital (339)

Mean 59

26.8

4.0

2.5

1.0

  

India (Abdul Latheef 2011) [12]

Hospital (205)

47% >40

14.6

 

5.3

9.2

  

Taiwan (Jih 2009) [137]

National (34380)

33% >60

  

20.6

2.7

  

Taiwan (Hu 2013) [166]

Hospital (2306)

 

24.3

  

14.8

  

Taiwan (Wu CY 2010) [142]

National (702932)

    

1.0

  

Japan (Kurokawa 2007) [28]

Dermatology (316)

 

42.1

4.1

6.6

15.2

  
  

Median (range)

32.3 (14.6–56.2

13.1 (4.0–32.1

8.8 (2.5–20.6)

6.0 (0.6–14.8)

6.9 (1.7–8.1)

2.7 (1.6–10.7)

  

Quartile range (IQR)

26.2–41.4 (15.2)

6.2–20.1 (13.8)

6.3–13.2 (6.9)

1.2–12.9 (11.7)

5.1–7.7 (2.6)

2.2–6.7 (4.6)

NA Data not available, IQR Interquartile range

aAsthma

bRespiratory infections

cAngina pectoris

Patients with certain underlying diseases have apparently increased risk of HZ; however, it may be difficult to ascertain whether such relationships are causal, reflect underlying pathology, or are coincidental. In cancer, SLE, and other diseases treated with immunosuppressants, HZ may be largely treatment-related, although the disease too may make an indeterminate contribution to increasing the risk [10]. In others, for example, diabetes and renal disease, impaired CMI may be a common factor. Adjusted for age and other confounding variables, several comorbidities have been identified as independent risk factors for HZ, most notably renal disease, malignancies, and SLE (Fig. 6) [137, 157167].

Renal disease

The incidence of HZ increases across the spectrum of renal disease, with transplant patients at highest risk followed by peritoneal dialysis and haemodialysis [157, 159, 160, 341343]. The risk of HZ in haemodialysis is heightened by corticosteroid use, but may be mitigated by iron and vitamin D supplementation [334, 335].

Inflammatory autoimmune diseases

HZ frequently afflicts patients with connective tissue disorders [344], with double the risk in rheumatoid arthritis [158]. Patients with SLE have impaired CMI and are treated with immunosuppressant anti-inflammatory drugs, which significantly increases their risk of HZ [137, 161, 345, 346], particularly if they have neuropsychiatric manifestations, renal involvement, or receive cyclophosphamide [166]. Likewise, increased risk of HZ associated with inflammatory bowel disease probably reflects iatrogenic immunosuppression in many patients [162, 347].

Cancer

Cancer patients may be immunosuppressed due to malignancy, its treatment, or both [12, 39, 348]. Risk of HZ is increased in both solid and haematologic cancers [158, 349, 350], especially leukaemia and lymphoma [137, 158].

Pulmonary disease

Both immune dysregulation and corticosteroid therapy may account for increased risk of HZ in chronic obstructive pulmonary disease. Patients taking oral corticosteroids are at the greatest risk [164].

Diabetes

Patients with diabetes have impaired VZV-specific CMI [351]; however, evidence that diabetes is a risk factor for HZ [137, 158, 352] is inconclusive.

Peptic ulcer disease

Peptic ulcer disease independently predicts HZ, having excluded confounding effects of anti-inflammatory drugs and Helicobacter pylori infection [163].

Psychiatric disorders

CMI is also diminished in psychiatric disorders. The risk of HZ is increased in patients with affective psychoses, neurotic illness, personality disorders and other mental disorders, especially among those younger than 60 [353].

Complicating presentations and disease associations

Post-herpetic neuralgia

The most common complication of HZ in adults everywhere is pain outlasting the eruptive phase [94]. Definitions of PHN are inconsistent, ranging from ≥1 to ≥6 months since rash onset; however, PHN may persist for years [10]. Reported rates vary widely, depending on patients’ age profiles and the definitions used [20]; nonetheless, the incidence generally ranges between ≤10 to ≥25%, with up to 20% still enduring pain after 6 months (Table 5) [11, 12, 15, 18, 20, 21, 23, 25, 26, 28, 30, 96, 104, 130, 137, 154, 340, 354359]. PHN correlates strongly with advancing age [15, 18, 21, 96, 102, 137, 340, 356, 357], the other major prognostic factors being the severity of HZ and intensity of acute pain [23, 99, 137, 356, 357, 360362]. Comorbid risk factors include diabetes, lymphoma/leukaemia, SLE [137, 363], peptic ulcer disease [364], and micro-nutrient deficiencies [333]. There is also evidence of specific phenotypic [358] and genotypic predispositions [365368]. Bortezomib may aggravate PHN independently of VZV reactivation [369].
Table 5

Herpes zoster complication rates in Asia-Pacific patients

Country (source)

Setting (number of patients)

Age profile (years)

Proportions with complications (%)

Post-herpetic neuralgia (months)

Ocular

Otic

Motor

Infections

≥1 overall

NS

≥1

≥3

≥6

   

Skin

LRT

 

Taiwan (Lin 2010) [136]

Hospitals (2.93% of 672783)

63% >40

52.5 (neurologic including PHN)

24.1

52.4

 

19.0

10.1

47.0

Australia (MacIntyre 2003) [102]

Hospitals (4718)

Mean 69

33.1 neurologic

16.0

   

58.5

Korea (Kim YM 2008) [11]

Dermatology (297)

NA

30.0

   

7.7

NA

1.4a

9.8

40.7

Korea (Lee 2006) [354]

Hospital (333)

NA

15.6

   

6.9

0.6

0.3a

1.5

NA

Korea (Park 2004) [26]

Dermatology (1089)

NA

7.4

   

3.2

0.2

0.4a

1.8

NA

Philippines (Jara 2010) [15]

Hospital (221)

Mean 43

  

2.3

 

5.0

  

6.3

12.2

Thailand (Aunhachoke 2011) [30]

Hospitals/tertiary centres (180)

Mean 59

  

19.4

 

7.2

    

Singapore (Oh 1997) [340]

Hospital (67)

Mean 50

13.4

   

5.0

  

61.0

85.0

India (Abdul Latheef 2011) [12]

Hospital (205)

47% >40

10.2

    

1.0

0.5

13.6

34.6

Australia (Stein 2009) [104]

General Practice (379)b

100% >50

15.0

   

16.2c

   

61.3c

Japan (Akiyama 2000) [454]

Hospital (1432)

Mean 54

      

0.8

  

India (Gopal 2010) [449]

Dermatology (100)

       

3.0

  

Korea (Son 2011) [448]

Hospital (711)

       

2.1

  

Korea (Min 2007) [418]

Dermatology (1787)

Mean 62

     

4.7

   

Korea (Kim SH 2008) [372]

Dermatology (1496)

     

8.7

    

New Zealand (Wallis 2014) [22]

General Practice (278)

55% >50

    

11.2

    

New Zealand (Reid 2014) [17]

General Practice (339)

71% ≥51

    

6.3

    

Thailand (Tunsuriyawong 2005) [154]

Hospital (399)

Mean 59

16.8

   

6.3

    

Singapore (Goh 1997) [18]

Dermatology outpatients (164)

Mean 49

 

50.0

28.0

17.0

     

Japan (Imafuku 2014) [359]

Dermatology (764)

Median 61

 

31.6

12.4

7.1

     

Taiwan (Tsai TF 2014) [20]

General Practice & Hospitals (150)

Mean 65

   

20.7

     

Korea (Song 2014) [25]

Specialist centres (151)

Mean 64

  

38.4

24.1

     

Japan (Kurokawa 2002) [23]

Hospitals (263)

Mean 59

   

26.2

     

Japan (Kurokawa 2007) [28]

Hospitals (316)

   

24.7

12.4

     

Korea (Cho 2014) [357]

Dermatology (305)

Mean 53

  

6.2

      

Taiwan (Jih 2009) [137]

National (34280)

33% >60

 

13.3

8.6

      

Korea (Choi 2010) [130]

Cancer screening (282)

  

17.7

       

China (Yang 2005) [355]

Dermatology (178)

NA

 

21.9

       

Korea (Herr 2002) [356]

Dermatology (188)

NA

 

17.0

       

China (Zhu 2009) [358]

Anaesthesiology (49)

Mean 65

 

20.4

       

Korea (Cheong 2014) [96]

National (11502)

100% >50

20.6

        

China (Song 2002) [21]

Dermatology (522)

Mean 47

6.9

        
  

Median (range)

17.0 (2.3–50.0)

7.2 (3.2–24.1)

1.0 (0.2–52.4)

0.8 (0.8–3.0)

10.0 (1.5–61.0)

47.0 (12.2–85.0)

  

Quartile range (IQR)

11.3–23.0 (11.7)

6.3–11.2 (4.9)

0.6–4.7 (4.1)

0.5–1.8 (1.3)

5.6–15.0 (9.4)

37.7–59.9 (22.3)

NS Not specified, LRT Lower respiratory tract, PHN Post-herpetic neuralgia, NA Data not available, IQR Interquartile range

aNeurogenic bladder

bIncident cases

cHospitalised patients

Neuropathy, inflammation and secondary complications

HZ causes multifarious complications, especially inflammatory sequelae, which affect up to half or more of hospitalised HZ patients. The most common besides PHN involve the skin, eyes or, less often, ear, nose and throat (Table 5) [11, 12, 15, 26, 30, 102, 104, 136, 340, 354]. Uncommon complications include muscular weakness or paralysis and serious – sometimes life-threatening – cerebral or visceral inflammation. Elderly or immunocompromised individuals are more frequently and often worse affected [30, 96, 340, 370].

Eye

The most common and severe complications stem from VZV reactivation in trigeminal ganglion, which is the most frequently affected non-spinal location [11, 12, 23, 26, 29, 34, 371]. In particular, HZ ophthalmicus (HZO) arising from the ophthalmic division accounts for 5% to 25% of HZ cases in Asia-Pacific countries [11, 15, 17, 22, 30, 102, 104, 136, 154, 340, 354] (Table 5). The majority of cases, especially those accompanied by nose eruptions (Hutchinson's sign) [372375], are complicated by secondary inflammation such as conjunctivitis, keratitis [376378], scleritis, and uveitis/iridocyclitis [372374, 379381]. Such complications can cause glaucoma and are potentially blinding, especially if not treated promptly [379, 382]. However, inflammatory sequelae may not manifest until some time after an HZ episode [383]. Early and intensive antiviral therapy is particularly important for patients with HIV/AIDS, who tend to have worse and treatment-refractory inflammation, with resultant vision loss [384386].

Molecular diagnostic techniques have revealed VZV reactivation to be a predominant cause of anterior uveitis in South and East Asian countries [387389], with significantly increased risk within 1 year following HZ, especially HZO [390]. VZV is also a major cause of acute retinal necrosis [391397] in the region, and of progressive outer retinal necrosis, which is usually seen in severely immunocompromised patients [398402]. Both conditions have particularly poor visual outcomes, even when treated appropriately [375, 391, 392, 397, 399, 403407].

Less common ocular complications include, corneal endotheliitis [408], retinochoroiditis [381], optic neuritis [409411], oculomotor palsy [371], dacryoadenitis [412, 413], superior orbital fissure syndrome [414], orbital apex syndrome [415, 416], and central retinal vein occlusion [417].

Ear, nose and throat

Occasionally, VZV reactivation in the facial nerve genicular ganglion causes HZ oticus (Ramsay Hunt syndrome) [418, 419]. Patients often have multiple neuropathies and diverse symptoms, depending on the cranial and facial nerve branches involved. As elsewhere, the characteristic triad is facial palsy, auricular rash and ear pain [418, 420422]; however, some cases affect the tongue, soft palate, or throat [423, 424], and the rash may precede facial paralysis, not appear until afterwards [420], or be absent [424]. Many patients experience hearing loss and vestibulo-cochlear symptoms such as tinnitus and vertigo [418, 420, 425, 426]. The seventh and eighth cranial nerves are most commonly affected [420, 427], but many atypical cranial neuropathies have also been identified [428431]; Ramsay Hunt syndrome has been associated with dysphonia [46, 424, 429, 432, 433], laryngitis [434, 435], loss of taste [436], chronic cough [437], hiccups [435, 438], dysphagia [46, 424, 429, 439], and persistent vomiting [438]. Other rare complications include jugular foramen syndrome [440] and non-facial neuromotor deficits [441]. In addition to Ramsay Hunt syndrome, zoster sine herpete is increasingly recognised as a major aetiologic factor in idiopathic Bell’s palsy [442444] and Ménière's disease [445, 446].

HZ oticus generally responds to prompt antiviral therapy, with good outcomes [421, 430]; however, half of patients may not recover fully from facial palsy [420, 421], with even lower rates among those who are older [427], have multiple cranial neuropathies [420], or are not treated [419]. The diversity of manifestations, often occurring sine herpete, creates potential for misdiagnosis [419]. It is vital for clinicians to remain alert to the possibility of HZ, so that treatment can begin early enough to avoid potentially life-threatening sequelae of VZV reactivation in the head and/or neck [438, 447].

Neuromuscular

Fewer than 5% of HZ cases in Asian patients cause motor neuropathy [448450]. Though more common in the elderly or immunocompromised [450, 451], such complications also affect immunocompetent individuals [452, 453]. Among 711 Korean HZ patients, 2.1% had neuromotor weakness, predominantly affecting cranial rather than spinal nerves [448]. The incidence was 0.8% among 1432 Japanese patients [454] and 3% in an Indian cohort [449]. Such complications may arise before skin lesions appear and are likely underdiagnosed because they are masked by overriding pain [455, 456]; they may also occur some time after HZ onset [452, 457, 458]. Other presentations include gastrointestinal or bladder dysfunction [10], myelitis [450, 459461], and myositis [462]. VZV infection is implicated in the aetiology of Guillain-Barré syndrome [463465].

Face and eye

VZV reactivation is a common cause of Bell's palsy [466]. HZO may present as orbital myositis preceding skin eruptions [462], and sometimes causes complete ophthalmoplegia [467472].

Limbs

Paresis of the ipsilateral shoulder or arm [473477], occurs in 3–5% of HZ cases, but is underdiagnosed [478, 479]. Some cases are due to brachial plexopathy [480, 481], and others to Brown-Séquard hemiplegia [460, 482]. Lower limb neuropathy may manifest as foot drop [449, 483], and HZ paresis-induced femoral fracture has been reported [484].

Trunk and abdomen

Cervical myelitis can cause diaphragmatic paralysis with resultant dyspnoea [457, 485487]. Segmental paresis may cause abdominal protrusion or pseudohernia [488492], which are associated with gastrointestinal complications, notably constipation due to intestinal pseudo-obstruction or colonic ileus [488, 493496].

Lumbosacral

Voiding dysfunction associated with sacral HZ is uncommon but not rare, especially among immunocompromised patients [497]. The incidence among 423 Taiwanese HZ patients was 4% overall, and 29% among those with lumbosacral HZ [498]. Urinary problems include neuropathic bladder [499], loss of voiding sensation [500] and occasional acute urinary retention [461, 501503]. Other complications include faecal incontinence [504] rectal ulcer [505] and sciatica [506].

Vasculopathy

Though rare, vasculitic cerebral inflammation is the most serious neurologic complication of HZ; VZV from intracranial branches of the trigeminal nerve that invades and inflames the carotid artery or its branches, may cause fatal strokes [9, 10].

Cerebrovascular

Cerebral arteritis arising from HZ, especially HZO, significantly increases the risk of thromboembolic or haemorrhagic strokes [507, 508]. Those affected may have no visible lesions [509, 510] and strokes may be delayed [511516] or occur without characteristic risk factors or symptoms [512, 513, 517, 518], leading HZ-associated stroke to be underdiagnosed [514, 519]. HIV/AIDS might be suspected in otherwise healthy younger individuals [518, 520].

Cerebral inflammation

Rare but severe and sometimes fatal neurologic complications include meningitis or meningo-encephalitis [521526], cerebellitis [527], and encephalitis [528, 529]. Other reports include posterior reversible encephalopathy syndrome [530], CLIPPERS syndrome [531], and fatal meningo-encephalomyelitis [532]. Again, those affected are generally immunocompromised [9, 10], although accruing evidence suggests that such complications affect young and/or immunocompetent individuals more often than was supposed [521, 533538].

Ocular

Cases of Horner’s syndrome and related cranial nerve palsies [539542] have been attributed to HZO-induced arteritis and VZV meningitis [543]. Reported HZ retinopathies include visual loss due to central retinal artery occlusion and vasculitic chorioretinopathy [404, 544, 545].

Cardiovascular

Intriguing evidence hints at a link between HZ and cardiovascular disease in Asia. There are modestly elevated risks of acute coronary syndrome, arrhythmia and coronary artery disease following HZ [546, 547]. Herpetic infections may also be associated with atherosclerosis and thrombosis [546], with reports of HZ-associated deep vein thrombosis [548] and peripheral vascular disease [525]. Myocarditis [549] and unexplained recurrent asystole [550] following HZ have also been reported. Interestingly, however, Japanese patients with prior HZ had lower blood pressure than those with no history [551].

Skin

The most common dermatologic complications are secondary infections but numerous others have been described [9]. Rare complications include folliculitis, syringitis, and vasculitis [552554]. HZ can also cause hair loss [555, 556].

Infections

Secondary infections complicate up to 30% of HZ cases [136], rising to 60% in vulnerable hospitalised patients [340]. The most common are staphylococcus or streptococcus superinfections [9, 10]. Other opportunistic organisms include moraxella [557], and aspergillus [558]. Bacterial infections are more likely in patients with diabetes [559, 560] and potentially serious, with necrotising fasciitis reported in one immunocompromised patient [561]. Immunocompromised patients, particularly those with HIV/AIDS, may rarely become reinfected by varicella despite a history of HZ [562].

Isotopic responses

HZ may render affected skin susceptible to other infections or dermatoses, for example, moloscum contagiosum, mycosis fungoides [154], erythema multiforme [563], and psoriasis [564, 565]. Diverse ‘isotopic’ responses at healed HZ sites include: vitiligo [566], fungal granuloma [567], furuncles [568], granulomatous reactions [569574], erythemas [575578], lichen planus [579, 580], morphea and bullae [581583], perforating collagenosis [584, 585], keratolysis [586] and sarcoidosis [587, 588], reticulohystiocytosis [589], nodular degeneration [590, 591], verrucous hyperplasia [592], mucinosis [593], urticaria [594], prurigo nodularis [595], graft-versus-host reaction [596], drug-induced eruption [597], adenocarcinoma [598], leukaemia cutis [599], Kaposi’s sarcoma [600], and tufted angioma [601].

