A systematic literature review of herpes zoster incidence worldwide

Figures & data

Figure 1. PRISMA diagram

*The authors were contacted to retrieve the underlying data (numerators and denominators) of these figures.**Systematic reviews/meta-analyses were checked for possibly missed relevant original articles.HZ, herpes zoster; N, number; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Distribution of publications (N = 69) by (A) Study design, (B) Case identification method, (C) Incidence data stratification.

The total number of studies add up to 77 studies as 8 studies utilized more than one method to detect HZ (see Table 1)

HZ, herpes zoster; ICD, International Classification of Diseases

Table 1. Characteristics of included studies (N = 69)

Author, year	Country	Study design	Study period	Setting	Age (years)	Case definition	Patient type	Type of incidence data reported	Stratifications
Liu, 2015^Citation63	Australia	Prospective passive surveillance study	1 January 2006–31 December 2009	The 45 and Up Study in New South Wales	≥45	Drug prescription or ICD codes (inpatients only)	Inpatients and outpatients	Incidence rate	Age
MacIntyre, 2015^Citation64	Australia	Retrospective passive surveillance study	1 July 2006–31 March 2013	6,302 GPs captured in the Bettering the Evaluation of Care and Health database, and the (Repatriation) Pharmaceutical Benefits Scheme database	≥50	ICPC codes or drug prescription	Outpatients	Cumulative incidence	Age, case definition (GP visits or antiviral prescriptions)
Stein, 2009^Citation65	Australia	Retrospective passive surveillance study	1 April 2000–30 September 2006	6,460 GPs captured in the Bettering the Evaluation of Care and Health database, and the (Repatriation) Pharmaceutical Benefits Scheme database	≥50	ICPC codes or drug prescription	Outpatients	Cumulative incidence	Age, case definition (GP visits or antiviral prescriptions)
McDonald, 2017^Citation30	Canada	Retrospective passive surveillance study	1 November 2009–31 October 2015	Alberta Health Care Insurance Plan Registry, an Albertan health insurance	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, gender
Marra, 2016^Citation29	Canada	Retrospective passive surveillance study	1 January 1997–31 December 2012	Population-DataBC® Medical Services Plan and Discharge Abstract Database, linked to the outpatient prescription database PharmaNet; British Columbia	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age, year
Russel, 2014^Citation31	Canada	Retrospective passive surveillance study	1 January 1994–31 December 2010	Alberta’s universal, publicly funded health-care insurance system databases	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age, year
Tanuseputro, 2011^Citation33	Canada	Retrospective passive surveillance study	1 April 1992–31 March 2010	Canadian Institute of Health Information Discharge Abstract Database (Ontario) and Ontario Health Insurance Plan	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age, year
Russel, 2007^Citation32	Canada	Retrospective passive surveillance study	1 January 1990–31 December 2002	Hospital Morbidity Inpatient database and the Alberta Health Care Insurance Plan Registry; Alberta Province	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age, gender, year
Edgar, 2007^Citation28	Canada	Retrospective passive surveillance study	1 January 1994–31 December 2003	British Columbia Ministry of Health Medical Services Plan database (physician billing data)	≥65	ICD codes	Outpatients	Cumulative incidence	-
Lu, 2018^Citation67	China	Retrospective active surveillance study	December 2012 – March 2013	52 communities/villages in three districts of Beijing (Xicheng, Changping and Miyun)	≥50	Self-report	Outpatients	Cumulative incidence	Age, gender
Li, 2016^Citation66	China	Retrospective active surveillance study	May 2013 – May 2014	One rural township each in Jiangsu, Jiangxi, Heilongjiang and Hebei and one community from Shanghai	≥50	Self-report	Inpatients and outpatients	Cumulative incidence	Age, gender, year
