Rising Burden of Herpes Zoster among General Adults and Increased-Risk Groups in Eastern China, 2015-2021: A...

This study aims to deliver contemporary, population-based estimates of herpes zoster (HZ) incidence, temporal trends, complications, healthcare utilisation and direct costs among general adults and adults with increased-risk conditions.

A retrospective cohort study using the Yinzhou Integrated Health Platform (2015-2021; China) was performed. Incident HZ was ascertained after a 1-year washout; increased-risk conditions were pre-specified (immunocompromising/autoimmune). We calculated age-/sex-standardised incidence, assessed trends with joinpoint regression and summarised HZ-related outpatient visits, hospitalisations and direct medical costs [Chinese yuan (¥) and US dollars ($)].

Among 5.42 million person-years, including 790,410 subjects, 25,855 incident HZ events were identified. Overall incidence was 4.77/1000 person-years (PY) [95% confidence interval (CI) 4.71-4.83] and 16.13/1000 PY (95% CI 15.25-17.06) in increased-risk adults [incidence rate ratio (IRR) 3.44 versus in adults without immunocompromising conditions or autoimmune diseases (AIDs)]. Incidence rose with age (peak 70-79 years overall; 60-69 years increased-risk) and was higher in women. Postherpetic neuralgia (PHN) was the most frequent complication (8.96% overall; 10.88% increased-risk). Standardised incidence increased from 4.67 to 7.51/1000 PY during 2015-2021 [annual percentage change (APC) 7.94%], with a steep rise to 2019 and plateau thereafter. Hospitalisation among incident HZ was 1.35%. Mean direct cost per episode was Chinese yuan (¥)625.52 [US dollars ($)94.35] for outpatients and ¥8854.03 ($1335.45) for inpatients; increased-risk outpatients incurred higher mean costs (¥1205.47, $181.82). Across strata, complications - especially PHN - were associated with more visits and higher expenditure.

HZ imposes a rising, age- and risk-concentrated burden in Chinese adults, with PHN being the principal driver of resource use and costs. These real-world estimates support prioritising zoster vaccination for adults ≥ 50 years and clinically vulnerable groups, and integrating HZ surveillance and management within chronic-disease programmes.