Dental

Jaw osteonecrosis and tooth loss are rare complications of trigeminal HZ. Cases have been reported in both immunocompetent and immunocompromised Asians; the mechanism remains unknown [602610].

Disease associations

Emerging evidence from Taiwan and Japan suggests that patients with HZ are at increased subsequent risk of cardiovascular disease [546, 547], lymphoma [611] and other cancers [466, 612, 613], renal failure [614], SLE [615], multiple sclerosis [616], chronic fatigue syndrome [617], depression [618, 619] and erectile dysfunction [620]; however, the causality and significance of these associations remains unclear. Prevalent comorbidities such as metabolic syndrome disorders probably contribute to cardiovascular risk [547], while immunosuppression may underlie other conditions. Like HZ, kidney disease [160, 335], cancer [466, 612, 621, 622], and depression [158] are also associated with immunosuppression, and HZ may occur coincidentally either before or after these conditions manifest.

Anecdotal reports implicate VZV reactivation in rare conditions such as inappropriate secretion of antidiuretic hormone [85, 87, 623626], drug-induced hypersensitivity syndrome [627], mononucleosis syndrome [628], thrombocytopenia [629], and graft-versus-host disease [630].

Healthcare utilisation

As in the West, HZ-associated pain, morbidity and debility, result in heavy healthcare utilisation, especially among elderly patients, which imposes major burdens on healthcare systems and incurs substantial socio-economic costs in Asia-Pacific countries [20, 25, 30, 96, 102, 104, 136, 137, 140]. Although uncomplicated cases can usually be treated in community or outpatient settings, this usually entails several visits [20, 30, 96, 102]; Korean HZ patients averaged seven visits to a primary physician [96], and among 150 elderly Taiwanese patients, more than 80% consulted a doctor, with 20% hospitalised [20].

Hospitalisation

Throughout Asia-Pacific, HZ is consistently among the disorders that dermatologists or pain specialists treat most often, and is the most common dermatosis in patients aged 60–70 years [149, 631641]. Hospitalisation rates for HZ range from ~9–51/100000 PY (Table 6) [2, 7, 102, 104, 136138, 140, 147]; complications account for around half of admissions (Table 5) [102, 104, 136] and, therefore, hospitalisation rates likewise increase with age and are highest among elderly or immunocompromised patients [96, 102, 104, 136, 138, 140, 147, 642]. Older patients and those with complications stay longer in hospital [136, 137].
Table 6

Herpes zoster hospitalisation rates, durations and associated healthcare costs in Asia-Pacific countries

Country (source)

Study period

Age profile (years)

Hospitalisations (100000 person years)

Hospitalisation duration (days)

Healthcare costs (US$ equivalent)c

Overall average

Complications

Per patient

Annual total (millions)

 

None

With

Outpatient

Inpatient

 

Taiwan (Lin 2010) [136]

2000–2005

All ages

14.6

8.3

8.0

8.6

  

7.7 in 2000 → 9.8 in 2004 (NT$ 319,000,000)

≥80

105.1

    

204.0

Taiwan (Jih 2009) [137]

2000–2006

All ages

16.1

8.3

  

78.4

1800.3

0.669773 (NT$ 14,147,543)

0–20

 

6.06

    

≥60

59.5% of total

9.19

    

59.5% of total

Korea (Cheong 2014) [96]

2009

≥50 years

88.8d

10.93

 

14.75e

176.0 (161.0–240.0f)

63.2

Australia (Stein 2009) [104]

1998–2005

≥50 years

28.0a

6.8a

6.0

8.6 (5.2–14.6b)

 

3922.2a

27.5

≥80

95.8

      

Thailand (Aunhachoke 2011) [30]

2007–2008

Mean 59

    

90.4 (by 180 days follow-up)

~1.1% per capita income

Korea (Choi WS) [140]

2003–2007

All ages

22.0–32.0

     

75.9 increasing by 14–20% per year to 143.8

Australia (MacIntyre 2003) [102]

1998–1999

Mean 69

25.0

12.7

     

>50

53.0% of total

      

≥80

>150.0

      

Korea (Song 2014) [25]

2009–2010

Mean 64

 

8.9

     

Korea (Kim YJ) [138]

2011

All ages

51.2

      

≥80

266.3

      

Australia (Carville 2010) [147]

2006–2007

All ages

9.1a

      

≥80

89.4a

      

Australia (Araújo 2007) [7]

2000–2002

All ages

10.0a

      

Australia (Heywood 2014) [2]

2006–2010

All ages

10.4

      

aPrincipal diagnosis of herpes zoster

bHerpes zoster encephalitis

cValues not already stated in US$ equivalent, converted at average annual exchange rate in year prior to publication

dBased on prevalence rate of 18.54/1000 persons

ePost-herpetic neuralgia

fSeverely immunocompromised

Healthcare expenditure

Accordingly, HZ-related healthcare costs also increase proportionally with patients’ age and parallel rising incidence [136, 137]. Total expenditure in Taiwan rose by 1.22-fold from US$7.7 million in 2000 to $US 9.8 million in 2004 [136], and in Korea by 20% between 2003 and 2007 (Table 6) [140]. Direct healthcare costs in Thailand are equivalent to 1.1% of annual per capita income, a similar ratio to that in developed nations [30].

HZ in the Asia-Pacific region evidently imposes very substantial burdens on both patients and the wider community, strongly supporting the case for early intervention and prevention to reduce both HZ-related morbidity and associated healthcare expenditure [20, 25, 30, 96, 102, 104, 140].

Management and prevention

Routine HZ management in Asia-Pacific is the same as elsewhere, mainly relying on antiviral and analgesic drugs to reduce the severity and duration of acute herpetic rash and pain, which may in turn decrease the risk and intensity of PHN [643, 644].

Antiviral therapies

Standard care entails aciclovir, valaciclovir, or famciclovir for 7 days [643]. These are most effective if commenced within 3 days of onset [645] but as starting later may still be beneficial, patients with HZO, who are immunocompromised, have disseminated HZ, or are at high risk for PHN, should start antiviral therapy even beyond 72 hours [643646]. Topical or oral aciclovir are effective in most mild-moderate HZ, including HZO [647651]; nevertheless aciclovir is least favoured nowadays because its lower bioavailability necessitates more frequent dosing [9, 644, 652]. Though comparative data are sparse [643, 652], Asian studies support the use of other antivirals.

A meta-analysis including data from Taiwan [653, 654] and China, found valaciclovir and famciclovir superior to aciclovir in reducing HZ-associated pain, with comparable safety [652]. Valaciclovir resolves pain significantly faster than aciclovir [31, 653655], while famciclovir has comparable efficacy but fewer adverse effects, and may also be more cost-effective [656, 657]. Penciclovir is also effective at lower doses than aciclovir, with better safety [658]. Specifically, aciclovir or its prodrug valaciclovir have been associated with neurotoxicity, and nephrotoxicity in East Asian patients with renal impairment [659669], whereas famciclovir was safe and effective in patients with renal dysfunction [670, 671]. Treating HZ keratopathy with aciclovir ointment has been reported to cause superficial punctate keratopathy [672]. Ganciclovir may be a more effective alternative [673, 674], especially in aciclovir-resistant acute retinal necrosis [675]; success with intravitreal foscarnet following acyclovir failure has also been reported [676]. Valaciclovir and famciclovir are thought to have similar efficacy [643, 677], but Japanese researchers reported significantly faster pain relief with famciclovir [678]. In Caucasians, sirovudine treated acute HZ as safely and effectively as aciclovir but with fewer recurrences [679]; however, sirovudine has potentially fatal interactions with 5-fluorouracil prodrugs, which killed 18 Japanese cancer patients [680].

Pain relief

Pain control is crucial to HZ management, not only for acute analgesia, but also because pain severity predicts PHN [9, 643, 644]. Although prompt antiviral therapy reduces acute HZ-associated pain, an updated meta-analysis concluded that aciclovir does not reduce the incidence of PHN and found insufficient evidence to evaluate the effect of other antiviral agents [681]. In practice, antiviral therapy is usually given concomitantly with corticosteroids or analgesics, according to the degree of pain.

Corticosteroids

Oral corticosteroids relieve pain, accelerate lesion healing and hasten functional recovery; however, being immunosuppressive they cannot be given without concomitant antiviral therapy. Moreover, corticosteroids should be used with caution in patients with common comorbidities such as diabetes and hypertension and do not prevent or relieve PHN [643, 645, 646]. Nevertheless, corticosteroid injections have successfully treated cases of Ramsay Hunt syndrome and refractory PHN in Chinese patients [682, 683].

Analgesia

Pain relief should start early and be intensified as necessary during acute HZ to control pain and reduce the likelihood of developing PHN, which is much harder to treat [656, 684, 685]. Pain management steps-up from first-line acetaminophen or non-steroidal anti-inflammatory drugs to opioid narcotics for moderate-to-severe pain, to which anticonvulsants, tricyclic antidepressants or corticosteroids are added if pain remains uncontrolled [646]. The same second- and third-line analgesics are used to treat PHN if topical agents prove ineffective [643, 646].

Indian physicians have reported rapid and effective pain relief with topical acetylsalicylic acid dissolved in chloroform [686]. Others confirmed the efficacy of the anticonvulsants pregabalin and gabapentin for relieving acute herpetic pain [687, 688], and found pregabalin superior to amitriptyline for PHN [684]. Compared with placebo, pregabalin relieved PHN and was also associated with decreased sleep interference and significant improvements in health-related QoL [689]. Gabapentin is another effective and well-tolerated treatment for PHN [690] and combined with morphine in another trial, reduced pain more than either agent alone [691]. Chinese investigators found oxycodone-acetaminophen effective, safe and superior to other analgesics in HZ and PHN [692696]. Reports from Australia, Japan, New Zealand and Taiwan have affirmed the efficacy of topical [697699] or injected lidocaine [700, 701]. Transdermal fentanyl was found to be more effective than tramadol, providing excellent pain relief in HZ and PHN and improving QoL, both alone [702, 703] and combined with clodine [704]. Other experimental therapies with good reported outcomes in patients from Asia-Pacific countries include: topical interferon alpha [705, 706], adenine arabinoside (vidarabine) [707, 708], povidone-iodine [709], transdermal ribavirin [710], bromovinyl deoxyuridine (brivudin) [711], intravenous prostaglandin E1 [355, 712715], the anticoagulant argatroban [716]; the tricyclic antidepressant milnacipran [717], human immunoglobulin [718], injected methylcobalamin [719], and botulinum toxin [720].

Nerve blockade is increasingly popular for treating intractable PHN or preventing PHN by reducing severe pain, particularly in East Asia [363, 721742]; ambulatory patient-controlled systems have been successful in Taiwan [743, 744]. However, the true efficacy of nerve blocks is difficult to quantify because many trials were uncontrolled [9]. Furthermore, epidural injections require utmost caution due to the potential for infection and/or life-threatening complications [745755]. An implanted injection port may lessen the risk of infection [756].

Neurosurgery may trigger HZ [269271] and though neuroablation has also been used, its efficacy is unproven and it may exacerbate PHN [757]; neuromodulation may provide an alternative but needs further investigation [758, 759].

Alternative treatment modalities

Asia-Pacific authors have contributed substantial literature on alternative HZ therapies (Additional file 1). Success has been reported with herbal decoctions, acupuncture and other traditional Chinese medicine techniques, energy-based modalities, and combination therapies. Treatments evaluated in intractable HZ and PHN, include Ganoderma lucidum [760, 761], Keishikajutsubuto and Bushi-matsu [762], bee venom [763], intravenous vitamin C [764], computed tomography-guided radiofrequency thermo-coagulation [765], spinal cord stimulation [758], ultrasound-guided pulsed radiofrequency [766], and scrambler therapy [767]. Although many studies found these alternatives superior to conventional medicine, the strength of this evidence is dubious – due to conceptual differences between traditional Asian and Western medicine, many such studies do not conform to conventional evidence-based precepts [768770].

Unmet treatment needs

Despite an armamentarium of potentially effective medications, current therapies have limitations and are not used to best advantage in older patients, who bear the brunt of HZ [646]. In particular, many patients start therapy too late, the optimal combination of therapies remains uncertain, antiviral agents are underprescribed [22, 645, 771], and even with prompt intervention a substantial proportion remain refractory to treatment; up to 20% of patients with PHN still have persistent neuralgia after 6 months (Table 5) [1820, 23, 28, 359, 771]. Aciclovir-resistant ocular VZV infections have been encountered [675, 676, 772, 773].

Given the substantial and rising burden of HZ and formidable treatment challenges facing physicians in the Asia-Pacific region, especially among elderly, immunocompromised or other high risk adults, such as those with renal disease, prevention is both rational and appealing [20, 25, 9496, 104, 136, 140, 144147, 160, 644]. Accordingly, investigators have evaluated HZ prophylaxis with antiviral drugs or vaccines.

Prevention approaches

Antiviral prophylaxis in high-risk patients

HZ is a very common complication following HSCT [170, 774]. Long-term prophylaxis with low-dose aciclovir [775778] or valaciclovir [779] significantly reduces the incidence of VZV reactivation and serious complications, and is recommended for the duration of immunotherapy and continuing through 1 year after HSCT [776, 778]. Such prophylaxis also prevents HZ in patients receiving bortezomib [780, 781]. Similarly, no bone marrow transplant recipients developed HZ during 3–6 months of low-dose aciclovir and ganciclovir therapy; however, rapid onset of HZ after antiviral therapy was discontinued highlighted the need for ongoing prophylaxis [782]. Immunisation against VZV may be necessary to preclude HZ in high-risk patients [776]; therefore, Asian researchers have evaluated the potential of HZ prophylaxis with varicella vaccines.

VZV immunisation

A survey of Japanese paediatricians, who might have enhanced immunity through VZV re-exposures, confirmed lower incidence of HZ than the general population, suggesting that varicella vaccine may likewise protect against HZ [319]. Also in Japan, immunisation with live varicella vaccine (Oka/BIKEN) enhanced CMI to VZV in adults age ≥50 years [783, 784], and in subjects aged 60–70 with or without diabetes [785]. A case of recurrent HZO cured by varicella vaccination was also reported [786]. In studies that evaluated live-attenuated VZV vaccine in HSCT [774, 787], Oka/RIT (Varilrix™ Glaxo-SmithKline Biologicals, Rixensart, Belgium) was safe but poorly immunogenic. A systematic review concluded that although inactivated VZV vaccine may reduce HZ severity in stem cell transplant recipients, more research was required [788]. Thus, alternative approaches to preventing HZ in such patients are probably needed [787].

During a 20-year endeavour to develop the first specific HZ vaccine, researchers reformulated Oka/Merck varicella vaccine (Varivax® Merck & Co. Inc., Whitehouse Station, NJ, USA.) to produce a higher-titre live-attenuated VZV vaccine – Zostavax® (Merck & Co. Inc.) [10, 789]. In the culminating Shingles Prevention Study (SPS), Zostavax® immunisation reduced the incidence of HZ among adults ≥60 years old by 51%, PHN by 67% and the HZ-related burden of illness by 61%, as well as improving QoL and performance of daily activities in subjects who developed HZ [95]. The US Food and Drug Administration licenced Zostavax® in 2006 [644]; it was also approved by the European Medicines Agency [96] and subsequently by authorities in Australia [644] New Zealand [652], Korea [790, 791], Malaysia [792], and other Asian countries [793796]. The US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP), recommends routine vaccination for all non-contraindicated persons age ≥60 years; importantly though, Zostavax® is not indicated to treat extant HZ or PHN [10]. An independent review of SPS concluded that there is insufficient proof that Zostavax® prevents PHN beyond reducing the incidence of HZ. Further, since SPS patients were predominantly Caucasian, its findings might not apply to other races [797].

Zostavax® in Asia-Pacific

Production shortfalls of Zostavax® after initial licensure restricted its supply [1, 2]. Though since resolved, this issue affected vaccine availability and uptake in Asia-Pacific countries [2]. For example, 2011 vaccination rates among Australian inpatients in 2011 were 34% for HZ, compared with 52% for pneumococcal vaccine and 64% for influenza [798]. This explains the scarcity of Asian data on Zostavax®. One pilot study of 21 healthy adults ≥30 years old, including eight Filipinos, found Zostavax® to be immunogenic and generally well-tolerated [799].

Cost-effectiveness

The substantial economic burden of HZ includes direct healthcare costs as well as indirect costs of disability and lost productivity [10, 30, 140]. US and European researchers have modelled the pharmaco-economics of HZ vaccination. US estimates of cost per quality-adjusted life-years gained (QALY), varied widely depending on the assumptions used. Routine immunisation at age 70 or 60 cost US$ 37000 and US$ 86000 respectively, within the range of standard thresholds, whereas the estimated cost of US$ 287000 at age 50 was deemed too high [800]. Analyses in European countries predicted that vaccinating adults above the ages of 50, 60, 65 or aged 70–79 would be cost-effective, with high likelihood of not exceeding accepted thresholds of £ 30000 in the United Kingdom or € 30000 in Belgium [801]. A systematic review of 11 US and European studies concluded that vaccination at age 65–70 would probably be cost-effective in terms of QALYs gained, assuming it confers more than 10–15 years’ protection against PHN [802]; however, cost-effectiveness data from high-income countries may not apply worldwide, because healthcare provision and costs differ considerably between nations [801, 802]. Although high and rising healthcare costs of treating HZ documented in several Asia-Pacific countries [30, 104, 136, 137, 140] suggest that it would probably be no less cost-effective to immunise elders from this region than others, specific pharmacoeconomic data are lacking [790, 802]; such analyses are needed urgently to resolve current uncertainties and inform evidence-based decision-making by healthcare funders and providers.