Zhu, 2015^Citation68	China	Retrospective active surveillance study	28 October 2013 – NR	34 of the 126 counties/districts in Guangdong Province, selected using random sampling	≥50	Self-report	Outpatients	Cumulative incidence	Year
Schmidt, 2017^Citation78	Denmark	Retrospective passive surveillance study	1 January 1997–31 December 2013	Danish National Prescription Registry and Danish National Patient Registry	≥50	Drug prescription ICD codes (inpatients only)	Inpatients and outpatients	Cumulative incidence	Age, gender
Amirthalingam, 2018^Citation34	England	Retrospective unmatched cohort study	1 October 2005–30 September 2016	164 Royal College of General Practitioners – Research and Surveillance Centre practices across England	60–89	READ codes	Outpatients	Incidence rate	Age, gender, year
Jain, 2018^Citation38	England	Retrospective passive surveillance study	1 September 2003–31 August 2013	385 Clinical Practice Research Datalink practices across England	≥65	CPRD codes ICD codes (inpatients only)	Inpatients and outpatients	Incidence rate	Age, ethnicity, gender
Mick, 2010^Citation73	France	Prospective active surveillance study	1 January 2005–31 December 2005	225 GPs, 36 dermatologists, 15 neurologists and 5 physicians in pain clinics from a random sample of these physician types	≥50	Clinical	Outpatients	Cumulative incidence	Age, gender
Gonzalez Chiappe, 2010^Citation72	France	Retrospective passive surveillance study	1 January 2000–31 December 2008	~1200 GPs reporting to the French general practitioners’ Sentinelles electronic surveillance network	≥45	Clinical	Outpatients	Cumulative incidence	Age
Schmidt-Ott, 2018^Citation42	Germany	Prospective active surveillance study	November 2010 – December 2014	GPs, dermatologists and ophthalmologists in 3 German regions (Fulda, Leverkusen and Marl)	≥50	Clinical	Outpatients	Incidence rate	Age, gender
Hillebrand, 2015^Citation40	Germany	Retrospective passive surveillance study	1 January 2005–31 December 2009	German Pharmacoepidemiological Research Database, a national database	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Year
Ultsch, 2013^Citation43	Germany	Retrospective passive surveillance study	1 January 2005–31 December 2008	German Statutory Health Insurance System Allgemeine Ortskrankenkasse and Regional Association of SHI-Accredited Physicians (KV) in Hessen	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age
Ultsch, 2011^Citation44	Germany	Retrospective passive surveillance study	1 January 2007–31 December 2008	Association of Statutory Health Insurance Physicians database	≥50	ICD codes	Outpatients	Cumulative incidence	Age, gender, year
Schiffner-Rohe, 2010^Citation41	Germany	Retrospective passive surveillance study	1 January 2003–31 December 2004	An insurance database (Allgemeine Ortskrankenkasse Hessen/KV Hessen)	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age, gender, population (general population and IC only)
Alicino, 2017^Citation69	Italy	Retrospective passive surveillance study	1 January 2013–31 December 2015	56 GPs in Liguria, Puglia, Toscana and Veneto	≥50	ICD codes or drug prescription	Outpatients	Incidence rate	Age, gender
Gialloreti, 2010^Citation71	Italy	Retrospective passive surveillance study	1 January 2003–31 December 2005	342 GPs reporting in the Health Search Database of the Società Italiana Medici Generici, from Northern, Central and Southern Italy	≥50	ICD codes	Outpatients	Cumulative incidence	Age, population (general population and IC only)
Di Legami, 2007^Citation70	Italy	Prospective active surveillance study	1 January 2004–31 December 2004	All 24 GPs working in Torino and Cuorgnè, Piemonte	≥45	Clinical	Outpatients	Cumulative incidence	Age
Weitzman, 2013^Citation79	Israel	Retrospective passive surveillance study	1 January 2006–30 September 2010	Maccabi Healthcare Services database	≥45	ICD codes	Inpatients and outpatients	Incidence rate	Age
