Donahue J G, Choo P W, Manson J E, Platt R
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass., USA.
Arch Intern Med. 1995;155(15):1605-9.
There are few population-based studies of the natural history and epidemiology of herpes zoster. Although a relatively common cause of morbidity, especially among the elderly, contemporary estimates of herpes zoster incidence are lacking. Herein we describe a population-based investigation of incident and recurrent herpes zoster from 1990 through 1992 in a health maintenance organization.
The health maintenance organization's automated medical records contain clinical and administrative information about care rendered to patients in ambulatory settings, emergency departments, and hospitals. Cases of herpes zoster were ascertained by screening the medical record for coded diagnoses. The predictive value of a herpes zoster diagnosis code was determined by review of a sample of patient records. Records from all patients with potential recurrences were also reviewed.
The overall incidence, based on 1075 cases in 500,408 person-years, was 215 per 100,000 person-years (95% confidence interval, 192 to 240 per 100,000) and did not vary by gender. Although the rate increased sharply with age, approximately 5% of the cases occurred among children younger than 15 years. Infection with human immunodeficiency virus was documented in 5% of the persons with incident herpes zoster and cancer in 6%. Four persons had confirmed recurrences of herpes zoster (744 per 100,000 person-years; 95% confidence interval, 203 to 1907); three of these persons were infected with the human immunodeficiency virus.
The recorded incidence of herpes zoster was 64% higher than that reported 30 years ago; the age-standardized rate was more than twofold higher. Immunosuppressive conditions had little impact on overall incidence, although they were strongly associated with early recurrences.
关于带状疱疹自然史和流行病学的基于人群的研究较少。尽管带状疱疹是发病率相对较高的原因，尤其是在老年人中，但目前缺乏当代对带状疱疹发病率的估计。在此，我们描述了1990年至1992年在一家健康维护组织中对新发和复发性带状疱疹进行的基于人群的调查。
该健康维护组织的自动化医疗记录包含了在门诊、急诊科和医院为患者提供的临床和管理信息。通过筛查病历中的编码诊断来确定带状疱疹病例。通过审查患者记录样本确定带状疱疹诊断代码的预测价值。还审查了所有有潜在复发患者的记录。
基于500,408人年中的1075例病例，总体发病率为每10万人年215例（95%置信区间为每10万人年192至240例），且发病率在性别上无差异。尽管发病率随年龄急剧上升，但约5%的病例发生在15岁以下儿童中。在新发带状疱疹患者中，5%的人记录有人类免疫缺陷病毒感染，6%的人患有癌症。有4人确诊为带状疱疹复发（每10万人年744例；95%置信区间为203至1907例）；其中3人感染了人类免疫缺陷病毒。
记录的带状疱疹发病率比30年前报告的高出64%；年龄标准化发病率高出两倍多。免疫抑制状况对总体发病率影响不大，尽管它们与早期复发密切相关。