HZ immunisation guidelines and recommendations

Given the potential for HZ immunisation to efficaciously and safely reduce the associated burden of illness [10], as well as cost-effectiveness considerations, organisations in several Asia-Pacific countries have incorporated HZ vaccination into adult immunisation schedules (Table 7) [2, 5, 8, 642, 791796]. Neither Japan nor Singapore has such guidelines and The Association of Physicians of India does not recommend HZ immunisation, due to lack of national epidemiology data [803].
Table 7

Asia-Pacific guidelines for immunisation against herpes zoster

Country

Title

Issuing organisation

Year (last update)

Age thresholds

Name

Status

Routine

Optional

Australia [8]

The Australian Immunisation Handbook

Technical Advisory Group on Immunisation

Government

2015

60–79

 

Australia & New Zealand [5]

Immunisation of Older People

Australia & New Zealand Society for Geriatric Medicine

Society

2011

≥60

 

India [803]

Medicine Update. Adult Immunization

Association of Physicians of India

Society

2013

No recommendationa

Indonesia [793]

Adult Immunization Schedule

Specialist Doctors Association of Indonesia

Society

2014

≥50

 

Malaysia [792]

Position Statement on Vaccination Against the Herpes Zoster Virus in Older Adults

Malaysian Society of Geriatric Medicine

Society

2014

60–79

50–59

New Zealand [642]

Immunisation Handbook

New Zealand Ministry of Health

Government

2016

>50

 

Philippines [794]

Handbook on Adult Immunization for Filipinos

Philippine Society for Microbiology and Infectious Diseases

Society

2012

≥60

 

South Korea [791]

Recommended Immunization Schedule for Adults in Korea

Korean Society of Infectious Diseases

Society

2012

>65

50–59

Taiwan [796]

Clinical Handbook for Adult Immunization

Taiwan Association of Family Medicine

Society

2010

≥60

 

Thailand [795]

Recommended Adult and Elderly Immunization Schedule

Thailand Royal College of Physicians

Society

2014

≥60

 

aThe Association of Physicians of India does not recommend herpes zoster vaccine for adults, due to lack of reliable data on the epidemiology and burden of herpes zoster in India

Most HZ immunisation guidelines are published by professional societies, with only Australia and New Zealand having government-issued guidelines [8, 642]. Since Asian epidemiological and clinical data are sparse, local guidelines generally follow the ACIP [10], with very similar recommendations for indicated and non-licenced uses, administration, and precautions or contraindications (Table 8). Like ACIP, most Asia-Pacific guidelines recommend routine immunisation from age 60; however, some age thresholds vary. The New Zealand Ministry of Health and Indonesia Specialist Doctors Association both recommend immunisation from age 50 [642, 793], though this is not state funded. The Korean Society of Infectious Diseases recommends routine vaccination above age 65 [791], with vaccination from age 50 at patients’ own discretion. Similarly, The Australian Department of Health [8] and the Malaysian Society of Geriatric Medicine [792] do not recommend routine vaccination for persons aged 50–59, but sanction this as a personal option, with the caveats that the duration of protection remains undetermined. However, the Malaysian Society of Geriatric Medicine does not recommend vaccinating patients older than 80, due to lack of efficacy, and the Australian guidelines likewise note that vaccination may confer less clinical benefit in this age group [8]. The New Zealand guidelines [642] uniquely specify active untreated tuberculosis as a contraindication and the Australian guidelines are alone in indicating vaccination of persons from age 50 who are household contacts of immunocompromised individuals [8]. Based on evidence that co-administering Zostavax® with pneumococcal polysaccharide vaccine may reduce its immunogenicity compared with administration 4 weeks apart [804], the Australian and New Zealand Society for Geriatric Medicine recommended against giving these vaccines concomitantly [5]; however, a later study suggested that this may not compromise Zostavax® effectiveness [8, 805], and the Australian 2015 guidelines recommend that Zostavax® can be given at the same time as pneumococcal polysaccharide vaccine, using separate syringes and injection sites [8].
Table 8

Concordance between herpes zoster immunisation recommendations from US ACIP and Asia-Pacific countries

Indications and administration

• Routine immunisation with one dose of HZ vaccine for all persons age ≥60: – With or without prior HZ – With chronic medical conditions (eg, chronic kidney disease, diabetes, rheumatoid arthritis, lung disease), except those listed as contraindications or precautions

• HZ vaccine can be co-administered with other indicated adult vaccines, eg, influenza

Unlicensed categories/ purposes

• Persons immunised with varicella zoster vaccine

• Persons younger than the minimum recommended or optional age threshold

• HZ vaccine is not to be used to treat existing HZ or its complications

Precautions

• Moderate/severe acute illness

• Anticipated immunosuppression

• Anti-herpetic pharmacotherapy

Contraindications

• Hypersensitivity to vaccine components

• Morbid or medical immunosuppression or immunodeficiency: – HIV/AIDS – Transplant recipients – Systemic immunosuppressive therapy (including high-dose steroids and recombinant immune modulators

• Pregnancy

HZ Herpes zoster, US ACIP United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, HIV/AIDS human immunodeficiency virus/acquired immunodeficiency syndrome

Discussion

Ours is the most comprehensive audit yet of HZ in the Asia-Pacific region. We have reviewed almost every available paper published on the subject over 21 years since 1994 in 14 countries whose populations constitute the majority of not only Asians, but indeed the global population. The information collated provides a valuable resource and reference by which to gauge future progress.

Knowledge and data gaps

Contrary to a preconception that there may be a dearth of Asian data, we discovered a wealth of evidence on all aspects of HZ. However, our review does affirm that Asian data are patchy; in particular, there is very little information from South-East Asian populations numbering hundreds of millions, which probably reflects pragmatic healthcare imperatives in resource-limited settings [3]. Limiting the scope of the survey to 21 years may have missed epidemiology data published prior to 1994. The review may have excluded some relevant articles which did not specify that VZV infection was reactivated. It is also possible that some articles with no country affiliation field in the databases searched may have been overlooked; however, searching several databases reduced this possibility. Epidemiology data from Indonesia, Malaysia, the Philippines, and Vietnam are needed to provide a more balanced picture. There are also limited Asian data on the safety and efficacy of the HZ vaccine and, in particular, its cost-effectiveness [137, 140, 790, 802].

Conclusions

Data gaps notwithstanding, there is compelling evidence to conclude that the epidemiology and risk factors for HZ in the Asia-Pacific region are not remarkably different from those in Western populations [7]. However, with a vastly larger absolute aged population, Asia bears a unique burden of HZ. The estimated number of Asians1 age >60 in 2015 is 489,397,421, which by 2035 will nearly double to 924,520,454 [806]. Assuming an annual incidence of HZ in unvaccinated individuals of approximately 12/1000 person-years [136, 137], this equates to approximately 16089 new HZ cases daily in 2015 and 30395 in 2035, more than half of which might be prevented by HZ immunisation. Data affirming rising incidence of HZ in countries across Asia-Pacific bear out these projections. Consequently, HZ in the Asia-Pacific region exacts huge and increasing tolls of morbidity, debility and diminished life quality that incur significant healthcare expenditure and indirect socioeconomic costs [20, 25, 30, 96, 104, 136, 137, 140].

This review also highlights that HZ is uniquely complex among infectious diseases, often complicated and defies disciplinary boundaries. Despite a plethora of conventional and alternative treatments, none is singularly effective [25]; current approaches can go only so far to alleviating the disease burden, especially among the elderly who constitute most patients, and then at considerable expense [95]. Thus, the rationale for prevention is very strong [20, 102, 145]. Yet although a specific HZ vaccine is available and recommended by immunisation guidelines in many countries, it remains underused. This typifies how preventive healthcare for the elderly continues to be neglected in Asia, despite repeated calls to make this a higher public health priority [3, 4, 6]. It is more urgent now than ever to address this situation.

Call to action

We look forward to being able to report in future that advances in preventive healthcare have alleviated the growing burden of HZ in the Asia-Pacific region. This audit is just a beginning – realising this ambition will be impossible without redoubled efforts by the medical fraternity, healthcare authorities and all other stakeholders to change prevailing mindsets and afford higher priority to adult immunisation in general and HZ in particular. We urge all concerned to heed this call to action.

Footnotes
1

Afghanistan, Bangladesh, Bhutan, Brunei, Burma, Cambodia, China, Hong Kong, India, Indonesia, Iran, Japan, Laos, Macau, Malaysia, Maldives, Mongolia, Nepal, North Korea, Pakistan, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, Timor-Leste, Vietnam.

 

Abbreviations

ACIP: 

Advisory Committee on Immunization Practices

AIDS: 

Acquired immunodeficiency syndrome

CLIPPERS: 

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids

CMI: 

Cell-mediated immunity

HAART: 

Highly-active antiretroviral therapy

HIV: 

Human immunodeficiency virus

HSCT: 

Haematopoietic stem cell transplant

HZ: 

Herpes zoster

HZO: 

Herpes zoster ophthalmicus

PHN: 

Post-herpetic neuralgia

PY: 

Person-years

QoL: 

Quality of life

SLE: 

Systemic lupus erythematosus

SPS: 

Shingles Prevention Study

US: 

United States

VZV: 

Varicella zoster virus

WHO: 

World Health Organization

Declarations

Acknowledgements

MSD funded preparation of the manuscript, but had no role in designing the study, data collection or analysis, drafting or approving the manuscript, or the decision to submit for publication. The authors thank Dr. David Neil (PhD), of Content Ed Net (Taiwan) for providing professional medical writing services, which were remunerated by Merck Sharp & Dohme (I.A.) Corp, Taiwan.

Funding

The authors received no specific research funding for the work described in this manuscript.

Availability of data and materials

All supporting data are either contained within the manuscript or were excerpted from the sources cited, and can be shared upon request.

Authors’ contributions

LKC conceived and coordinated the study, acquired and interpreted data, and revised manuscript drafts for important intellectual content. HA, LYC, SD, BD, TK, XL, DM, JYP, PJHP, SR, TT, and CWW, refined the review protocol, provided and/or reviewed or interpreted data, and revised manuscript drafts for important intellectual content. MYC, KTK, HNL, EMFL, CKL, LNP, and ERSP, contributed to refining the review protocol, and reviewed data and manuscript drafts. All authors read and approved the final manuscript.

Competing interests

The authors are members of The Asia-Pacific Working Group for Herpes Zoster, which is supported financially by Merck Sharp & Dohme (I.A.) Corp. (MSD), Taiwan, and received honoraria for consultancy services in this capacity. The authors declare no other competing interests besides membership of this MSD Advisory Board.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Not applicable.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Center for Geriatrics and Gerontology, Taipei Veterans General Hospital
(2)
Aging and Health Research Center, National Yang Ming University
(3)
National Center for Geriatrics and Gerontology
(4)
Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital
(5)
Department of Internal Medicine, Faculty of Medicine, University of Indonesia
(6)
The Center of Gerontology and Geriatrics, West China Medical School/West China Hospital, Sichuan University
(7)
Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo
(8)
Division of Infectious Diseases, Daegu Fatima Hospital
(9)
Rophi Clinic, 38 Irrawaddy Rd. #07-54/55, Mount Elizabeth Novena Specialist Centre
(10)
Geriatric Medicine Centre (Healthy Ageing), Hong Kong Sanatorium and Hospital
(11)
Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital
(12)
Division of Geriatrics, Department of Internal Medicine, Peking Union Medical College Hospital
(13)
Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Jubilee Hills
(14)
National Skin Centre
(15)
Geriatric Center, St. Luke’s Medical Center
(16)
Division of Geriatrics, Department of Medicine, University Malaya Medical Centre
(17)
Ropata Medical Centre
(18)
Division of Infectious Diseases, Department of Medicine, Chulalongkorn University
(19)
Department of Family Medicine, College of Medicine, Kyung Hee University