Toyama, 2018^Citation49	Japan	Prospective active surveillance study	1 January 1997–31 December 2017	33 dermatology clinics and dermatology departments of 10 flagship general hospitals associated with the Miyazaki Dermatologist Society, in Miyazaki Prefecture	≥60	Clinical	Outpatients	Cumulative incidence	Year
Imafuku, 2018^Citation45	Japan	Retrospective passive surveillance study	1 January 2005–31 December 2014	Japan Medical Data Center-Claims Database, a national health insurance database	50–74	ICD codes and drug prescription	Inpatients and outpatients	Incidence rate	Age, gender
Shiraki, 2017^Citation46	Japan	Prospective active surveillance study	1 June 2009–30 November 2015	36 dermatology clinics and dermatology departments of 7 flagship general hospitals belonging to the Miyazaki Dermatologist Society, Miyazaki Prefecture	70–79	Clinical	Outpatients	Cumulative incidence	Gender
Takao, 2015^Citation47	Japan	Prospective active surveillance study	1 December 2008–30 November 2012	Shozu County, Kagawa Prefecture, Japan	≥50	Clinical	Inpatients and outpatients	Incidence rate	Age, gender
Toyama, 2009^Citation48	Japan	Prospective active surveillance study	1 January 1997–31 December 2006	39 dermatology clinics and dermatology departments of 7 flagship general hospitals associated with the Miyazaki Dermatologist Society, in Miyazaki Prefecture	≥50	Clinical	Outpatients	Cumulative incidence	Age, gender
Pierik, 2012^Citation53	NL	Retrospective passive surveillance study	1 January 2004–31 December 2008	ZorgGroep Almere, a database of 22 GPs in Almere	≥60	ICPC codes	Outpatients	Cumulative incidence	Age
Opstelten, 2006^Citation52	NL	Prospective active surveillance study	1 January – 31 December 2001	Second Dutch National Survey of General Practice; 186 GPs in 90 practices nationwide	≥45	ICPC codes	Outpatients	Cumulative incidence	Age, gender (no both genders data)
Opstelten, 2005^Citation51	NL	Prospective active surveillance study	1 January – 31 December 2001	Second Dutch National Survey of General Practice; 186 GPs in 90 practices nationwide	≥65	ICPC codes	Outpatients	Cumulative incidence	-
Opstelten, 2002^Citation50	NL	Retrospective passive surveillance study	1 August 1994–31 July 1999	Huisartsen Netwerk Utrecht, a general practice research database in the province of Utrecht; 22 GPs in 6 locations	≥45	ICPC codes	Outpatients	Incidence rate	Age
Rimseliene, 2016^Citation80	Norway	Retrospective passive surveillance study	2008–2012	Norwegian Health Economics Administration database	≥70	ICPC codes	Outpatients	Cumulative incidence	-
Turner, 2018^Citation75	New Zealand	Retrospective passive surveillance study	1 January 2005–31 December 2015	39 consenting general practices from two primary health organizations in lower North Island	≥50	natural language processing software algorithm	Outpatients	Incidence rate	Age, year
Reid, 2014^Citation74	New Zealand	Retrospective passive surveillance study	1 January 2009–31 December 2013	A large group practice in Lower Hutt	≥51	Coding (NR) or drug prescription	Outpatients	Cumulative incidence	Age, gender
Albrecht, 2015^Citation81	Poland	Retrospective passive surveillance study	2013	Świętokrzyskie Province Division of the National Health Fund	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	-
Kim, 2014^Citation82	South Korea	Retrospective passive surveillance study	1 January 2011–31 December 2011	National Health Insurance Service database	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age
Muñoz-Quiles, 2017^Citation58	Spain	Retrospective passive surveillance study	1 January 2009–31 December 2014	SIA (not defined) database and Hospitalization Minimum Data Set, Valencian Region	≥50	ICD codes	Inpatients and outpatients	Incidence rate	-
Esteban-Vasallo, 2014^Citation55	Spain	Retrospective passive surveillance study	1 January 2005–31 December 2012	Madrid regional public health system	≥45	ICPC codes	Outpatients	Cumulative incidence	Age, gender, year
