Herpes zoster hospitalization burden in Spain during the initial period of recombinant zoster vaccine implementation

Herpes zoster (HZ) is a vaccine-preventable disease with increasing incidence and hospitalization burden, particularly among older adults and immunocompromised individuals, who have an increased risk. In 2021, Spain introduced systematic vaccination with the recombinant zoster vaccine (RZV). We conducted a retrospective, descriptive study using hospital discharge data from the Spanish Minimum Basic DataSet (MBDS) for the years 2022-2023. Hospitalization rates (HR), mortality rates (MR), case fatality rates (CFR), length of stay, comorbidities, and costs were analyzed nationally and for the region of Madrid. A total of 16,277 HZ-related hospitalizations were recorded in Spain, with 80% occurring in individuals aged ≥65 y. The HR was 16.85 per 100,000 inhabitants, and the CFR was 7.44%. In Madrid, 3263 hospitalizations were recorded, with a higher HR (23.73 per 100,000) and CFR (6.41%) compared to the national average. Complicated HZ cases accounted for over 64% of hospitalizations nationally and 69% in Madrid. Total hospitalization costs were €98.1 million in Spain and €21.4 million in Madrid. This is the first study to assess HZ hospitalization burden in Spain and Madrid following the introduction of RZV. The findings highlight the substantial toll of HZ on older and immunocompromised populations. Future studies with longer follow-up are needed to assess vaccine impact.