References

  1. Harpaz R, Hales CM, Bialek S. Update on herpes zoster vaccine: licensure for persons aged 50 through 59 years. MMWR Morb Mortal Wkly Rep. 2011;60:1528.Google Scholar
  2. Heywood AE, Wang H, Macartney KK, McIntyre P. Varicella and herpes zoster hospitalizations before and after implementation of one-dose varicella vaccination in Australia: an ecological study. Bull World Health Organ. 2014;92:593–604.Google Scholar
  3. Isahak I. Steering Committee for Prevention and Control of Infectious Diseases in Asia. Adult immunization—a neglected issue in Southeast Asia. Southeast Asian J Trop Med Public Health. 2000;31:173–84.Google Scholar
  4. Verma R, Khanna P, Chawla S. Vaccines for the elderly need to be introduced into the immunization program in India. Hum Vaccin Immunother. 2014;10:2468–70.Google Scholar
  5. Woodward M. Immunisation of older people. J Pharm Pract Res. 2012;42:316–22.Google Scholar
  6. Wong SY. Adult vaccination update 2014. The Singapore Fam Physician. 2014;40:27–32.Google Scholar
  7. Araújo LQ, MacIntyre CR, Vujacich C. Epidemiology and burden of herpes zoster and post-herpetic neuralgia in Australia, Asia and South America. Herpes. 2007;14(Suppl 2):40–4.Google Scholar
  8. Australian Technical Advisory Group on Immunisation. The Australian Immunisation Handbook. 10th ed (updated June 2015). Canberra: Australian Government Department of Health. 2015. http://www.health.gov.au/internet/immunise/publishing.nsf/content/7B28E87511E08905CA257D4D001DB1F8/$File/Aus-Imm-Handbook.pdf. Accessed 17 Jan 2017.
  9. Thomas J. Herpes zoster: Complications and management. J Pak Assoc Dermatol. 2004;14:237–43.Google Scholar
  10. Harpaz R, Ortega-Saznchez IR, Seward JF. Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57(RR-5):1–30.PubMedGoogle Scholar
  11. Kim YM, Lee SY, Lee JS, Park YL, Whang KU, Cho MK, et al. Epidemiological and clinical study on herpes zoster in the Province of Chungcheongnam-do (2004–2006). Korean J Dermatol. 2008;46:1488–94.Google Scholar
  12. Abdul Latheef EN, Pavithran K. Herpes zoster: a clinical study in 205 patients. Indian J Dermatol. 2011;56:529–32.PubMedPubMed CentralView ArticleGoogle Scholar
  13. Shukuwa T, Chen WY, Kobayashi A. Statistical analysis of herpes zoster observed at Sasebo City General Hospital. Nishinihon J Dermatol. 2002;64:477–82.View ArticleGoogle Scholar
  14. Naveen KN, Tophakane RS, Hanumanthayya K, Pv B, Pai VV. A study of HIV seropositivity with various clinical manifestation of herpes zoster among patients from Karnataka, India. Dermatol Online J. 2011;17:3.PubMedGoogle Scholar
  15. Jara MFA, Roa FC. The clinical presentation of herpes zoster patients and predictors of postherpetic neuralgia: A 5-year retrospective study at the section of dermatology, University of the Philippines - Philippine General Hospital. J Phil Dermatol Soc. 2010;19:8–12.Google Scholar
  16. Leung AYH, Yuen KY, Cheng VCC, Lie AKW, Liang R, Kwong YL. Clinical characteristics of and risk factors for herpes zoster after hematopoietic stem cell transplantation. Haematologica. 2002;87:444–6.PubMedGoogle Scholar
  17. Reid JS, Ah WB. Herpes zoster (shingles) at a large New Zealand general practice: incidence over 5 years. N Z Med J. 2014;127:56–60.PubMedGoogle Scholar
  18. Goh CL, Khoo L. A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic. Int J Dermatol. 1997;36:667–72.PubMedView ArticleGoogle Scholar
  19. Song JY, Chung BS, Choi KC, Shin BS. A 5-year period clinical observation on herpes zoster and the incidence of postherpetic neuralgia (2002–2006); a comparative analysis with the historical control group of a previous study (1995–1999). Korean J Dermatol. 2008;46:431–6.Google Scholar
  20. Tsai TF, Yao CA, Yu HS, Lan CC, Chao SC, Yang JH, et al. Herpes zoster-associated severity and duration of pain, health-related quality of life, and healthcare utilization in Taiwan: a prospective observational study. Int J Dermatol. 2015;54:529–36.PubMedView ArticleGoogle Scholar
  21. Song T. Statistical analysis of 522 cases of patient with herpes-zoster. Med J Wuhan Univ. 2002;23:379–82.Google Scholar
  22. Wallis KA, Hood LJ, Rao K. Herpes zoster: when do patients present and who gets antiviral treatment? J Prim Health Care. 2014;6:108–13.PubMedGoogle Scholar
  23. Kurokawa I, Kumano K, Murakawa K. Clinical correlates of prolonged pain in Japanese patients with acute herpes zoster. J Int Med Res. 2002;30:56–65.PubMedView ArticleGoogle Scholar
  24. Kang CI, Choi CM, Hong SS, Kim HB, Kim NJ, Oh MD, et al. The incidence of herpes zoster in otherwise healthy young soldiers of Korean army. Infect Chemother. 2006;38:45–6.Google Scholar
  25. Song H, Lee J, Lee M, Choi WS, Choi JH, Lee MS, et al. Burden of illness, quality of life, and healthcare utilization among patients with herpes zoster in South Korea: a prospective clinical-epidemiological study. Int J Infect Dis. 2014;20:23–30.PubMedView ArticleGoogle Scholar
  26. Park SY, Kim JY, Kim CD, Kim CW, Lee KS. A clinical study on herpes zoster during the last 10-year-period (1994–2003). Korean J Dermatol. 2004;42:1531–5.Google Scholar
  27. Das AL, Sayal SK, Gupta CM, Chatterjee M. Herpes zoster in patients with HIV infection. Indian J Dermatol Venereol Leprol. 1997;63:101–4.PubMedGoogle Scholar
  28. Kurokawa I, Murakawa K, Kumano K. The change in zoster-associated pain treated with oral valaciclovir in immunocompetent patients with acute herpes zoster. Int J Clin Pract. 2007;61:1223–9.PubMedView ArticleGoogle Scholar
  29. Sawhney MPS, Sharma YK, Sayal SK. Mode of detection of HIV infection - A retrospective study of 612 cases. Med J Armed Forces India. 2005;61:220–3.PubMedPubMed CentralView ArticleGoogle Scholar
  30. Aunhachoke K, Bussaratid V, Chirachanakul P, Chua-Intra B, Dhitavat J, Jaisathaporn K, et al. Measuring herpes zoster, zoster-associated pain, post-herpetic neuralgia-associated loss of quality of life, and healthcare utilization and costs in Thailand. Int J Dermatol. 2011;50:428–35.PubMedView ArticleGoogle Scholar
  31. Achar A, Chakraborty PP, Ghosh T, Naskar B, Guharay T, Bisai S. Clinical efficacy and tolerability of valacyclovir versus acyclovir in treatment of herpes zoster. Iran J Dermatol. 2011;14:52–7.Google Scholar
  32. Kim CG, Na CH, Choi KC, Shin BS. A comparative study of the clinical findings associated with herpes zoster and according to age. Korean J Dermatol. 2009;47:1338–44.Google Scholar
  33. Kim HJ, Sung HC, Kim DW, Lee WJ, Lee SJ, Na GY. Clinical features of herpes zoster according to immune state. Korean J Dermatol. 2006;44:149–56.Google Scholar
  34. Cockburn DM, Douglas IS. Herpes zoster opthalmicus. Clin Exp Optom. 2000;83:59–64.PubMedView ArticleGoogle Scholar
  35. Naveen KN, Pradeep AV, Kumar JS, Hegde SP, Pai VV, Athanikar SB. Herpes zoster affecting all three divisions of trigeminal nerve in an immunocompetent male: a rare presentation. Indian J Dermatol. 2014;59:423.Google Scholar
  36. Sangeeta N, Robindro Singh W, Brajach SO. Herpes zoster in a healthy adult: Report of a case with oro-cutaneous presentations. JMS J Med Soc. 2011;25:99–101.Google Scholar
  37. Watanabe K, Funaki M. Images in clinical medicine: Zoster of the tympanic membrane. N Engl J Med. 2011;365:e40.PubMedView ArticleGoogle Scholar
  38. Hong SB, Lee JW, Chang SG, Lee MH, Haw CR. Herpes zoster of the penis. Korean J Urol. 2005;46:1001–3.Google Scholar
  39. Gopalan V, Nair RG, Pillai S, Oberholzer T. Genital herpes zoster as a consequence of cancer chemotherapy-induced immunosuppression: report of a case. J Infect Chemother. 2012;18:955–7.PubMedView ArticleGoogle Scholar
  40. Watanabe D, Kuhara T, Ishida N, Takama H, Tamada Y, Matsumoto Y. Herpes zoster of the nipple: rapid DNA-based diagnosis by the loop-mediated isothermal amplification method. Int J STD AIDS. 2010;21:66–7.PubMedView ArticleGoogle Scholar
  41. Izu K, Yamamoto O, Yasumoto S, Hashimoto T, Sata T, Tokura Y. Herpes zoster occurring as a solitary nodule on the index finger. Br J Dermatol. 2004;150:365–6.PubMedView ArticleGoogle Scholar
  42. Chen WH, Li TH, Lee LH, Huang CC. Varicella-zoster virus infection and nummular headache: a possible association with epicranial neuralgia. Intern Med. 2012;51:2439–41.PubMedView ArticleGoogle Scholar
  43. Hon C, Au WY, Cheng VC. Ophthalmic zoster sine herpete presenting as oculomotor palsy after marrow transplantation for acute myeloid leukemia. Haematologica. 2005;90 Suppl 12:EIM04.PubMedGoogle Scholar
  44. Kim YH, Choi IJ, Kim HM, Ban JH, Cho CH, Ahn JH. Bilateral simultaneous facial nerve palsy: clinical analysis in seven cases. Otol Neurotol. 2008;29:397–400.PubMedView ArticleGoogle Scholar
  45. Furuta Y, Fukuda S, Suzuki S, Takasu T, Inuyama Y, Nagashima K. Detection of varicella-zoster virus DNA in patients with acute peripheral facial palsy by the polymerase chain reaction, and its use for early diagnosis of zoster sine herpete. J Med Virol. 1997;52:316–9.PubMedView ArticleGoogle Scholar
  46. Fujiwara K, Furuta Y, Fukuda S. A case of associated laryngeal paralysis caused by varicella zoster virus without eruption. Case Rep Med. 2014;2014:916265.PubMedPubMed CentralGoogle Scholar
  47. Powell KF, Wilson HG, Croxson MC, Marshall MR, Wong EH, Anderson NE, et al. Herpes zoster meningoencephalitis without rash: Varicella zoster virus DNA in CSF. J Neurol Neurosurg Psychiatry. 1995;59:198–9.PubMedPubMed CentralView ArticleGoogle Scholar
  48. Chen MJ, Chen KH, Chung YM, Li AF, Chou CK, Hsu WM. Detection of varicella-zoster virus DNA in the iris of a zoster sine herpete patient. Int J Biomed Sci. 2006;2:302–4.PubMedPubMed CentralGoogle Scholar
  49. Lo CH, Chiang CP. Herpes zoster duplex bilateralis. Intern Med. 2013;52:2841.PubMedView ArticleGoogle Scholar
  50. Shin JW, Kim DH, Whang KU, Lee J, Park Y, Cho MK, et al. A case of zoster duplex bilateralis. Ann Dermatol. 2009;21:423–5.PubMedPubMed CentralView ArticleGoogle Scholar
  51. Mabuchi T, Yamaoka H, Kato M, Ikoma N, Tamiya S, Song HJ, et al. Case of disseminated vesicles of herpes zoster developing one day before the onset of local eruption in a hospitalized immunocompromised patient. Tokai J Exp Clin Med. 2013;38:52–4.PubMedGoogle Scholar
  52. Kim H, Kang JN, Seol JE, Seo JK, Sung HS. Epidemiology and clinical features of disseminated herpes zoster. Korean J Dermatol. 2013;51:507–12.Google Scholar
  53. Qi X-L, Li C-X, Gao T-W. Herpes zoster generalisatus caused by long-term treatment of cyclosporin: A case report. J Clin Dermatol. 2006;35:313–14.Google Scholar
  54. Park S-H, Lee SY, Yi JH, Choi HS, Yun SK, Kim HU, Ihm CW. A case of herpes zoster duplex unilateralis with herpes zoster generalisatus. Korean J Dermatol. 2005;43:1579–81.Google Scholar
  55. Takaoka Y, Miyachi Y, Yoshikawa Y, Tanioka M, Fujisawa A, Endo Y. Bilateral disseminated herpes zoster in an immunocompetent host. Dermatol Online J. 2013;19:13.PubMedGoogle Scholar
  56. Gupta LK, Kuldeep CM, Mittal A, Singhal H. Multidermatomal herpes zoster in an immunocompetent female. Indian J Dermatol Venereol Leprol. 2005;71:210–11.PubMedView ArticleGoogle Scholar
  57. Sun ZH, Guo YY, Li M, Yao ZR. Disseminated herpes zoster in immunocompetent patients not due to varicella-zoster virus gene mutation. Chin Med J. 2013;126:3193.PubMedGoogle Scholar
  58. Mittal RR. Disseminated herpes zoster. Indian J Dermatol Venereol Leprol. 1995;61:148–9.PubMedGoogle Scholar
  59. Gahalaut P, Chauhan S. Herpes zoster duplex bilateralis in an immunocompetent host. Indian Dermatol Online J. 2012;3:31–3.PubMedPubMed CentralView ArticleGoogle Scholar
  60. Lee H, Jung HJ, Park MY, Ann JY. Herpes zoster duplex symmetricus in a healthy patient. Korean J Dermatol. 2011;49:1098–101.Google Scholar
  61. Tsai YC, Tsai TF. Herpes zoster duplex bilateralis symmetricus. Dermatol Sin. 2015;33:37–8.View ArticleGoogle Scholar
  62. Yoon KJ, Kim SH, Lee EH, Choi JH. Disseminated herpes zoster in an immunocompetent elderly patient. Korean J Pain. 2013;26:195–8.PubMedPubMed CentralView ArticleGoogle Scholar
  63. Brar BK, Gupta RR, Saghni SS. Bilateral herpes - zoster of widely separated dermatomes in a non-immunocompromised female. Indian J Dermatol Venereol Leprol. 2002;68:48–9.PubMedGoogle Scholar
  64. Agrawal S, Aara N, Bumb R. Herpes zoster duplex bilateralis symmetricus in an immunocompetent subject. Int J Dermatol. 2014;53:e281–2.PubMedView ArticleGoogle Scholar
  65. Oh KH, Ahn C, Kim YS, Han JS, Kim S, Lee JS, et al. Atypical generalized zoster with suspicious esophageal involvement and early relapse in an adult renal transplant recepient. Transplant Proc. 2002;34:1174–7.PubMedView ArticleGoogle Scholar
  66. Tan HH, Goh CL. Viral infections affecting the skin in organ transplant recipients: epidemiology and current management strategies. Am J Clin Dermatol. 2006;7:13–29.PubMedView ArticleGoogle Scholar
  67. Kui YP, Hye IL, Ji YK, Kap SL, Seong JS, Chang KH. A case of herpes zoster multiplex in five disparate dermatomes. Korean J Dermatol. 2008;46:973–6.Google Scholar
  68. Yoo KH, Park JH, Kim BJ, Kim MN, Song KY. Herpes zoster duplex bilateralis in a patient with breast cancer. Cancer Res Treat. 2009;41:50–2.PubMedPubMed CentralView ArticleGoogle Scholar
  69. Ko DH, Park SY, Yoon TJ. A case of bilateral recurrent herpes zoster in multiple myeloma. Korean J Dermatol. 2006;44:1460–3.Google Scholar
  70. Teranishi H, Sakiyama M, Nagatoshi Y, Nomura Y, Inagaki J, Yanai F, et al. Acute lymphoblastic leukemia complicated with varicella zoster virus meningoencephalitis and visceral dissemination after related bone marrow transplantation. Rinsho Ketsueki. 2011;52:287–92.PubMedGoogle Scholar
  71. Endoh K, Kawai N, Itoh K, Tominaga K, Kusumoto S, Fukuda M, et al. An autopsy case of non-Hodgkin's lymphoma complicated by fulminant infiltration by disseminated herpes zoster. Jpn J Chemother. 2000;48:75–8.Google Scholar
  72. Ryu DJ, Jung JY, Lee S, Lee JH. A case of herpes zoster duplex bilateralis, a diagnostic clue of human immunodeficiency virus infection. Korean J Dermatol. 2010;48:339–41.Google Scholar
  73. Rajashekar TS, Singh G, Shivakumar V, Okade R. Recurrent herpes zoster duplex symmetricus in HIV infection. Indian J Dermatol. 2008;53:33–4.PubMedPubMed CentralView ArticleGoogle Scholar
  74. Sundriyal D, Kapoor R, Kumar N, Walia M. Multidermatomal herpes zoster. BMJ Case Rep. 2014. doi:10.1136/bcr-2014-205024.Google Scholar
  75. Zhang B, Zhao HX, Lun WH, Sun N, Yang D, Liang HY, et al. Generalized varicella-zoster virus infection: A case report. J Clin Dermatol. 2013;42:595–7.Google Scholar
  76. Chacko S, John TJ, Babu PG, Jacob M, Kaur A, Mathai D. Clinical profile of AIDS in India: a review of 61 cases. J Assoc Physicians India. 1995;43:535–8.PubMedGoogle Scholar
  77. Higashitake I, Higaki T, Souda N, Yamada H. Recurrent herpes zoster seen in the patient of human immunodeficiency virus infection. Skin Res. 2004;3:216–9.Google Scholar
  78. Kar HK, Gautam RK, Jain RK, Puri P, Doda V. Disseminated cutaneous herpes zoster: A clinical predictor of human immunodeficiency virus infection. Indian J Dermatol Venereol Leprol. 1995;61:40–1.PubMedGoogle Scholar
  79. Shin BS, Na CH, Song IG, Choi KC. A case of human immunodeficiency virus infection initially presented with disseminated herpes zoster. Ann Dermatol. 2010;22:199–202.PubMedPubMed CentralView ArticleGoogle Scholar
  80. Kim WJ, Park JW, Shin DH, Choi JS, Kim KH. A case of human immunodeficiency virus infection in recurrent herpes zoster. Korean J Dermatol. 2005;43:271–3.Google Scholar
  81. Kim MS, Choi H, Na CH, Shin BS. A 5-year period clinical study of 16 cases with disseminated herpes zoster (2008–2012). Korean J Dermatol. 2013;51:322–8.Google Scholar
  82. Doki N, Miyawaki S, Tanaka M, Kudo D, Wake A, Oshima K, et al. Visceral varicella zoster virus infection after allogeneic stem cell transplantation. Transpl Infect Dis. 2013;15:314–8.PubMedView ArticleGoogle Scholar
  83. Saitoh H, Takahashi N, Nanjo H, Kawabata Y, Hirokawa M, Sawada K. Varicella-zoster virus-associated fulminant hepatitis following allogeneic hematopoietic stem cell transplantation for multiple myeloma. Intern Med. 2013;52:1727–30.PubMedView ArticleGoogle Scholar
  84. Ni XS, Ouyang J, Zhu WH, Wang C, Chen B. Autologous hematopoietic stem cell transplantation for progressive multiple sclerosis: report of efficacy and safety at three yr of follow up in 21 patients. Clin Transplant. 2006;20:485–9.PubMedView ArticleGoogle Scholar
  85. Ohara F, Kobayashi Y, Akabane D, Maruyama D, Tanimoto K, Kim SW, et al. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as a manifestation of visceral varicella zoster virus infection in a patient with non-Hodgkin's lymphoma. Am J Hematol. 2007;82:416.PubMedView ArticleGoogle Scholar
  86. Yakushijin Y, Minamoto Y, Takada K, Otsuka M, Yasukawa M, Fujita S. A case of fatal varicella zoster infection with refractory abdominal pain as an early symptom. Kansenshogaku Zasshi. 2004;78:64–9.PubMedView ArticleGoogle Scholar
