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Herpes Zoster and Vascular Risk

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Herpes Zoster: Postherpetic Neuralgia and Other Complications

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Abstract

Herpes zoster or shingles results from reactivation of varicella zoster virus, usually due to a decline in cell-mediated immunity with age or immunosuppression. Although the commonest complication is post-herpetic neuralgia, herpes zoster has increasingly been associated with vascular complications. Several large epidemiological studies using electronic health records in different European and Asian populations have found an association between herpes zoster and increased risk of stroke in the following months. A similar transient increase in the risk of myocardial infarction has been shown after herpes zoster in two UK studies. There are likely to be several mechanisms underlying the relationship between infections such as herpes zoster and acute vascular events. Infections in general induce inflammation which can lead to endothelial dysfunction and promote a pro-coagulant state. For herpes zoster specifically, VZV vasculopathy is likely to be a key contributor to vascular complications affecting the central nervous system. This infiltrative disorder of vessel walls is associated with productive VZV replication in arteries that results in pathological vascular remodelling. Typically early adventitial infection occurs, after which the virus spreads through the media towards the lumen. Disruption of smooth muscle cells in the media affects the risk of aneurysm formation, while intimal thickening contributes to vascular occlusion and ischaemia. Improved identification of populations at risk from vascular complications following shingles and better understanding of the timing and nature of this relationship will be essential to target interventions effectively.

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Abbreviations

AIS:

Acute ischaemic stroke

CI:

Confidence interval

CPRD:

Clinical Practice Research Datalink

EHR:

Electronic health record

HR:

Hazard ratio

HZ:

Herpes zoster

HZO:

Herpes zoster ophthalmicus

IR:

Incidence ratio

IRR:

Incidence rate ratio

MI:

Myocardial infarction

PVD:

Peripheral vascular disease

SAH:

Subarachnoid haemorrhage

SVV:

Simian varicella virus

THIN:

The Health Improvement Network

TIA:

Transient ischaemic attack

VZV:

Varicella zoster virus

References

  1. Guess H, Broughton D, Melton L et al (1986) Population-based studies of varicella complications. Pediatrics 78(4 pt 2):723–727

    PubMed  CAS  Google Scholar 

  2. Rovnak J, Kennedy PGE, Badani H et al (2015) A comparison of herpes simplex virus type 1 and varicella-zoster virus latency and reactivation. J Gen Virol 96(7):1581–1602

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Insinga DRP, Itzler RF, Pellissier JM et al (2005) The incidence of herpes zoster in a United States administrative database. J Gen Intern Med 20(8):748–753

    Article  PubMed  PubMed Central  Google Scholar 

  4. van Hoek AJ, Gay N, Melegaro A et al (2009) Estimating the cost-effectiveness of vaccination against herpes zoster in England and Wales. Vaccine 27(9):1454–1467

    Article  PubMed  Google Scholar 

  5. Smeeth L, Thomas SL, Hall AJ et al (2004) Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 351(25):2611–2618

    Article  CAS  PubMed  Google Scholar 

  6. Warren-Gash C, Hayward AC, Hemingway H et al (2012) Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study. J Infect Dis 206(11):1652–1659

    Article  PubMed  PubMed Central  Google Scholar 

  7. Whitaker HJ, Farrington CP, Spiessens B et al (2006) Tutorial in biostatistics: the self-controlled case series method. Stat Med 25(10):1768–1797

    Article  PubMed  Google Scholar 

  8. Langan SM, Minassian C, Smeeth L et al (2014) Risk of stroke following herpes zoster: a self-controlled case-series study. Clin Infect Dis 58(11):1497–1503

    Article  PubMed  PubMed Central  Google Scholar 

  9. Minassian C, Thomas SL, Smeeth L et al (2015) Acute cardiovascular events after herpes zoster: a self-controlled case series analysis in vaccinated and unvaccinated older residents of the United States. PLoS Med 12(12):e1001919

    Article  PubMed  PubMed Central  Google Scholar 

  10. Thomas SL, Minassian C, Ganesan V et al (2014) Chickenpox and risk of stroke: a self-controlled case series analysis. Clin Infect Dis 58(1):61–68

    Article  PubMed  Google Scholar 

  11. Kang J-H, Ho J-D, Chen Y-H et al (2009) Increased risk of stroke after a herpes zoster attack, a population-based follow-up study. Stroke 40(11):3443–3448

    Article  CAS  PubMed  Google Scholar 

  12. Lin H-C, Chien C-W, Ho J-D (2010) Herpes zoster ophthalmicus and the risk of stroke: a population-based follow-up study. Neurology 74(10):792–797

    Article  PubMed  Google Scholar 

  13. Breuer J, Pacou M, Gauthier A et al (2014) Herpes zoster as a risk factor for stroke and TIA a retrospective cohort study in the UK. Neurology 82(3):206–212

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sreenivasan N, Basit S, Wohlfahrt J et al (2013) The short- and long-term risk of stroke after herpes zoster - a nationwide population-based cohort study. PLoS One 8(7):e69156

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sundström K, Weibull CE, Söderberg-Löfdal K et al (2015) Incidence of herpes zoster and associated events including stroke—a population-based cohort study. BMC Infect Dis 15(1):488

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Hope-Simpson RE (1965) The nature of herpes zoster: a long-term study and a new hypothesis. Proc R Soc Med 58(1):9–20

    PubMed  PubMed Central  CAS  Google Scholar 

  17. Kangro HO, Ward A, Argent S et al (1988) Detection of specific IgM in varicella and herpes zoster by antibody-capture radioimmunoassay. Epidemiol Infect 101(1):187–195