Morant-Talamante, 2013^Citation57	Spain	Retrospective passive surveillance study	1 January 2007–20 December 2010	Abucasis electronic medical database and the Hospital Data Surveillance System, in the Valencian community	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, gender, year
Cebrian-Cuenca, 2010^5Citation4	Spain	Prospective active surveillance study	1 December 2006–30 November 2007	24 GP offices of the public healthcare system of the Autonomous Community of Valencia	≥50	Clinical	Outpatients	Cumulative incidence	Age
Garcia-Cenoz, 2008^Citation56	Spain	Retrospective passive surveillance study	1 January 2005–31 December 2006	“La base de datos de la historia clinica informatizada de atencion primaria”, Navarra	≥50	ICPC codes	Outpatients	Cumulative incidence	Age
Sundström, 2015^Citation77	Sweden	Retrospective passive surveillance study	January 2008 – December 2010	Västra Götaland County	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, gender, year
Nilsson, 2015^Citation76	Sweden	Retrospective passive surveillance study	1 January – 31 December 2011	Swedish National Pharmacy Register	≥50	Drug prescription	Inpatients and outpatients	Cumulative incidence	Age
Lu, 2018^Citation62	Taiwan	Retrospective passive surveillance study	1 January 2004–31 December 2008	NHIRD, a national health insurance database	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age, year
Chao, 2011^Citation59	Taiwan	Retrospective passive surveillance study	1 January 2000–31 December 2008	National Health Insurance Research Database	≥50	ICD codes	Outpatients	Cumulative incidence	Age, year
Lin, 2010^Citation62	Taiwan	Retrospective passive surveillance study	1 January 2000–31 December 2005	National Health Insurance Research Database	≥50	ICD codes	Inpatients and outpatients	Cumulative incidence	Age
Jih, 2009^Citation60	Taiwan	Retrospective passive surveillance study	1 January 2000–31 December 2006	National Health Insurance Research Database	>80	ICD codes	Inpatients and outpatients	Incidence rate	-
Walker, 2018^Citation39	UK	Retrospective passive surveillance study	1 September 2013–31 August 2016	Clinical Practice Research Datalink practices across the UK (number of practices NR)	68–79	READ codes ICD codes (inpatients only)	Inpatients and outpatients	Incidence rate	Gender
Gauthier, 2009^Citation37	UK	Retrospective passive surveillance study	1 January 2000–31 March 2006	603 General Practice Research Datalink practices, the UK	≥50	GPRD codes	Outpatients	Incidence rate	Age, gender
Fleming, 2004^Citation36	UK and NL	Retrospective passive surveillance study	1 January 1994–31 December 2001	Weekly Returns Service of the Royal College of General Practitioners in England and Wales and Dutch Sentinel practice network (number of GPs NR)	≥45	Clinical	Outpatients	Cumulative incidence	Age, gender (no “both genders” data)
Brisson, 2003^Citation35	UK	Retrospective passive surveillance study	1 January 1991–31 December 2000	69 Royal College of General Practitioners practices across England and Wales and participating GPs in the National Survey of Morbidity in General Practice database	≥45	ICD codes	Inpatients and outpatients	Cumulative incidence	Age
Harpaz, 2018^Citation27	USA	Retrospective passive surveillance study	1 January 1998–31 December 2016	Two Medstat MarketScan databases: Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefits	≥45	ICD codes	Outpatients	Cumulative incidence	Age, year
Kawai, 2016^Citation19	USA	Retrospective passive surveillance study	1 January 1980–31 December 2007	Rochester Epidemiology Project, conducted in Olmsted County, Minnesota	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, year
Johnson, 2015^Citation18	USA	Retrospective passive surveillance study	1 January 2011–31 December 2011	Two Medstat MarketScan databases: Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefits	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, gender