  87. Au WY, Ma SY, Cheng VC, Ooi CG, Lie AK. Disseminated zoster, hyponatraemia, severe abdominal pain and leukaemia relapse: recognition of a new clinical quartet after bone marrow transplantation. Br J Dermatol. 2003;149:862–5.PubMedView ArticleGoogle Scholar
  88. Kurtovic J, Webster GJM, Singh-Grewal I, Bullpitt P, Haindl W, Wakefield D, et al. Acalculous cholecystitis, multifocal gastrointestinal infarction and pancreatitis resulting from Varicella-zoster virus. Intern Med J. 2005;35:69–70.PubMedView ArticleGoogle Scholar
  89. Wang Z, Ye J, Han YH. Acute pancreatitis associated with herpes zoster: Case report and literature review. World J Gastroenterol. 2014;20:18053–6.PubMedPubMed CentralGoogle Scholar
  90. Okimura H, Muto M, Ichimiya M, Mogami S, Takahata H, Asagami C. A case of herpes zoster associated with colitis. J Dermatol. 1996;23:631–4.PubMedView ArticleGoogle Scholar
  91. Ching DW. Severe, disseminated, life threatening herpes zoster infection in a patient with rheumatoid arthritis treated with methotrexate. Ann Rheum Dis. 1995;54:155.PubMedPubMed CentralView ArticleGoogle Scholar
  92. Hashizume H, Umayahara T. Acute respiratory distress syndrome due to varicella zoster virus pneumonitis in an immunocompromised patient with herpes zoster. J Dermatol. 2013;40:1064–5.PubMedView ArticleGoogle Scholar
  93. Nakamura M, Kanazawa M, Yamaguchi K, Akizuki M, Satoh S, Inada S. Pneumonia caused by varicella-zoster virus in a patient with rheumatoid arthritis. Nihon Kyobu Shikkan Gakkai Zasshi. 1996;34:610–5.PubMedGoogle Scholar
  94. Miyazaki T, Tanabe Y, Iseki M. Treatment and recent topics of postherpetic neuralgia. Japan Med Assoc J. 2005;48:505–10.Google Scholar
  95. Sanford M, Keating GM. Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults. Drugs Aging. 2010;27:159–76.PubMedView ArticleGoogle Scholar
  96. Cheong C, Lee TJ. Prevalence and healthcare utilization of herpes zoster and postherpetic neuralgia in South Korea: disparity among patients with different immune statuses. Epidemiol Health. 2014;36:e2014012.PubMedPubMed CentralView ArticleGoogle Scholar
  97. Higa K, Mori M, Hirata K, Hori K, Manabe H, Dan K. Severity of skin lesions of herpes zoster at the worst phase rather than age and involved region most influences the duration of acute herpetic pain. Pain. 1997;69:245–53.PubMedView ArticleGoogle Scholar
  98. Sagong C, Yeo KY, Kim JS, Yu HJ, Kim DH. The relationship among pain, depression, and anxiety in patients with herpes zoster. Korean J Dermatol. 2009;47:403–10.Google Scholar
  99. Decroix J, Partsch H, Gonzalez R, Mobacken H, Goh CL, Walsh JB, et al. Factors influencing pain outcome in herpes zoster: An observational study with valaciclovir. J Eur Acad Dermatol Venereol. 2000;14:23–33.PubMedView ArticleGoogle Scholar
  100. Noh TW, Park HJ, Kim SH, Kang YS, Lee UH, Park HS. A clinical study of herpes zoster focused on the characteristics of pruritus in herpes zoster. Korean J Dermatol. 2012;50:591–8.Google Scholar
  101. Chant KG, Sullivan EA, Burgess MA, Ferson MJ, Forrest JM, Baird LM, et al. Varicella-zoster virus infection in Australia. Aust N Z J Public Health. 1998;22:413–8.PubMedView ArticleGoogle Scholar
  102. MacIntyre CR, Chu CP, Burgess MA. Use of hospitalization and pharmaceutical prescribing data to compare the prevaccination burden of varicella and herpes zoster in Australia. Epidemiol Infect. 2003;131:675–82.PubMedPubMed CentralView ArticleGoogle Scholar
  103. Lee BW. Review of varicella zoster seroepidemiology in India and Southeast Asia. Trop Med Int Health. 1998;3:886–90.PubMedView ArticleGoogle Scholar
  104. Stein AN, Britt H, Harrison C, Conway EL, Cunningham A, Macintyre CR. Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older. Vaccine. 2009;27:520–9.PubMedView ArticleGoogle Scholar
  105. Dashraath P, Ong ES, Lee VJ. Seroepidemiology of varicella and the reliability of a self-reported history of varicella infection in Singapore military recruits. Ann Acad Med Singapore. 2007;36:636–41.PubMedGoogle Scholar
  106. Chow VTK. Rapid detection of varicella-zoster viral antibodies by latex agglutination assay: A practical experience for medical and science undergraduates. Biochem Educ. 1998;26:248–51.View ArticleGoogle Scholar
  107. Fatha N, Ang LW, Goh KT. Changing seroprevalence of varicella zoster virus infection in a tropical city state, Singapore. Int J Infect Dis. 2014;22:73–7.PubMedView ArticleGoogle Scholar
  108. Juffrie M, Graham RR, Tan RI, Widjaja S, Mulyadi S, Weil J, et al. Seroprevalence of hepatitis A virus and varicella zoster antibodies in a Javanese community (Yogyakarta, Indonesia). Southeast Asian J Trop Med Public Health. 2000;31:21–4.PubMedGoogle Scholar
  109. Sam IC, Tariman H, Chan YF, Bador MK, Yusof MY, Hassan H. Varicella-zoster virus seroprevalence in healthcare workers in Kuala Lumpur, Malaysia. Med J Malaysia. 2008;63:429–30.PubMedGoogle Scholar
  110. Barzaga NG, Roxas JR, Florese RH. Varicella zoster virus prevalence in Metro Manila, Philippines. J Am Med Assoc (SE Asia). 1994;274(Suppl):S633–35.Google Scholar
  111. Lokeshwar MR, Agrawal A, Subbarao SD, Chakraborty MS, Ram Prasad AV, Weil J, et al. Age related seroprevalence of antibodies to varicella in India. Indian Pediatr. 2000;37:714–9.PubMedGoogle Scholar
  112. Migasena S, Simasathien S, Desakorn V, Phonrat B, Suntharasamai P, Pitisuttitham P, et al. Seroprevalence of varicella-zoster virus antibody in Thailand. Int J Infect Dis. 1997;2:26–30.View ArticleGoogle Scholar
  113. Bhattarakosol P, Chantarabul S, Pittayathikhun K, Mung-mee V, Punnarugsa V. Prevalence of anti-varicella zoster IgG antibody in undergraduate students. Asian Pac J Allergy Immunol. 1996;14:129–31.PubMedGoogle Scholar
  114. Lolekha S, Tanthiphabha W, Sornchai P, Kosuwan P, Sutra S, Warachit B, et al. Effect of climatic factors and population density on varicella zoster virus epidemiology within a tropical country. Am J Trop Med Hyg. 2001;64:131–6.PubMedGoogle Scholar
  115. Srichomkwun P, Apisarnthanarak A, Thongphubeth K, Yuekyen C, Mundy LM. Evidence of vaccine protection among Thai medical students and implications for occupational health. Infect Control Hosp Epidemiol. 2009;30:585–8.PubMedView ArticleGoogle Scholar
  116. Suwanpakdee D, Laohapand C, Moolasart V, Lomtong P, Krairojananan N, Srisawat P, et al. Serosurveillance of varicella and hepatitis B infection after reported cases in medical students and the relationship between past varicella disease history and immunity status. J Med Assoc Thai. 2012;95 Suppl 5:S80–5.PubMedGoogle Scholar
  117. Kowitdamrong E, Pancharoen C, Thammaborvorn R, Bhattarakosol P. The prevalence of varicella-zoster virus infection in normal healthy individuals aged above 6 months. J Med Assoc Thai. 2005;88 Suppl 4:S7–11.PubMedGoogle Scholar
  118. O'Grady KA, Merianos A, Patel M, Gilbert L. High seroprevalence of antibodies to varicella zoster virus in adult women in a tropical climate. Trop Med Int Health. 2000;5:732–6.PubMedView ArticleGoogle Scholar
  119. Gidding HF, MacIntyre CR, Burgess MA, Gilbert GL. The seroepidemiology and transmission dynamics of varicella in Australia. Epidemiol Infect. 2003;131:1085–9.PubMedPubMed CentralView ArticleGoogle Scholar
  120. Lin YJ, Huang LM, Lee CY, Chih TW, Lee PL, Chang LY, et al. A seroepidemiological study of Varicella-Zoster virus in Taipei City. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1996;37:11–5.PubMedGoogle Scholar
  121. Wu MF, Yang YW, Lin WY, Chang CY, Soon MS, Liu CE. Varicella zoster virus infection among healthcare workers in Taiwan: seroprevalence and predictive value of history of varicella infection. J Hosp Infect. 2012;80:162–7.PubMedView ArticleGoogle Scholar
  122. Kangro HO, Osman HK, Lau YL, Heath RB, Yeung CY, Ng MH. Seroprevalence of antibodies to human herpesviruses in England and Hong Kong. J Med Virol. 1994;43:91–6.PubMedView ArticleGoogle Scholar
  123. Fung LW, Lao TT, Suen SS, Chan OK, Lau TK, Ngai KL, et al. Seroprevalence of varicella zoster virus among pregnant women in Hong Kong: comparison with self-reported history. Vaccine. 2011;29:8186–8.PubMedView ArticleGoogle Scholar
  124. Liu JJ, Wang ML, Gan L, Liao WJ, Chen J. Seroepidemiology of varicella-zoster virus infection measured by the fluorescent antibody to membrane antigen test. Zhonghua Liu Xing Bing Xue Za Zhi. 2009;30:371–5.PubMedGoogle Scholar
  125. Zhou Z, Wang S, Chu Y, Xie G. Survey of seroprevalence of varicella zoster virus in healthy population in Shanghai. Chin J Vaccin Immun. 2006;2:137–9.Google Scholar
  126. Wang Y. Seroepidemiological survey of prevalence of varicella-zoster virus in healthy population in Shenzen City. Chin Trop Med. 2006;7:1166–7.Google Scholar
  127. Pan W, Zhang X, Cai Z, Zhang H. A sero-epidemiological investigation on varicella-zoster virus in healthy people in Fujian. Pract Prev Med. 2003;6:864–5.Google Scholar
  128. Han SB, Kang KR, Huh DH, Lee HC, Kim JH, Kang JH, et al. Seroepidemiology of varicella-zoster virus in Korean adolescents and adults using fluorescent antibody to membrane antigen test. Epidemiol Infect. 2015;143:1643–50.PubMedView ArticleGoogle Scholar
  129. Kang CI, Choi CM, Park TS, Lee DJ, Oh MD, Choe KW. Incidence of herpes zoster and seroprevalence of varicella-zoster virus in young adults of South Korea. Int J Infect Dis. 2008;12:245–7.PubMedView ArticleGoogle Scholar
  130. Choi YJ, Kim KH, Oh MD. Genotype of varicella zoster virus isolated from Korean elderly patients with herpes zoster. Infect Chemother. 2010;42:162–70.View ArticleGoogle Scholar
  131. Lee H, Cho HK, Kim KH. Seroepidemiology of varicella-zoster virus in Korea. J Korean Med Sci. 2013;28:195–9.PubMedPubMed CentralView ArticleGoogle Scholar
  132. Kang JH, Park YS, Park SY, Kim SB, Ko KP, Seo YH. Varicella seroprevalence among health care workers in Korea: validity of self-reported history and cost-effectiveness of prevaccination screening. Am J Infect Control. 2014;42:885–7.PubMedView ArticleGoogle Scholar
  133. Kim YH, Hwang JY, Lee KM, Choi JH, Lee TY, Choi JS, et al. Seroepidemiologic survey of varicella-zoster virus in Korean adults using glycoprotein enzyme immuno assay and fluorescent antibody to membrane antigen test. Ann Dermatol. 2011;23:39–43.PubMedPubMed CentralView ArticleGoogle Scholar
  134. Yoshida N, Tsumura N, Toyomasu K, Sagawa K. Antibody titers against measles, rubella, mumps and varicella-zoster viruses in medical students. Sangyo Eiseigaku Zasshi. 2007;49:21–6.PubMedView ArticleGoogle Scholar
  135. National Institute of Infectious Diseases, Japan. National Epidemiological Surveillance of Vaccine-Preventable Diseases, 2015. Age distribution of varicella EIA-IgG antibody positives in Japan, 2015. http://www.nih.go.jp/niid/ja/y-graphs/6358-varicella-yosoku-serum2015.html. Accessed 27 Sept 2016.
  136. Lin YH, Huang LM, Chang IS, Tsai FY, Lu CY, Shao PL, et al. Disease burden and epidemiology of herpes zoster in pre-vaccine Taiwan. Vaccine. 2010;28:1217–20.PubMedView ArticleGoogle Scholar
  137. Jih JS, Chen YJ, Lin MW, Chen YC, Chen TJ, Huang YL, et al. Epidemiological features and costs of herpes zoster in Taiwan: a national study 2000 to 2006. Acta Derm Venereol. 2009;89:612–6.PubMedView ArticleGoogle Scholar
  138. Kim YJ, Lee CN, Lim CY, Jeon WS, Park YM. Population-based study of the epidemiology of herpes zoster in Korea. J Korean Med Sci. 2014;29:1706–10.PubMedPubMed CentralView ArticleGoogle Scholar
  139. Toyama N, Shiraki K. Epidemiology of herpes zoster and its relationship to varicella in Japan: A 10-year survey of 48,388 herpes zoster cases in Miyazaki prefecture. J Med Virol. 2009;81:2053–8.PubMedView ArticleGoogle Scholar
  140. Choi WS, Noh JY, Huh JY, Jo YM, Lee J, Song JY, et al. Disease burden of herpes zoster in Korea. J Clin Virol. 2010;47:325–9.PubMedView ArticleGoogle Scholar
  141. Wu PY, Wu HD, Chou TC, Sung FC. Varicella vaccination alters the chronological trends of herpes zoster and varicella. PLoS One. 2013;8:e77709.PubMedPubMed CentralView ArticleGoogle Scholar
  142. Wu CY, Hu HY, Huang N, Pu CY, Shen HC, Chou YJ. Do the health-care workers gain protection against herpes zoster infection? A 6-year population-based study in Taiwan. J Dermatol. 2010;37:463–70.PubMedView ArticleGoogle Scholar
  143. Chao DY, Chien YZ, Yeh YP, Hsu PS, Lian IB. The incidence of varicella and herpes zoster in Taiwan during a period of increasing varicella vaccine coverage, 2000–2008. Epidemiol Infect. 2012;140:1131–40.PubMedView ArticleGoogle Scholar
  144. Pongsumpun P. Local stability analysis of age structural model for herpes zoster in Thailand. Int J Math Comput Stat Nat Phys Eng. 2013;7:1146–52.Google Scholar
  145. Nelson MR, Britt HC, Harrison CM. Evidence of increasing frequency of herpes zoster management in Australian general practice since the introduction of a varicella vaccine. Med J Aust. 2010;193:110–3.PubMedGoogle Scholar
  146. Kelly HA, Grant KA, Gidding H, Carville KS. Decreased varicella and increased herpes zoster incidence at a sentinel medical deputising service in a setting of increasing varicella vaccine coverage in Victoria, Australia, 1998 to 2012. Euro Surveill. 2014;19(41):pii=20926. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20926.
  147. Carville KS, Riddell MA, Kelly HA. A decline in varicella but an uncertain impact on zoster following varicella vaccination in Victoria, Australia. Vaccine. 2010;28:2532–8.PubMedView ArticleGoogle Scholar
  148. Bak H, Ahn SK. A statistical study of dermatoses (2000–2004). Korean J Dermatol. 2005;43:1192–9.Google Scholar
  149. Lee H-J, Choi SI, Ahn SK. A statistical study of dermatoses in Wonju (2005 ~ 2009). Korean J Dermatol. 2010;48:460–7.Google Scholar
  150. Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand. Annual Epidemiological Surveillance Reports. 1993–2014. http://www.boe.moph.go.th/boedb/surdata/disease.php?dcontent=old&ds=77. Accessed 03 Aug 2015.
  151. Ogunjimi B, Van Damme P, Beutels P. Herpes zoster risk reduction through exposure to chickenpox patients: A systematic multidisciplinary review. PLoS One. 2013;8:e66485.Google Scholar
  152. Jardine A, Conaty SJ, Vally H. Herpes zoster in Australia: Evidence of increase in incidence in adults attributable to varicella immunization? Epidemiol Infect. 2011;139:658–65.PubMedView ArticleGoogle Scholar
  153. Jeong SK, Kim IH. Recurrence rate of herpes zoster during the previous decade. Korean J Dermatol. 2012;50:287–9.Google Scholar
  154. Tunsuriyawong S, Puavilai S. Herpes zoster, clinical course and associated diseases: A 5-year retrospective study at Ramathibodi Hospital. J Med Assoc Thai. 2005;88:678–81.PubMedGoogle Scholar
  155. Ikeda M, Hiroshige K, Abiko Y, Onoda K. Impaired specific cellular immunity to the varicella-zoster virus in patients with herpes zoster oticus. J Laryngol Otol. 1996;110:918–21.PubMedView ArticleGoogle Scholar
  156. Tang H, Moriishi E, Okamoto S, Okuno Y, Iso H, Asada H, et al. A community-based survey of varicella-zoster virus-specific immune responses in the elderly. J Clin Virol. 2012;55:46–50.PubMedView ArticleGoogle Scholar
  157. Lin SY, Liu JH, Lin CL, Tsai IJ, Chen PC, Chung CJ, et al. A comparison of herpes zoster incidence across the spectrum of chronic kidney disease, dialysis and transplantation. Am J Nephrol. 2012;36:27–33.PubMedView ArticleGoogle Scholar
  158. Hata A, Kuniyoshi M, Ohkusa Y. Risk of Herpes zoster in patients with underlying diseases: a retrospective hospital-based cohort study. Infection. 2011;39:537–44.PubMedPubMed CentralView ArticleGoogle Scholar
  159. Kuo CC, Lee CT, Lee IM, Ho SC, Yang CY. Risk of herpes zoster in patients treated with long-term hemodialysis: a matched cohort study. Am J Kidney Dis. 2012;59:428–33.PubMedView ArticleGoogle Scholar
  160. Wu MY, Hsu YH, Su CL, Lin YF, Lin HW. Risk of herpes zoster in CKD: a matched-cohort study based on administrative data. Am J Kidney Dis. 2012;60:548–52.PubMedView ArticleGoogle Scholar
  161. Chen HH, Chen YM, Chen TJ, Lan JL, Lin CH, Chen DY. Risk of herpes zoster in patients with systemic lupus erythematosus: a three-year follow-up study using a nationwide population-based cohort. Clinics (Sao Paulo). 2011;66:1177–82.View ArticleGoogle Scholar
  162. Tsai SY, Yang TY, Lin CL, Tsai YH, Kuo CF, Kao CH. Increased risk of varicella zoster virus infection in inflammatory bowel disease in an Asian population: a nationwide population-based cohort study. Int J Clin Pract. 2015;69:228–34.PubMedView ArticleGoogle Scholar
  163. Chen JY, Cheng TJ, Chang CY, Lan KM, Weng SF, Sheu MJ, et al. Increased incidence of herpes zoster in adult patients with peptic ulcer disease: A population-based cohort study. Int J Epidemiol. 2013;42:1873–81.PubMedView ArticleGoogle Scholar