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Asiki G, Stockdale L, Kasamba I et al (2015) Pilot study of antibodies against varicella zoster virus and human immunodeficiency virus in relation to the risk of developing stroke, nested within a rural cohort in Uganda. Trop Med Int Health 20(10):1306–1310

    Article  CAS  PubMed  Google Scholar 

  19. Sébire G, Meyer L, Chabrier S (1999) Varicella as a risk factor for cerebral infarction in childhood: a case-control study. Ann Neurol 45(5):679–680

    Article  PubMed  Google Scholar 

  20. Askalan R, Laughlin S, Mayank S et al (2001) Chickenpox and stroke in childhood: a study of frequency and causation. Stroke J Cereb Circ 32(6):1257–1262

    Article  CAS  Google Scholar 

  21. Wang C-C, Lin C-L, Chang Y-J et al (2014) Herpes zoster infection associated with acute coronary syndrome: a population-based retrospective cohort study. Br J Dermatol 170(5):1122–1129

    Article  PubMed  Google Scholar 

  22. Wu P, Lin C-L, Sung F-C et al (2014) Increased risk of cardiovascular events in patients with herpes zoster: a population-based study. J Med Virol 86(5):772–777

    Article  PubMed  Google Scholar 

  23. Siddiqi SA, Nishat S, Kanwar D et al (2012) Cerebral venous sinus thrombosis: association with primary varicella zoster virus infection. J Stroke Cerebrovasc Dis 21(8):917.e1–917.e4

    Article  Google Scholar 

  24. Chan J, Bergstrom RT, Lanza DC et al (2004) Lateral sinus thrombosis associated with zoster sine herpete. Am J Otolaryngol 25(5):357–360

    Article  PubMed  Google Scholar 

  25. Orme HT, Smith AG, Nagel MA et al (2007) VZV spinal cord infarction identified by diffusion-weighted MRI (DWI). Neurology 69(4):398–400

    Article  CAS  PubMed  Google Scholar 

  26. Massano J, Ferreira D, Toledo T et al (2008) Stroke and multiple peripheral thrombotic events in an adult with varicella. Eur J Neurol 15(10):e90–e91

    Article  CAS  PubMed  Google Scholar 

  27. Rabah F, El-Banna N, Abdel-Baki M et al (2012) Post varicella thrombosis-report of two cases and literature review. Pediatr Infect Dis J 31(9):985–987

    Article  PubMed  Google Scholar 

  28. Gagliardi AMZ, Gomes Silva BN, Torloni MR et al. (2012) Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev (10):CD008858.

    Google Scholar 

  29. Sanford M, Keating GM (2010) Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults. Drugs Aging 27(2):159–176

    Article  CAS  PubMed  Google Scholar 

  30. Public Health England. Shingles vaccine coverage report, England, Sept 2014 to May 2015 [Cited 2016 Jan 28]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448407/hpr2615_shngls.pdf

  31. Ouwendijk WJ, Verjans GM (2015) Pathogenesis of varicelloviruses in primates. J Pathol 235(2):298–311

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Roberts ED, Baskin GB, Soike K et al (1984) Pathological changes of experimental simian varicella (Delta herpesvirus) infection in African green monkeys (Cercopithecus aethiops). Am J Vet Res 45(3):523–530

    PubMed  CAS  Google Scholar 

  33. Arbab-Zadeh A, Nakano M, Virmani R et al (2012) Acute Coronary Events. Circulation 125(9):1147–1156

    Article  PubMed  PubMed Central  Google Scholar 

  34. Corrales-Medina VF, Madjid M, Musher DM (2010) Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis 10(2):83–92

    Article  PubMed  Google Scholar 

  35. Nagel MA, Gilden D (2016) Developments in varicella zoster virus vasculopathy. Curr Neurol Neurosci Rep 16(2):12. doi:10.1007/s11910-015-0614-5

    Article  CAS  Google Scholar 

  36. Nagel MA, Cohrs RJ, Mahalingam R et al (2008) The varicella zoster virus vasculopathies Clinical, CSF, imaging, and virologic features. Neurology 70(11):853–860

    Article  CAS  PubMed  Google Scholar 

  37. Nagel MA, Traktinskiy I, Azarkh Y et al (2011) Varicella zoster virus vasculopathy: analysis of virus-infected arteries. Neurology 77(4):364–370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK

    Charlotte Warren-Gash

  2. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

    Charlotte Warren-Gash

  3. Division of Infection & Immunity, University College London, Cruciform Building, London, WC1E 6BT, UK

    Judith Breuer

Authors
  1. Charlotte Warren-Gash
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  2. Judith Breuer
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Corresponding author

Correspondence to Charlotte Warren-Gash .

Editor information

Editors and Affiliations

  1. Department of Medicine, University of Toronto Department of Medicine, TORONTO, Ontario, Canada

    C. Peter N. Watson

  2. College of Physicians & Surgeons, Columbia University College of Physicians & Surgeons, New York, New York, USA

    Anne A. Gershon

  3. Department of Medicine, Division of Infectious Diseases, University of California, San Diego, La Jolla, California, USA

    Michael N. Oxman

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Warren-Gash, C., Breuer, J. (2017). Herpes Zoster and Vascular Risk. In: Watson, C., Gershon, A., Oxman, M. (eds) Herpes Zoster: Postherpetic Neuralgia and Other Complications. Adis, Cham. https://doi.org/10.1007/978-3-319-44348-5_8

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  • DOI: https://doi.org/10.1007/978-3-319-44348-5_8

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  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-44346-1

  • Online ISBN: 978-3-319-44348-5

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