Chen, 2014^Citation16	USA	Retrospective passive surveillance study	1 January 2005–31 December 2009	Commercially insured, Medicare and Medicaid administrative medical and pharmacy claims databases	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age
Krishnarajah, 2014^Citation20	USA	Retrospective passive surveillance study	1 January 2006–31 December 2010	MarketScan Medicaid database	50–64	ICD codes	Inpatients and outpatients	Cumulative incidence	Age, gender, year
Suaya, 2014^Citation24	USA	Unmatched retrospective cohort study	1 January 2005–31 December 2009	Three MarketScan databases: Commercial, Medicare and Medicaid databases	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, population (general population and IC only)
Hales, 2013^Citation17	USA	Retrospective passive surveillance study	1 January 1992–31 December 2010	Medicare, a national health insurance program	>65	ICD codes	Inpatients and outpatients	Incidence rate	Age, ethnicity, gender, year
Langan, 2013^Citation21	USA	Unmatched retrospective cohort study	1 January 2007–31 December 2009	Medicare, a national health insurance program	≥65	ICD codes and/or drug prescription	Inpatients and outpatients	Incidence rate	Age, ethnicity, gender, population (general population and IC only), case definition (with or without antiviral prescriptions)
Leung, 2011^Citation22	USA	Retrospective passive surveillance study	1 January 1993–31 December 2006	Two Medstat MarketScan databases: Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefits	≥45	ICD codes	Outpatients	Cumulative incidence	Age, gender, year
Chaves, 2007^Citation15	USA	Retrospective active surveillance study	2 February 2004–27 May 2004	National Adult Immunization Survey	≥65	Self-report	Outpatients	Cumulative incidence	Age, ethnicity, gender
Yawn, 2007^Citation25	USA	Retrospective passive surveillance study	1 January 1996–31 December 2001	Rochester Epidemiology Project, conducted in Olmsted County, Minnesota	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, gender
Insinga, 2005^Citation7	USA	Retrospective passive surveillance study	1 July 2000–30 June 2001	Medstat MarketScan database	≥50	ICD codes	Inpatients and outpatients	Incidence rate	Age, gender, population (general population and IC only)
Mullooly, 2005^Citation23	USA	Retrospective passive surveillance study	1 January 1997–31 December 2002	Kaiser Permanente North-West California	≥45	ICD codes x estimated % of probable HZ	Inpatients and outpatients	Incidence rate	Age, gender, year
Yih, 2005^Citation26	USA	Retrospective active surveillance study	1 January 1999–31 December 2003	Behavioral Risk Factor Surveillance System survey, Massachusetts	≥45	Self-report	Inpatients and outpatients	Cumulative incidence	Age, year

Cumulative incidence: Number of new HZ cases per 1,000 population

Incidence rate: Number of new HZ cases per 1,000 person-years

GP, general practitioner/practice; GPRD, general practice research database; HZ, herpes zoster; IC, immunocompetent; ICD, International Classification of Diseases; ICPC, International Classification of Primary Care; NL, The Netherlands; NR, not reported; QAT, quality assessment tool; UK, United Kingdom; USA, United States of America.

Figure 3. Overall HZ incidence in the general population ≥50 years by country (A) Cumulative incidence (B) Incidence rate

*Number of new HZ cases per 1,000 population † Number of new HZ cases per 1,000 person-yearsHZ, herpes zoster

Figure 4. Cumulative HZ incidence (number of new HZ cases per 1,000 population) by (A) Time, (B) Age (region).Source: Table 1Figure 2A: Studies with at least 2 years of data are depicted*Incidence rate (number of HZ cases per 1,000 person-years) converted to cumulative incidence (number of HZ cases per 1,000 population)HZ, herpes zosterNote: While 42 publications reported cumulative incidence, only 30 of these presented an overall incidence for those ≥50 years and are depicted here

Figure 4. (Continued)

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