  164. Yang YW, Chen YH, Wang KH, Wang CY, Lin HW. Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study. CMAJ. 2011;183:E275–80.PubMedPubMed CentralView ArticleGoogle Scholar
  165. Umezawa Y, Fukuchi O, Ito T, Saeki H, Nakagawa H. Risk of herpes zoster in psoriatic patients undergoing biologic treatment. J Dermatol. 2014;41:168–70.PubMedView ArticleGoogle Scholar
  166. Hu SC, Lin CL, Lu YW, Chen GS, Yu HS, Wu CS, et al. Lymphopaenia, anti-Ro/anti-RNP autoantibodies, renal involvement and cyclophosphamide use correlate with increased risk of herpes zoster in patients with systemic lupus erythematosus. Acta Derm Venereol. 2013;93:314–8.PubMedView ArticleGoogle Scholar
  167. Zou Y, Lin M, Sheng Z, Niu S. Bortezomib and lenalidomide as front-line therapy for multiple myeloma. Leuk Lymphoma. 2014;55:2024–31.PubMedView ArticleGoogle Scholar
  168. Lyu SM, Byun JY, Choi YW, Choi HY. Clinical features of dermatology-consulted inpatients - Focus on the differences between individual departments. Korean J Dermatol. 2014;52:215–21.Google Scholar
  169. Oh SI, Oh BH, Rho JR, Kim KB, Kim JJ, Song MG, et al. Results of heart transplantation in Korea. Korean J Med. 2001;60:228–33.Google Scholar
  170. Tzeng CH, Liu JH, Fan S, Wang SY, Wang SR, Chen KY, et al. Varicella zoster virus infection after allogeneic or autologous hemopoietic stem cell transplantation. J Formos Med Assoc. 1995;94:313–7.PubMedGoogle Scholar
  171. Nakasone H, Izutsu K, Wakita S, Yamaguchi H, Muramatsu-Kida M, Usuki K. Autologous stem cell transplantation with PCR-negative graft would be associated with a favorable outcome in core-binding factor acute myeloid leukemia. Biol Blood Marrow Transplant. 2008;14:1262–9.PubMedView ArticleGoogle Scholar
  172. Tsukamoto H, Nagafuji K, Horiuchi T, Miyamoto T, Aoki K, Takase K, et al. A phase I-II trial of autologous peripheral blood stem cell transplantation in the treatment of refractory autoimmune disease. Ann Rheum Dis. 2006;65:508–14.PubMedView ArticleGoogle Scholar
  173. Jiang Z, Xiao H, Pang Y, Xiao Y. The incidence of herpes zoster after hematopoietic stem cell transplantation. Chin J Infect Chemother. 2012;12:88–91.Google Scholar
  174. Chugh KS, Sharma SC, Singh V, Sakhuja V, Jha V, Gupta KL. Spectrum of dermatological lesions in renal allograft recipients in a tropical environment. Dermatology. 1994;188:108–12.PubMedView ArticleGoogle Scholar
  175. Prakash J, Singh S, Prashant GK, Kar B, Tripathi K, Singh PB. Mucocutaneous lesions in transplant recipient in a tropical country. Transplant Proc. 2004;36:2162–4.PubMedView ArticleGoogle Scholar
  176. Hwang EA, Kang MJ, Han SY, Park SB, Kim HC. Viral infection following kidney transplantation: long-term follow-up in a single center. Transplant Proc. 2004;36:2118–9.PubMedView ArticleGoogle Scholar
  177. Ko GB, Kim T, Kim SH, Choi SH, Kim YS, Woo JH, et al. Increased incidence of herpes zoster in the setting of cytomegalovirus preemptive therapy after kidney transplantation. Transpl Infect Dis. 2013;15:416–23.PubMedView ArticleGoogle Scholar
  178. Vinod PB, Sharma RK. Opportunistic infections (non-cytomegalovirus) in live related renal transplant recipients. Indian J Urol. 2009;25:161–8.PubMedPubMed CentralView ArticleGoogle Scholar
  179. Ng P, McCluskey P, McCaughan G, Glanville A, MacDonald P, Keogh A. Ocular complications of heart, lung, and liver transplantation. Br J Ophthalmol. 1998;82:423–8.PubMedPubMed CentralView ArticleGoogle Scholar
  180. Kreis H, Oberbauer R, Campistol JM, Mathew T, Daloze P, Schena FP, et al. Long-term benefits with sirolimus-based therapy after early cyclosporine withdrawal. J Am Soc Nephrol. 2004;15:809–17.PubMedView ArticleGoogle Scholar
  181. Tomonari A, Iseki T, Takahashi S, Ooi J, Takasugi K, Shimohakamada Y, et al. Varicella-zoster virus infection in adult patients after unrelated cord blood transplantation: a single institute experience in Japan. Br J Haematol. 2003;122:802–5.PubMedView ArticleGoogle Scholar
  182. Onozawa M, Hashino S, Haseyama Y, Hirayama Y, Iizuka S, Ishida T, et al. Incidence and risk of postherpetic neuralgia after varicella zoster virus infection in hematopoietic cell transplantation recipients: Hokkaido Hematology Study Group. Biol Blood Marrow Transplant. 2009;15:724–9.PubMedView ArticleGoogle Scholar
  183. Wu M, Huang F, Jiang X, Fan Z, Zhou H, Liu C, et al. Herpesvirus-associated central nervous system diseases after allogeneic hematopoietic stem cell transplantation. PLoS One. 2013;8:e77805.PubMedPubMed CentralView ArticleGoogle Scholar
  184. Suzuki J, Ashizawa M, Okuda S, Wada H, Sakamoto K, Terasako K, et al. Varicella zoster virus meningoencephalitis after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis. 2012;14:E7–12.PubMedView ArticleGoogle Scholar
  185. Au WY, Hon C, Cheng VCC, Ma ESK. Concomitant zoster myelitis and cerebral leukemia relapse after stem cell transplantation. Ann Hematol. 2005;84:59–60.PubMedView ArticleGoogle Scholar
  186. Fukuno K, Tomonari A, Takahashi S, Ooi J, Takasugi K, Tsukada N, et al. Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome-overt leukemia. Int J Hematol. 2006;84:79–82.PubMedView ArticleGoogle Scholar
  187. Kang EH, Chung MP, Kang SJ, An CH, Ahn JW, Han J, Lee. Clinical features and treatment response in 18 cases with idiopathic nonspecific interstitial pneumonia. Tuberc Respir Dis. 2000;48:530–41.View ArticleGoogle Scholar
  188. Ozono Y, Harada T, Yamaguchi K, Taura K, Hara K, Taguchi T. Nephrotic syndrome in the elderly–clinicopathological study. Nihon Jinzo Gakkai Shi. 1994;36:44–50.PubMedGoogle Scholar
  189. Satoh N, Abe T, Nakajima A, Sakuragi S. Recurrent varicella-zoster virus retinitis in a patient treated with systemic corticosteroids. Ocul Immunol Inflamm. 1998;6:185–8.PubMedView ArticleGoogle Scholar
  190. Xiao X, Lu Y, Su H, Zhong K, Chen X, Da Y, et al. Clinical features and treatment of angioimmunoblastic T-cell lymphoma. Chin J Clin Oncol. 2011;38:1103–6.Google Scholar
  191. Usami E, Kimura M, Matsuoka T, Okada K, Nakao T, Yoshimura T, et al. The frequency and risk factor of herpes zoster infection in non-Hodgkin's lymphoma patients. Jpn J Cancer Chemother. 2011;38:243–7.Google Scholar
  192. Mills AK, Taylor KM, Wright SJ, Bunce LH, Bashford J, White K, et al. Sustained responses following alternating chlorodeoxyadenosine (2CDA) and VAC regimen in poor-risk de-novo follicular non-hodgkin's lymphoma (NHL). In: Blood 2000;96(11) Part II: The 2nd Annual Scientific Meeting of the Haematology Society of Australia and New Zealand, Perth, WA, 25–28 July 2000. p. 243b.Google Scholar
  193. Au WY, Kwong YL. Frequent varicella zoster reactivation associated with therapeutic use of arsenic trioxide: portents of an old scourge. J Am Acad Dermatol. 2005;53:890–2.PubMedView ArticleGoogle Scholar
  194. Zhang Q, Mu LJ, Wang XB, Li L, Kang ZJ, Yan JS. Clinical analysis of hematologic disorders complicated with herpes zoster after treating with arsenic trioxide. J Leuk Lymphoma. 2011;20:412–4.Google Scholar
  195. Yamakura M, Tsuda K, Ugai T, Sugihara H, Nisihida Y, Takeuchi M, et al. High frequency of varicella zoster virus reactivation associated with the use of arsenic trioxide in patients with acute promyelocytic leukemia. Acta Haematol. 2014;131:76–7.PubMedView ArticleGoogle Scholar
  196. Au WY, Kumana CR, Lee HK, Lin SY, Liu H, Yeung DY, et al. Oral arsenic trioxide-based maintenance regimens for first complete remission of acute promyelocytic leukemia: a 10-year follow-up study. Blood. 2011;118:6535–43.PubMedView ArticleGoogle Scholar
  197. Chan AYK, Hooi LS. Outcome of 85 lupus nephritis patients treated with intravenous clophosphamide: A single centre 10 year experience. Med J Malays. 2000;55:14–20.Google Scholar
  198. Chan TM, Li FK, Wong RW, Wong KL, Chan KW, Cheng IK. Sequential therapy for diffuse proliferative and membranous lupus nephritis: cyclophosphamide and prednisolone followed by azathioprine and prednisolone. Nephron. 1995;71:321–7.PubMedView ArticleGoogle Scholar
  199. Chan TM, Li FK, Hao WK, Chan KW, Lui SL, Tang S, et al. Treatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppression. Lupus. 1999;8:545–51.PubMedView ArticleGoogle Scholar
  200. Mok CC, Ho CT, Siu YP, Chan KW, Kwan TH, Lau CS, et al. Treatment of diffuse proliferative lupus glomerulonephritis: a comparison of two cyclophosphamide-containing regimens. Am J Kidney Dis. 2001;38:256–64.PubMedView ArticleGoogle Scholar
  201. Liu G, Chen Y, Zuo C, Xie Q, Wang Z, Wang L, et al. Study on bolus cyclosphamide treatment for 64 cases of lupus nephritis. J West China Univ Med Sci. 2001;32:129–130,139.Google Scholar
  202. Mok CC, Ying KY, Mak A, To CH, Szeto ML. Outcome of protein-losing gastroenteropathy in systemic lupus erythematosus treated with prednisolone and azathioprine. Rheumatology (Oxford). 2006;45:425–9.View ArticleGoogle Scholar
  203. Kim JH, Cheon JH, Kim WH. The frequency and the course of the adverse effects of azathioprine/6-mercaptopurine treatment in patients with inflammatory bowel disease. Korean J Gastroenterol. 2008;51:291–7.PubMedGoogle Scholar
  204. Eisen HJ, Kobashigawa J, Keogh A, Bourge R, Renlund D, Mentzer R, et al. Three-year results of a randomized, double-blind, controlled trial of mycophenolate mofetil versus azathioprine in cardiac transplant recipients. J Heart Lung Transplant. 2005;24:517–25.PubMedView ArticleGoogle Scholar
  205. Zeher M, Doria A, Lan J, Aroca G, Jayne D, Boletis I, et al. Efficacy and safety of enteric-coated mycophenolate sodium in combination with two glucocorticoid regimens for the treatment of active lupus nephritis. Lupus. 2011;20:1484–93.PubMedView ArticleGoogle Scholar
  206. Hu W, Liu C, Xie H, Chen H, Liu Z, Li L. Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement. Nephrol Dial Transplant. 2008;23:1307–12.PubMedView ArticleGoogle Scholar
  207. Kim YS, Moon JI, Kim SI, Park K. Clear benefit of mycophenolate mofetil-based triple therapy in reducing the incidence of acute rejection after living donor renal transplantations. Transplantation. 1999;68:578–81.PubMedView ArticleGoogle Scholar
  208. Lu F, Tu Y, Peng X, Wang L, Wang H, Sun Z, et al. A prospective multicentre study of mycophenolate mofetil combined with prednisolone as induction therapy in 213 patients with active lupus nephritis. Lupus. 2008;17:622–9.View ArticleGoogle Scholar
  209. Hegde S, Annamalai R, Biswas J. Extensive herpes zoster involvement following mycophenolate mofetil therapy for sarcoidosis. J Ophthalmic Inflamm Infect. 2012;2:47–8.PubMedView ArticleGoogle Scholar
  210. Satoh S, Tada H, Murakami M, Tsuchiya N, Inoue T, Togashi H, et al. The influence of mycophenolate mofetil versus azathioprine and mycophenolic acid pharmacokinetics on the incidence of acute rejection and infectious complications after renal transplantation. Transplant Proc. 2005;37:1751–3.PubMedView ArticleGoogle Scholar
  211. Yap DY, Yu X, Chen XM, Lu F, Chen N, Li XW, et al. Pilot 24 month study to compare mycophenolate mofetil and tacrolimus in the treatment of membranous lupus nephritis with nephrotic syndrome. Nephrology (Carlton). 2012;17:352–7.View ArticleGoogle Scholar
  212. Mak SK, Lo KY, Lo MW, Chan SF, Tong GM, Wong PN, et al. Efficacy of enteric-coated mycophenolate sodium in patients with active lupus nephritis. Nephrology (Carlton). 2008;13:331–6.View ArticleGoogle Scholar
  213. Li L, Wang H, Lin S, et al. Mycophenolate mofetil treatment for diffuse proliferative lupus nephritis: a multicenter clinical trial in China. Zhonghua Nei Ke Za Zhi. 2002;41:476–9.PubMedGoogle Scholar
  214. Xie QX, Han CX, Li JY, Lin XC, Zhao L, Huang HW, et al. Application of low-dosage mycophenolate mofetil in living renal transplantation of lineal consanguinity. J Clin Rehab Tissue Eng Res. 2009;13:924–6.Google Scholar
  215. Jenks KA, Stamp LK, O'Donnell JL, Savage RL, Chapman PT. Leflunomide-associated infections in rheumatoid arthritis. J Rheumatol. 2007;34:2201–3.PubMedGoogle Scholar
  216. Yoo HG, Yu HM, Jun JB, Jeon HS, Yoo WH. Risk factors of severe infections in patients with rheumatoid arthritis treated with leflunomide. Mod Rheumatol. 2013;23:709–15.PubMedView ArticleGoogle Scholar
  217. Cui TG, Hou FF, Ni ZH, Chen XM, Zhang FS, Zhu TY, et al. Treatment of proliferative lupus nephritis with leflunomide and steroid: a prospective multi-center controlled clinical trial. Zhonghua Nei Ke Za Zhi. 2005;44:672–6.PubMedGoogle Scholar
  218. Muir VJ, Plosker GL. Cladribine tablets: in relapsing-remitting multiple sclerosis. CNS Drugs. 2011;25:239–49.PubMedView ArticleGoogle Scholar
  219. Kim SJ, Moon JH, Kim H, Kim JS, Hwang YY, Intragumtornchai T, et al. Non-bacterial infections in Asian patients treated with alemtuzumab: A retrospective study of the Asian Lymphoma Study Group. Leuk Lymphoma. 2012;53:1515–24.PubMedView ArticleGoogle Scholar
  220. Chung BH, Kim Y, Jeong HS, Hong YA, Choi BS, Park CW, et al. Clinical outcome in patients with chronic antibody-mediated rejection treated with and without rituximab and intravenous immunoglobulin combination therapy. Transpl Immunol. 2014;31:140–4.PubMedView ArticleGoogle Scholar
  221. Ito K, Okamoto M, Maruyama F, Handa K, Yamamoto Y, Watanabe M, et al. Alteration in antibody-mediated immunity in patients with rituximab-combined chemotherapy and incidence of herpes zoster. Gan To Kagaku Ryoho. 2010;37:99–102.PubMedGoogle Scholar
  222. Kurokawa T, Hase M, Tokuman N, Yoshida T. Immune reconstitution of B-cell lymphoma patients receiving CHOP-based chemotherapy containing rituximab. Hematol Oncol. 2011;29:5–9.PubMedView ArticleGoogle Scholar
  223. Lee SD, Kim SH, Kong SY, Kim YK, Lee SA, Park SJ. ABO-incompatible living donor liver transplantation without graft local infusion and splenectomy. HPB (Oxford). 2014;16:807–13.View ArticleGoogle Scholar
  224. Tu MF, Zheng W, Lin NJ, Zhang YT, Wang XP, Song YQ, et al. Efficacy and safety of fludarabine-based combination chemotherapy in patients with previously untreated follicular non-Hodgkin's lymphoma. Tumor. 2011;31:58–63.Google Scholar
  225. Furie R, Nicholls K, Cheng TT, Houssiau F, Burgos-Vargas R, Chen SL, et al. Efficacy and safety of abatacept in lupus nephritis: A twelve-month, randomized, double-blind study. Arthritis Rheum. 2014;66:379–89.View ArticleGoogle Scholar
  226. Lee EB, Fleischmann R, Hall S, Wilkinson B, Bradley JD, Gruben D, et al. Tofacitinib versus methotrexate in rheumatoid arthritis. N Engl J Med. 2014;370:2377–86.PubMedView ArticleGoogle Scholar
  227. Winthrop KL, Yamanaka H, Valdez H, Mortensen E, Chew R, Krishnaswami S, et al. Herpes zoster and tofacitinib therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2014;66:2675–84.View ArticleGoogle Scholar
  228. Wang X, Zhao J, Zhu S, Xia B. Herpes zoster in Crohn's disease during treatment with infliximab. Eur J Gastroenterol Hepatol. 2014;26:237–9.PubMedView ArticleGoogle Scholar
  229. Choi KD, Song HJ, Kim JS, Jung HC, Song IS. Efficacy and safety of treatment with infliximab in Crohn's disease-the experience of single center in Korea. Korean J Gastroenterol. 2005;46:48–55.PubMedGoogle Scholar
  230. Kim YJ, Kim JW, Lee CK, Park HJ, Shim JJ, Jang JY, et al. Clinical outcome of treatment with infliximab in Crohn's disease: a single-center experience. Korean J Gastroenterol. 2013;61:270–8.PubMedView ArticleGoogle Scholar
  231. Yi YS, Chung JS, Song MK, Shin HJ, Seol YM, Choi YJ, et al. The risk factors for herpes zoster in bortezomib treatment in patients with multiple myeloma. Korean J Hematol. 2010;45:188–92.PubMedPubMed CentralView ArticleGoogle Scholar
  232. Kim SJ, Kim K, Kim BS, Lee HJ, Kim H, Lee NR, et al. Bortezomib and the increased incidence of herpes zoster in patients with multiple myeloma. Clin Lymphoma Myeloma. 2008;8:237–40.PubMedView ArticleGoogle Scholar
  233. Kim MG, Kim YJ, Kwon HY, Park HC, Koo TY, Jeong JC, et al. Outcomes of combination therapy for chronic antibody-mediated rejection in renal transplantation. Nephrology (Carlton). 2013;18:820–6.View ArticleGoogle Scholar
  234. Tong Y, Qian J, Li Y, Meng H, Jin J. The high incidence of varicella herpes zoster with the use of bortezomib in 10 patients. Am J Hematol. 2007;82:403–4.PubMedView ArticleGoogle Scholar
  235. Zhong YP, Chen SL, Li X, Hu Y, Zhang JJ. Bortezomib combined with other drugs for treating 60 cases of multiple myeloma. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2009;17:214–7.PubMedGoogle Scholar
  236. Khalafallah AA, Woodgate M, Koshy K, Patrick A. Ophthalmic manifestations of herpes zoster virus in patients with multiple myeloma following bone marrow transplantation. BMJ Case Rep. 2013; doi:10.1136/bcr-2012-007625.
  237. Zhang YQ, Liang R, Bai QX, Zhang T, Yang L, Wang YW, et al. PAD regimen for relapsed or refractory patients with multiple myeloma. Zhonghua Xue Ye Xue Za Zhi. 2009;30:260–3.PubMedGoogle Scholar
  238. Muta T, Nakanishi H, Yasunaga M, Senba S, Murakami H, Kan S, et al. Safety evaluation of bortezomib in multiple myeloma patients with severe renal failure. Jpn J Cancer Chemother. 2011;38:237–41.Google Scholar
  239. Li CM, Lu H, Wu HX, Qiu HX, Qian SX, Xu W, et al. Therapeutic efficacy of bortezomib-based chemotherapy on 40 patients with multiple myeloma. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2010;18:1511–4.PubMedGoogle Scholar
  240. Yang G, Chen W, Wu Y. Bortezomib, dexamethasone plus thalidomide for treatment of newly diagnosed multiple myeloma patients with or without renal impairment. Chin J Cancer Res. 2013;25:155–60.PubMedPubMed CentralGoogle Scholar
  241. He J, Yang L, Han X, Zheng G, Zheng W, Wei G, et al. The choice of regimens based on bortezomib for patients with newly diagnosed multiple myeloma. PLoS One. 2014;9:e99174.PubMedPubMed CentralView ArticleGoogle Scholar
  242. Huang B, Li J, Xu X, Zheng D, Zhou Z, Liu J. Successful treatment of renal light chain (AL) amyloidosis with bortezomib and dexamethasone (VD). Pathol Biol (Paris). 2015;63:17–20.View ArticleGoogle Scholar
  243. Zhang Y, Shi B, Chen X, Xia Y, Ye L, Liu L, et al. Bortezomib combined with doxorubicin and dexamethasone for patients with refractory senile mantle cell lymphoma. Chin J Clin Oncol. 2011;38:1092–4.Google Scholar
  244. Zhong YP, Chen SL. Effect of treatment by bortezomib with other drugs for the refractory multiple myeloma. J Leuk Lymphoma. 2009;18:538–40.Google Scholar
  245. Zhu JJ, Li L, Ye XJ, He JS, Cai Z. Bortezomib combined with epirubicin and dexamethasone in treatment of multiple myeloma. J Pract Oncol. 2013;28:520–2.Google Scholar
  246. Ohguchi H, Sugawara T, Ishikawa I, Okuda M, Tomiya Y, Yamamoto J, et al. A retrospective analysis of bortezomib therapy for Japanese patients with relapsed or refractory multiple myeloma: beta2-microglobulin associated with time to progression. Int J Hematol. 2009;89:342–7.PubMedView ArticleGoogle Scholar
  247. Coiffier B, Osmanov EA, Hong X, Scheliga A, Mayer J, Offner F, et al. Bortezomib plus rituximab versus rituximab alone in patients with relapsed, rituximab-naive or rituximab-sensitive, follicular lymphoma: a randomised phase 3 trial. Lancet Oncol. 2011;12:773–84.PubMedView ArticleGoogle Scholar
  248. Yang GZ, Chen WM, Shen M, Fu LN, Jiang L, Gao W, et al. Sequential therapy of BTD and MPT regimen for the newly-diagnosed multiple myeloma patients no eligible for bone marrow transplantation. J Leuk Lymphoma. 2011;20:350–2.Google Scholar
  249. Zhai YP, Liu HN, Yu YP, Zhou XG, Song P, Li F, et al. Treatment of primary systemic amyloidosis with the combination of bortezomib and dexamethasone. Zhonghua Xue Ye Xue Za Zhi. 2010;31:319–22.PubMedGoogle Scholar
  250. Gu HT, Shu MM, Gao GX, Dong BX, Liang R, Yang L, et al. Efficacy comparison between standard and reduced doses of bortezomib combined with adriamycin and dexamethasone in the treatment of patients with multiple myeloma. Zhonghua Xue Ye Xue Za Zhi. 2013;34:622–5.PubMedGoogle Scholar
  251. Zhao Y, Dou LP, Wang SH, Bo J, Wang QS, Huang WR, et al. The efficacy and safety of PAD and VAD regimens for untreated multiple myeloma. Zhonghua Nei Ke Za Zhi. 2010;49:762–4.PubMedGoogle Scholar
  252. Hung MH, Kuo JR, Huang KF, Wang WC. Sacral herpes zoster presenting as sciatica. CMAJ. 2010;182:E534.PubMedPubMed CentralView ArticleGoogle Scholar
  253. Sachdeva S, Prasher P. Herpes zoster following saphenous venectomy for coronary bypass surgery. J Card Surg. 2010;25:28–9.PubMedView ArticleGoogle Scholar
  254. Basavaraj S, Prakash BG, Shetty TS, Sandhya D, Kallada S. Delayed facial nerve weakness after intact canal wall tympanomastoidectomy. Otol Neurotol. 2014;35:1003–6.PubMedView ArticleGoogle Scholar
  255. Lee MR, Ryman W. Herpes zoster following cryosurgery. Australas J Dermatol. 2005;46:42–3.PubMedView ArticleGoogle Scholar
  256. Brandon EL, Akers J, Rapeport D. Development of bilateral herpes zoster following thoracoscopic splanchnicectomy. Anaesth Intensive Care. 2006;34:382–3.PubMedGoogle Scholar
  257. Park KS, Yoon TR, Kim SK, Park HW, Song EK. Acute postoperative herpes zoster with a sciatic nerve distribution after total joint arthroplasty of the ipsilateral hip and contralateral knee. J Arthroplasty. 2010;25:497. e11-5.PubMedGoogle Scholar
  258. Choi HJ, Kim JH, Lee YM. Herpes zoster developing within recent subciliary incision scar. J Craniofac Surg. 2012;23:930–1.PubMedView ArticleGoogle Scholar
  259. Lin KC, Wang CC, Wang KY, Liao YC, Kuo JR. Reactivation of herpes zoster along the trigeminal nerve with intractable pain after facial trauma: a case report and literature review. BMJ Case Rep. 2009; doi:10.1136/bcr.07.2008.0525.
  260. Furuta Y, Ohtani F, Fukuda S, Inuyama Y, Nagashima K. Reactivation of varicella-zoster virus in delayed facial palsy after dental treatment and oro-facial surgery. J Med Virol. 2000;62:42–5.PubMedView ArticleGoogle Scholar
  261. Furukawa K, Sakoh M, Kumon Y, Teraoka M, Ohta S, Ohue S, et al. Delayed facial palsy after microvascular decompression for hemifacial spasm due to reactivation of varicella-zoster virus. No Shinkei Geka. 2003;31:899–902.PubMedGoogle Scholar
  262. Baba T, Yamasaki A, Miyake A, Funakoshi T, Yakura K, Miyazaki D, et al. Varicella zoster virus iridocyclitis following macular hole surgery in a case of von Hippel-Lindau disease. Jpn J Clin Ophthalmol. 2011;65:333–7.Google Scholar
  263. Fujitani A, Hayasaka S. Herpes zoster ophthalmicus after cataract surgery in a patient with a history of gastric cancer. Ann Ophthalmol Glaucoma. 1997;29:57–8.Google Scholar
  264. Koide C. Multiple cranial nerve dysfunction after uncomplicated neurovascular decompression for hemifacial spasm. Otolaryngol Head Neck Surg Tokyo. 1997;69:72–5.Google Scholar
  265. Tsukahara T, Huang J, Oyamada T, Uchio E. Herpetic corneal endotheliitis in a case after deep lamellar keratoplasty for bacterial keratitis. Jpn J Clin Ophthalmol. 2010;64:1287–91.Google Scholar
  266. Gyo K, Honda N. Delayed facial palsy after middle-ear surgery due to reactivation of varicella-zoster virus. J Laryngol Otol. 1999;113:914–5.PubMedView ArticleGoogle Scholar
  267. Kohjitani A, Miyawaki T, Kasuya K, Shimada M. Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report. Cranio. 2002;20:135–8.PubMedView ArticleGoogle Scholar
  268. Walland MJ. Presumed ophthalmic Herpes zoster after contralateral cataract extraction. Acta Ophthalmol Scand. 1995;73:83–5.PubMedView ArticleGoogle Scholar
  269. Kam AC, Dan NG, Maclean J, Higgins D. Zoster related multiple cranial nerve palsies: an unusual complication following percutaneous balloon compression for trigeminal neuralgia. J Clin Neurosci. 1999;6:261–4.PubMedView ArticleGoogle Scholar
  270. Makkar JK, Singh NP, Rastogi V. Herpes zoster: Are selective nerve root injections the treatment or the cause? Pain Phys. 2010;13:196–8.Google Scholar
  271. Oh IH, Choi SK, Park BJ, Kim TS, Rhee BA, Lim YJ. The treatment outcome of elderly patients with idiopathic trigeminal neuralgia : Micro-vascular decompression versus gamma knife radiosurgery. J Korean Neurosurg Soc. 2008;44:199–204.PubMedPubMed CentralView ArticleGoogle Scholar
  272. Chen YH, Rau RH, Keller JJ, Lin HC. Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries. Br J Anaesth. 2012;108:278–82.PubMedView ArticleGoogle Scholar
  273. Terao M, Yamamoto T, Umeda J, Shirabe H. Drug induced herpes zoster (Do statin induce herpes zoster?). Skin Res. 2005;4:335–8.Google Scholar
  274. Chung SD, Tsai MC, Liu SP, Lin HC, Kang JH. Herpes zoster is associated with prior statin use: a population-based case–control study. PLoS One. 2014;9:e111268.PubMedPubMed CentralView ArticleGoogle Scholar
  275. Kano Y, Horie C, Inaoka M, Tadashi I, Mizukawa Y, Shiohara T. Herpes zoster in patients with drug-induced hypersensitivity syndrome/DRESS. Acta Derm-Venereol. 2012;92:206–7.PubMedView ArticleGoogle Scholar
  276. Follezou JY, Lan NY, Lien TX, Lafon ME, Tram LT, Hung PV, et al. Clinical and biological characteristics of human immunodeficiency virus- infected and uninfected intravascular drug users in Ho Chi Minh City, Vietnam. Am J Trop Med Hyg. 1999;61:420–4.PubMedGoogle Scholar
  277. Sivayathorn A, Srihra B, Leesanguankul W. Prevalence of skin disease in patients infected with human immunodeficiency virus in Bangkok, Thailand. Ann Acad Med Singapore. 1995;24:528–33.PubMedGoogle Scholar
  278. Supanaranond W, Desakorn V, Sitakalin C, Naing N, Chirachankul P. Cutaneous manifestations in HIV positive patients. Southeast Asian J Trop Med Public Health. 2001;32:171–6.PubMedGoogle Scholar
  279. Li ZH, Hua YH. Clinical analysis of skin and mucosa manifestations in 130 patients with HIV. J Clin Dermatol. 2013;42:720–2.Google Scholar
  280. Wiwanitkit V. Prevalence of dermatological disorders in Thai HIV-infected patients correlated with different CD4 lymphocyte count statuses: a note on 120 cases. Int J Dermatol. 2004;43:265–8.PubMedView ArticleGoogle Scholar
  281. Sungkanuparph S, Vibhagool A, Mootsikapun P, Chetchotisakd P, Tansuphaswaswadikul S, Bowonwatanuwong C. Opportunistic infections after the initiation of highly active antiretroviral therapy in advanced AIDS patients in an area with a high prevalence of tuberculosis. AIDS. 2003;17:2129–31.PubMedView ArticleGoogle Scholar
  282. Tzung TY, Yang CY, Chao SC, Lee JY. Cutaneous manifestations of human immunodeficiency virus infection in Taiwan. Kaohsiung J Med Sci. 2004;20:216–24.PubMedView ArticleGoogle Scholar
  283. Dwiyana RF, Rowawi R, Lestari M, Alisjahbana B, van der Ven AJ, Djajakusumah TS. Skin disorders in HIV-infected patients from West Java. Acta Med Indones. 2009;41 Suppl 1:18–22.PubMedGoogle Scholar
  284. Wong KH, Lee SS, Lo YC, Li PC, Ho HF, Sitt WH, et al. Profile of opportunistic infections among HIV-1 infected people in Hong Kong. Zhonghua Yi Xue Za Zhi (Taipei). 1995;55:127–36.Google Scholar
  285. Huang XJ, Li HY, Chen DX, Wang XC, Li ZC, Wu YS, et al. Clinical analysis of skin lesions in 796 Chinese HIV- positive patients. Acta Derm Venereol. 2011;91:552–6.PubMedView ArticleGoogle Scholar
  286. Chen XC, Lu XJ, Ye H, Gao YY. Clinical analysis of 109 HIV/AIDS patients. Chin J Infect Chemother. 2008;8:183–6.Google Scholar
  287. Oh MD, Park SW, Kim HB, Kim US, Kim NJ, Choi HJ, et al. Spectrum of opportunistic infections and malignancies in patients with human immunodeficiency virus infection in South Korea. Clin Infect Dis. 1999;29:1524–8.PubMedView ArticleGoogle Scholar
  288. Wani KA. Clinical profile of HIV/Aids patients in Srinagar, Kashmir, India. Int J Collab Res Intern Med Public Health. 2012;4:1703–12.Google Scholar
  289. Wadia RS, Pujari SN, Kothari S, Udhar M, Kulkarni S, Bhagat S, et al. Neurological Manifestations of HIV Disease. J Assoc Physicians India. 2001;49:343–8.PubMedGoogle Scholar
  290. Shobhana A, Guha SK, Neogi DK. Mucocutaneous manifestations of HIV infection. Indian J Dermatol Venereol Leprol. 2004;70:82–6.PubMedGoogle Scholar
  291. Arora U, Chopra S, Jindal N. HIV infection in families in and around Amritsar. J Indian Acad Clin Med. 2008;9:184–7.Google Scholar
  292. Ghate M, Deshpande S, Tripathy S, Nene M, Gedam P, Godbole S, et al. Incidence of common opportunistic infections in HIV-infected individuals in Pune, India: analysis by stages of immunosuppression represented by CD4 counts. Int J Infect Dis. 2009;13:e1–8.PubMedView ArticleGoogle Scholar
  293. Solomon SS, Hawcroft CS, Narasimhan P, Subbaraman R, Srikrishnan AK, Cecelia AJ, et al. Comorbidities among HIV-infected injection drug users in Chennai, India. Indian J Med Res. 2008;127:447–52.PubMedGoogle Scholar
  294. Jindal N, Aggarwal A, Kaur S. HIV seroprevalence and HIV associated dermatoses among patients presenting with skin and mucocutaneous disorders. Indian J Dermatol Venereol Leprol. 2009;75:283–6.PubMedView ArticleGoogle Scholar
  295. Kar HK, Narayan R, Gautam RK, Jain RK, Doda V, Sengupta D, et al. Mucocutaneous disorders in Hiv positive patients. Indian J Dermatol Venereol Leprol. 1996;62:283–5.PubMedGoogle Scholar
  296. Srirangaraj S, Venkatesha D. Opportunistic infections in relation to antiretroviral status among AIDS patients from south India. Indian J Med Microbiol. 2011;29:395–400.PubMedView ArticleGoogle Scholar
  297. Shahapur PR, Bidri RC. Recent trends in the spectrum of opportunistic infections in human immunodeficiency virus infected individuals on antiretroviral therapy in South India. J Nat Sci Biol Med. 2014;5:392–6.PubMedPubMed CentralView ArticleGoogle Scholar
  298. Song JY, Lee JS, Jung HW, Choi HJ, Lee JS, Eom JS, et al. Herpes zoster among HIV-infected patients in the highly active antiretroviral therapy era: Korean HIV cohort study. J Acquired Immune Defic Syndr. 2010;53:417–9.View ArticleGoogle Scholar
  299. Kim JM, Cho GJ, Hong SK, Chung JS, Jang KH, Kim CO, et al. Epidemiologic and clinical features of HIV infection/AIDS in Koreans. Korean J Med. 2001;61:355–64.View ArticleGoogle Scholar
  300. Nam TS, Seo KS, Lee KI, Kim YS, Hong JH, Kim GH, et al. The clinical study of hematoimmunologic features and opportunistic infections of patients with AIDS. Korean J Med. 1997;52:15–23.Google Scholar
  301. Choe KW, Oh MD, Park SW, Kim HB, Kim US, Kang SW, et al. Opportunistic infections and malignancies in 173 patients with HIV infection. Korean J Infect Dis. 1998;30:507–15.Google Scholar
  302. McNulty A, Li Y, Radtke U, Kaldor J, Rohrsheim R, Cooper DA, Donovan B. Herpes zoster and the stage and prognosis of HIV-1 infection. Genitourin Med. 1997;73:467–70.PubMedPubMed CentralGoogle Scholar
  303. Hung CC, Hsiao CF, Wang JL, Chen MY, Hsieh SM, Sheng WH, et al. Herpes zoster in HIV-1-infected patients in the era of highly active antiretroviral therapy: a prospective observational study. Int J STD AIDS. 2005;16:673–6.PubMedView ArticleGoogle Scholar
  304. Chopra S, Arora U. Skin and mucocutaneous manifestations: Useful clinical predictors of HIV/AIDS. J Clin Diagn Res. 2012;6:1695–8.PubMedPubMed CentralGoogle Scholar
  305. Kore SD, Kanwar AJ, Vinay K, Wanchu A. Pattern of mucocutaneous manifestations in human immunodeficiency virus-positive patients in North India. Indian J Sex Transm Dis. 2013;34:19–24.PubMedPubMed CentralView ArticleGoogle Scholar
  306. Mali RJ, Wankhade AB, Ghadage DP, Muley VA, Bhore AV. Cutaneous manifestations in HIV infected patients in rural area. J Pure Appl Microbiol. 2012;6:467–70.Google Scholar
  307. Panda S, Sarkar S, Mandal BK, Singh TB, Singh KL, Mitra DK, et al. Epidemic of herpes zoster following HIV epidemic in Manipur, India. J Infect. 1994;28:167–73.PubMedView ArticleGoogle Scholar
  308. Panda S, Kamei G, Pamei M, Sarkar S, Sarkar K, Singh ND, et al. Clinical features of HIV infection in drug users of Manipur. Natl Med J India. 1994;7:267–9.PubMedGoogle Scholar
  309. Antwal M, Gurjar R, Chidrawar S, Pawar J, Gaikwad S, Panchal N, et al. Clinical profile of HIV infected patients attending a HIV referral clinic in Pune. India Indian J Med Res. 2014;140:271–7.PubMedGoogle Scholar
  310. Lloyd A. HIV infection and AIDS. P N G Med J. 1996;39:174–80.PubMedGoogle Scholar
  311. Satishchandra P, Nalini A, Gourie-Devi M, Khanna N, Santosh V, Ravi V, et al. Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989–96). Indian J Med Res. 2000;111:14–23.PubMedGoogle Scholar
  312. Srikanth KP, Vijayakumar S, Aparna, Mallikarjun. A hospital based cross sectional study of mucocutaneous manifestations in the HIV infected. Int J Collab Res Intern Med Public Health. 2010;2:50–78.Google Scholar
  313. Fernandes MS, Bhat RM. Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count. Int J STD AIDS. 2015;26:414–9.PubMedView ArticleGoogle Scholar
  314. Singh HR, Singh NG, Singh TB. Estimation of CD4+ and CD8+ T-lymphocytes in human immunodeficiency virus infection and acquired immunodeficiency syndrome patients in Manipur. Indian J Med Microbiol. 2007;25:126–32.PubMedView ArticleGoogle Scholar
  315. Price P, Murdoch DM, Agarwal U, Lewin SR, Elliott JH, French MA. Immune restoration diseases reflect diverse immunopathological mechanisms. Clin Microbiol Rev. 2009;22:651–63.PubMedPubMed CentralView ArticleGoogle Scholar
  316. Choi WR, Seo MC, Sung KU, Lee HE, Yoon HJ. Herpes zoster immune reconstitution inflammatory syndrome in a HIV-infected patient: Case report and literature review. Infect Chemother. 2012;44:391–4.View ArticleGoogle Scholar
  317. Handa S, Narang T, Wanchu A. Dermatologic immune restoration syndrome: report of five cases from a tertiary care center in north India. J Cutan Med Surg. 2008;12:126–32.PubMedView ArticleGoogle Scholar
  318. Sharma A, Makrandi S, Modi M, Sharma A, Marfatia Y. Immune reconstitution inflammatory syndrome. Indian J Dermatol Venereol Leprol. 2008;74:619–21.PubMedView ArticleGoogle Scholar
  319. Terada K, Yoshihiro K, Kawano S, Morita T. Incidence of herpes zoster in pediatricians and family practitioners Estimation of efficacy of varicella vaccine for protection against herpes zoster in the elderly. Kawasaki Med J. 1994;20:99–102.Google Scholar
  320. Mittal RR. Infectivity of varicella and herpes zoster. Indian J Dermatol Venereol Leprol. 1996;62:196–7.PubMedGoogle Scholar
  321. Chandak SO, Pandilwar PK. Epidemic of herpes zoster in a family. J Oral Maxillofacial Surg Med Pathol. 2012;24:42–4.View ArticleGoogle Scholar
  322. Suzuki K, Yoshikawa T, Tomitaka A, Matsunaga K, Asano Y. Detection of aerosolized varicella-zoster virus DNA in patients with localized herpes zoster. J Infect Dis. 2004;189:1009–12.PubMedView ArticleGoogle Scholar
  323. Suzuki K, Yoshikawa T, Tomitaka A, Suzuki K, Matsunaga K, Asano Y. Detection of varicella-zoster virus DNA in throat swabs of patients with herpes zoster and on air purifier filters. J Med Virol. 2002;66:567–70.PubMedView ArticleGoogle Scholar
  324. Yoshikawa T, Ihira M, Suzuki K, Suga S, Tomitaka A, Ueda H, et al. Rapid contamination of the environments with varicella-zoster virus DNA from a patient with herpes zoster. J Med Virol. 2001;63:64–6.PubMedView ArticleGoogle Scholar
  325. Zhai JX, Ji J, Li M. Cutaneous tuberculosis complicated with squamous cell carcinoma. J Clin Dermatol. 2010;39:713–5.Google Scholar
  326. Kansal HM, Goel S. Cutaneous manifestations in cases of pulmonary tuberculosis: A clinical profile. J Indian Acad Clin Med. 2013;14:284–6.Google Scholar
  327. Kulkarni AG, Brid NS. Images in clinical medicine. Herpes zoster. N Engl J Med. 1995;332:1684.PubMedView ArticleGoogle Scholar
  328. Regunath H, Shivashankara KN, Sundeep KB, Bhaskar AP. Reactivation of Herpes zoster in an adult with Plasmodium infection. J Vector Borne Dis. 2008;45:251–3.PubMedGoogle Scholar
  329. Park B, Yun SJ, Lee JB, Lee SC, Won YH, Kim SJ. Analysis of dermatoses in pregnant patients. Korean J Dermatol. 2013;51:249–57.Google Scholar
  330. Kim WJ, Kim JY, Lee WJ, Lee SJ, Kim DW, Ko HC, et al. Investigation of the clinical manifestations of herpes zoster during pregnancy and its impact on the perinatal outcome. Korean J Dermatol. 2010;48:941–7.Google Scholar
  331. Thami GP, Kanwar AJ. Herpes zoster during pregnancy near term: to treat or not to treat? Aust N Z J Obstet Gynaecol. 1999;39:371.PubMedView ArticleGoogle Scholar
  332. Tsai YG, Lai JH, Kuo SY, Chen HC, Chang DM. Thymoma and hypogammaglobulinemia (Good’s syndrome): a case report. J Microbiol Immunol Infect. 2005;38:218–20.PubMedGoogle Scholar
  333. Chen JY, Chang CY, Lin YS, Hu ML. Nutritional factors in herpes zoster, postherpetic neuralgia, and zoster vaccination. Popul Health Manag. 2012;15:391–7.PubMedView ArticleGoogle Scholar
  334. Chao CT, Lee SY, Yang WS, Yen CJ, Chiang CK, Huang JW, et al. Serum vitamin D levels are positively associated with varicella zoster immunity in chronic dialysis patients. Sci Rep. 2014;4:7371.PubMedView ArticleGoogle Scholar
  335. Chao CT, Lai CF, Huang JW. Risk factors for herpes zoster reactivation in maintenance hemodialysis patients. Eur J Intern Med. 2012;23:711–5.PubMedView ArticleGoogle Scholar
  336. Chi CY, Chu CC, Liu JP, Lin CH, Ho MW, Lo WJ, et al. Anti-IFN-γ autoantibodies in adults with disseminated nontuberculous mycobacterial infections are associated with HLA-DRB1*16:02 and HLA-DQB1*05:02 and the reactivation of latent varicella-zoster virus infection. Blood. 2013;121:1357–66.PubMedView ArticleGoogle Scholar
  337. Cho JW, Shin DH, Lee KS. Polymorphism of the IL-10 gene is associated with susceptibility to herpes zoster in Korea. J Dermatol Sci. 2007;45:213–5.PubMedView ArticleGoogle Scholar
  338. Park SJ, Cho JW, Lee KS. Single nucleotide polymorphisms of interleukin-10 promoter gene in Korean herpes zoster patients. Korean J Dermatol. 2006;44:1325–31.Google Scholar
  339. Yuan LL, Wang LX, Xie YM, Yang W, Yang ZX, Zhuang Y, et al. Analysis on clinical features and treatment of herpes zoster patients hospitalized in real world. Zhongguo Zhongyao Zazhi. 2014;39:3469–73.PubMedGoogle Scholar
  340. Oh HM, Ho AY, Chew SK, Monteiro EH. Clinical presentation of herpes zoster in a Singapore hospital. Singapore Med J. 1997;38:471–4.PubMedGoogle Scholar
  341. Vikrant S. Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single center from north India. Perit Dial Int. 2014;34:426–33.PubMedPubMed CentralView ArticleGoogle Scholar
  342. Sato T, Inoue T, Endo K, Watanabe Y, Kikuta T, Tsuda M, et al. End-stage renal disease (ESRD) contributes to the increasing prevalence of herpes zoster. NDT Plus. 2009;2:263–4.PubMedPubMed CentralGoogle Scholar
  343. Muraya Y. Clinical and immunological evaluation of infection in patients on hemodialysis. J Infect Chemother. 1996;2:247–53.View ArticleGoogle Scholar
  344. Iwamoto M, Kamimura T, Nagashima T, Kamata Y, Aoki Y, Onishi S, et al. Healthcare-associated infections in rheumatology in Japan. Rheumatol Int. 2012;32:801–4.PubMedView ArticleGoogle Scholar
  345. Nishimaki T, Watanabe K, Satho Y, Okubo M, Kaise S, Miyata M, et al. Viral, fungal and mycobacterial infections in patients with systemic lupus erythematosus. Jpn J Rheumatol. 1999;9:45–54.Google Scholar
  346. Ishikawa O, Abe M, Miyachi Y. Herpes zoster in Japanese patients with systemic lupus erythematosus. Clin Exp Dermatol. 1999;24:327–8.PubMedView ArticleGoogle Scholar
  347. Naganuma M, Kunisaki R, Yoshimura N, Takeuchi Y, Watanabe M. A prospective analysis of the incidence of and risk factors for opportunistic infections in patients with inflammatory bowel disease. J Gastroenterol. 2013;48:595–600.PubMedView ArticleGoogle Scholar
  348. Binitha MP, Sarita SP, Manju M. Photoletter to the editor: Squamous cell carcinoma associated with and masquerading as molluscum contagiosum. J Dermatol Case Rep. 2013;7:103–5.PubMedPubMed CentralView ArticleGoogle Scholar
  349. Rajagopal R, Arora PN, Ramasastry CV, Kar PK. Skin changes in internal malignancy. Indian J Dermatol Venereol Leprol. 2004;70:221–5.PubMedGoogle Scholar
  350. Ayyamperumal A, Tharini G, Ravindran V, Parveen B. Cutaneous manifestations of internal malignancy. Indian J Dermatol. 2012;57:260–4.PubMedPubMed CentralView ArticleGoogle Scholar
  351. Okamoto S, Hata A, Sadaoka K, Yamanishi K, Mori Y. Comparison of varicella-zoster virus-specific immunity of patients with diabetes mellitus and healthy individuals. J Infect Dis. 2009;200:1606–10.PubMedView ArticleGoogle Scholar
  352. Mahajan S, Koranne R, Sharma S. Cutaneous manifestation of diabetes melitus. Indian J Dermatol Venereol Leprol. 2003;69:105–8.PubMedGoogle Scholar
  353. Yang YW, Chen YH, Lin HW. Risk of herpes zoster among patients with psychiatric diseases: a population-based study. J Eur Acad Dermatol Venereol. 2011;25:447–53.PubMedView ArticleGoogle Scholar
  354. Lee JY, Yoon NH, Park SD. A clinical study of the nature of pain associated with herpes zoster. Korean J Dermatol. 2006;44:1298–303.Google Scholar
  355. Yang YD, Wu JJ, Bi JJ, Lu YG, Zhu TY. Retrospective study of the characteristics of postherpetic neuralgia in 178 cases. Chin J Clin Rehab. 2005;9:23–5.Google Scholar
  356. Herr H. Prognostic factors of postherpetic neuralgia. J Korean Med Sci. 2002;17:655–9.PubMedPubMed CentralView ArticleGoogle Scholar
  357. Cho SI, Lee CH, Park GH, Park CW, Kim HO. Use of S-LANSS, a tool for screening neuropathic pain, for predicting postherpetic neuralgia in patients after acute herpes zoster events: a single-center, 12-month, prospective cohort study. J Pain. 2014;15:149–56.PubMedView ArticleGoogle Scholar
  358. Zhu SM, Liu YM, An ED, Chen QL. Influence of systemic immune and cytokine responses during the acute phase of zoster on the development of postherpetic neuralgia. J Zhejiang Univ Sci B. 2009;10:625–30.PubMedPubMed CentralView ArticleGoogle Scholar
  359. Imafuku S, Nakayama J, Higa K, Furue M, Takahara M, Katayama I, et al. One-year follow-up of zoster-associated pain in 764 immunocompetent patients with acute herpes zoster treated with famciclovir (FAMILIAR study). J Eur Acad Dermatol Venereol. 2014;28:1716–22.PubMedView ArticleGoogle Scholar
  360. Kanbayashi Y, Onishi K, Fukazawa K, Okamoto K, Ueno H, Takagi T, et al. Predictive factors for postherpetic neuralgia using ordered logistic regression analysis. Clin J Pain. 2012;28:712–14.PubMedView ArticleGoogle Scholar
  361. Zhang DP, He L. Risk factors and prevention measures of postherpetic neuralgia. Chin J Clin Rehab. 2005;9:118–9.Google Scholar
  362. Nithyanandam S, Dabir S, Stephen J, Joseph M. Eruption severity and characteristics in herpes zoster ophthalmicus: correlation with visual outcome, ocular complications, and postherpetic neuralgia. Int J Dermatol. 2009;48:484–7.PubMedView ArticleGoogle Scholar
  363. Nahm FS, Kim SH, Kim HS, Shin JW, Yoo SH, Yoon MH, et al. Survey on the treatment of postherpetic neuralgia in Korea; multicenter study of 1,414 patients. Korean J Pain. 2013;26:21–6.PubMedPubMed CentralView ArticleGoogle Scholar
  364. Chen JY, Lan KM, Sheu MJ, Tseng SF, Weng SF, Hu ML. Peptic ulcer as a risk factor for postherpetic neuralgia in adult patients with herpes zoster. J Med Virol. 2015;87:222–9.PubMedView ArticleGoogle Scholar
  365. Sumiyama D, Kikkawa EF, Kita YF, Shinagawa H, Mabuchi T, Ozawa A, et al. HLA alleles are associated with postherpetic neuralgia but not with herpes zoster. Tokai J Exp Clin Med. 2008;33:150–3.PubMedGoogle Scholar
  366. Sato M, Ohashi J, Tsuchiya N, Kashiwase K, Ishikawa Y, Arita H, et al. Association of HLA-A*3303-B*4403-DRB1*1302 haplotype, but not of TNFA promoter and NKp30 polymorphism, with postherpetic neuralgia (PHN) in the Japanese population. Genes Immun. 2002;3:477–81.PubMedView ArticleGoogle Scholar
  367. Ozawa A, Sasao Y, Iwashita K, Miyahara M, Sugai J, Iizuka M, et al. HLA-A33 and -B44 and susceptibility to postherpetic neuralgia (PHN). Tissue Antigens. 1999;53:263–8.PubMedView ArticleGoogle Scholar
  368. Sato-Takeda M, Ihn H, Ohashi J, Tsuchiya N, Satake M, Arita H, et al. The human histocompatibility leukocyte antigen (HLA) haplotype is associated with the onset of postherpetic neuralgia after herpes zoster. Pain. 2004;110:329–36.PubMedView ArticleGoogle Scholar
  369. Kirizume K, Imataki O, Shintani T, Fujihara S, Waki F, Ohue Y, et al. Aggravated post-herpetic neuralgia due to bortezomib. Rinsho Ketsueki. 2008;49:331–4.PubMedGoogle Scholar
  370. Choi WS, Kwon SS, Lee J, Choi SM, Lee JS, Eom JS, et al. Immunity and the burden of herpes zoster. J Med Virol. 2014;86:525–30.PubMedView ArticleGoogle Scholar
  371. Mehta J, Mahajan V, Khanna S. Disseminated zoster with polyneuritis cranialis and motor radiculopathy: Letter to editor. Neurol India. 2002;50:228–9.PubMedGoogle Scholar
  372. Kim SH, Suh MK. The clinical features of herpes zoster ophthalmicus in inpatients. Korean J Dermatol. 2008;46:1337–43.Google Scholar
  373. Ando K, Kohmoto H. Clinical features of herpes zoster ophthalmicus. Jpn J Clin Ophthalmol. 2000;54:385–7.Google Scholar
  374. Amaki S, Suzuki S, Shinbo R, Ando R, Oguchi Y, Shimizu H, et al. A statistical study of ocular complications of herpes zoster ophthalmicus and its prolongation factors. Nihon Ganka Gakkai Zasshi. 1995;99:289–95.PubMedGoogle Scholar
  375. Yoshida M, Hayasaka S, Yamada T, Yanagisawa S, Hayasaka Y, Nakamura N, et al. Ocular findings in Japanese patients with varicella-zoster virus infection. Ophthalmologica. 2005;219:272–5.PubMedView ArticleGoogle Scholar
  376. Kimata N, Nakagawa H, Araki H. Clinical features of herpes zoster keratitis. Jpn J Clin Ophthalmol. 1996;50:1113–6.Google Scholar
  377. Matsuda A, Tagawa Y, Abe N, Tsuda K, Matsuda H. Classification of corneal complications from varicella zoster virus. Jpn J Clin Ophthalmol. 1995;49:1519–23.Google Scholar
  378. McDonald EM, Patel DV, McGhee CN. A prospective study of the clinical characteristics of patients with herpes simplex and varicella zoster keratitis, presenting to a New Zealand emergency eye clinic. Cornea. 2015;34:279–84.PubMedView ArticleGoogle Scholar
  379. Zheng Y, Shi J. Clinical analysis of 58 cases of herpetic keratouveitis. Chin Ophthalmic Res. 2009;27:809–11.Google Scholar
  380. Thean JH, Hall AJ, Stawell RJ. Uveitis in Herpes zoster ophthalmicus. Clin Experiment Ophthalmol. 2001;29:406–10.PubMedView ArticleGoogle Scholar
  381. Hanajiri M, Matsumoto T, Hatano H, Ohno S. Herpes zoster ophthalmicus without skin eruptions. Jpn J Clin Ophthalmol. 1994;48:658–60.Google Scholar
  382. Kwok SK, Ho PCP, Chau GKO. Herpes zoster ophthalmicus - A family physician’s perspective. Hong Kong Pract. 2001;23:57–62.Google Scholar
  383. Albietz JM, Lenton LM. Late reactivation of herpes zoster keratitis results in band keratopathy. Optom Vis Sci. 2014;91:e149–55.PubMedView ArticleGoogle Scholar
  384. Cao L. Ophthalmic symptoms in AIDS. Int J Ophthalmol. 2009;9:393–4.Google Scholar
  385. Nithyanandam S, Joseph M, Stephen J. Ocular complications and loss of vision due to herpes zoster ophthalmicus in patients with HIV infection and a comparison with HIV-negative patients. Int J STD AIDS. 2013;24:106–9.PubMedView ArticleGoogle Scholar
  386. Gupta N, Sachdev R, Sinha R, Titiyal JS, Tandon R. Herpes zoster ophthalmicus: disease spectrum in young adults. Middle East Afr J Ophthalmol. 2011;18:178–82.PubMedPubMed CentralView ArticleGoogle Scholar
  387. Babu K, Kini R, Philips M, Subbakrishna DK. Clinical profile of isolated viral anterior uveitis in a South Indian patient population. Ocul Immunol Inflamm. 2014;22:356–9.PubMedView ArticleGoogle Scholar
  388. Ichikawa T, Sakai J, Yamauchi Y, Minoda H, Usui M. A study of 44 patients with Kirisawa type uveitis. Nihon Ganka Gakkai Zasshi. 1997;101:243–7.PubMedGoogle Scholar
  389. Tan WJ, Poh EW, Wong PY, Ho SL, Lim WK, Teoh SC. Trends in patterns of anterior uveitis in a tertiary institution in Singapore. Ocul Immunol Inflamm. 2013;21:270–5.PubMedView ArticleGoogle Scholar
  390. Wang TJ, Hu CC, Lin HC. Increased risk of anterior uveitis following herpes zoster: a nationwide population-based study. Arch Ophthalmol. 2012;130:451–5.PubMedView ArticleGoogle Scholar
  391. Sims JL, Yeoh J, Stawell RJ. Acute retinal necrosis: A case series with clinical features and treatment outcomes. Clin Exp Ophthalmol. 2009;37:473–7.PubMedView ArticleGoogle Scholar
  392. Roy R, Pal BP, Mathur G, Rao C, Das D, Biswas J. Acute retinal necrosis: clinical features, management and outcomes–a 10 year consecutive case series. Ocul Immunol Inflamm. 2014;22:170–4.PubMedView ArticleGoogle Scholar
  393. Sodeyama H, Todokoro D, Yamada N, Kishi S. Identification of causative virus and clinical course of acute retinal necrosis. Jpn J Clin Ophthalmol. 2014;68:947–52.Google Scholar
  394. Itoh N, Matsumura N, Ogi A, Nishide T, Imai Y, Kanai H, et al. High prevalence of herpes simplex virus type 2 in acute retinal necrosis syndrome associated with herpes simplex virus in Japan. Am J Ophthalmol. 2000;129:404–5.PubMedView ArticleGoogle Scholar
  395. Grover R, Ratho RK, Gupta V, Mahajan RC, Gupta A. Role of viral serology in the diagnosis of acute retinal necrosis syndrome. Ind J Pathol Microbiol. 2002;45:269–71.Google Scholar
  396. Madhavan HN. Laboratory investigations on viral and Chlamydia trachomatis infections of the eye: Sankara Nethralaya experiences. Indian J Ophthalmol. 1999;47:241–6.PubMedGoogle Scholar
  397. Mizuuchi K, Namba K, Kotake S, Ohno S. Clinical features of acute retinal necrosis at Hokkaido University Hospital. Nihon Ganka Gakkai Zasshi. 2008;112:136–40.PubMedGoogle Scholar
  398. Shimakawa M, Sato N. A case of AIDS complicated by progressive outer retinal necrosis. Nihon Ganka Gakkai Zasshi. 1999;103:137–43.PubMedGoogle Scholar
  399. Sittivarakul W, Aui-aree N. Clinical features, management and outcomes of progressive outer retinal necrosis (PORN) in southern Thailand. J Med Assoc Thai. 2009;92:360–6.PubMedGoogle Scholar
  400. Oshitari K, Arimoto H, Suzuki S, Oguchi Y. Rapidly progressive outer retinal necrosis in a patient with acquired immunodeficiency syndrome. Nihon Ganka Gakkai Zasshi. 1994;98:1141–6.PubMedGoogle Scholar
  401. Gill H, Cheung J, Wong I, Lie AK, Kwong YL. Varicella zoster virus progressive outer retinal necrosis after allogeneic haematopoietic stem cell transplantation. Br J Haematol. 2012;157:279.PubMedView ArticleGoogle Scholar
  402. Kim SJ, Park SJ, Yu HG, Kim NJ, Jang HC, Oh MD. Ocular manifestations of acquired immunodeficiency syndrome in Korea. J Korean Med Sci. 2012;27:542–6.PubMedPubMed CentralView ArticleGoogle Scholar
  403. Lim WK, Chee SP, Nussenblatt RB. Progression of varicella-zoster virus necrotizing retinopathy in an HIV-negative patient with transient immune deviation. Graefes Arch Clin Exp Ophthalmol. 2005;243:607–9.PubMedView ArticleGoogle Scholar
  404. Tseng CC, Chen SN, Hwang JF, Lin CJ, Chen HS. Progressive outer retinal necrosis associated with occlusive vasculitis in acquired immunodeficiency syndrome. J Formos Med Assoc. 2015;114:469–72.PubMed