Herpes zoster: Family history and psychological stress—Case–control study

doi:10.1016/j.jcv.2012.06.020

Journal of Clinical Virology

Volume 55, Issue 2, October 2012, Pages 153-157

https://doi.org/10.1016/j.jcv.2012.06.020 Get rights and content

Abstract

Background

Several studies have reported risk factors for herpes zoster (HZ), but their results remain controversial and difficult to compare because of their limitations regarding sampling and design.

Objectives

This study was aimed to determine risk factors in ambulatory patients aged 50 years or more, by consulting general practitioners (GPs) in France.

Study design

A prospective, national, matched case–control study was conducted. It involved 121 GPs who recruited 250 cases of HZ and 500 controls (matched by age and sex), aged 50 years and older, between April 2009 and September 2010. GP and patient questionnaires explored the following risk factors: family history of HZ, comorbidities, depression, anxiety, negative life events, physical trauma, alcohol and tobacco consumption, level of education, and various protective factors (such as exposure to children). Odds ratios were estimated using conditional logistic regression.

Results

In multivariate adjusted analysis, a family history of HZ (OR 3.69, 95% CI 1.81–7.51), a HAD depressive score ≥ 8 (OR 4.15, 95% CI 1.88–9.16), and a recent negative life event (OR 3.40, 95% CI 1.67–6.93) were all significantly associated with HZ.

Conclusions

This case–control study conducted in ambulatory patients in general practice reinforced the hypothesis that, in addition to the age-related decline in VZV-specific T-cell-mediated immunity, depression negative life event and familiar history of zoster increase the risk of occurrence of herpes zoster. In people with familiar history, this risk could be prevented by vaccination.

Section snippets

Study design

A case–control study was carried out in ambulatory adults in France between April 2009 and September 2010. Patients were recruited by general practitioners (GPs) belonging to the French ‘Sentinel's network’ (FSN). The FSN is a computerised system of volunteer GPs located throughout France, participating in the ongoing surveillance of 10 health indicators (including varicella and herpes zoster) as well as in ad-hoc epidemiological studies.¹³ The characteristics of the GPs of the FSN are

Results

Complete data were obtained from 250 cases and their 500 matched controls. The median age of cases was 67 years (range: 50–91 years), and the mean age difference between cases and their matched controls was 147 days. Amongst the included patients, 59% were female and 41% were male. There was no particular temporal trend of incidences associated with zoster in any month of the year amongst the 250 patients.

Discussion

The present study assessed risk factors for HZ in patients aged 50 years or older consulting a GP in France. A family history of HZ, depression, and a negative life event in the past 6 months were the variables retained in the final model, adjusted for age and sex.

Psychological stress and depression have been identified as potential risk factors for zoster that might operate by suppressing cell-mediated immunity, but controversy persists.⁷ Stressful life events have been shown to be risk factors

Funding

This work was co-constructed between INSERM and Sanofi-Pasteur MSD, who co-financed the study.

Competing interests

The authors do not have potential conflict of interest to declare. When the present work was done: A. Lasserre, PhD, was employee of Université Pierre et Marie Curie, Paris, France; F. Blaizeau, was employee of Université Pierre et Marie Curie, Paris, France; P. Gorwood, MD, was employee of the Hôpital Sainte Anne, Paris, France; K. Bloch, MD, was employee of Sanofi-Pasteur MSD, Lyon, France; P. Chauvin, MD, PhD, was employee of the INSERM, Paris, France; F. Liard, MD, is a general practitioner

Ethical approval

As it was stated by the French authorities (Comité de Protection des Personnes, Ile de France V, Paris), ethical approval was not necessary for this study. Two authorizations were obtained to recover and storage data related with this study: CNIL 091966, and CCTIRS 9291.

Acknowledgements

We thank all individuals who agreed to take part in the study, and the participating general practitioners belonging to the Sentinel network. This work was supported by a research grant co-funded by INSERM (Institut National de la Santé et de la recherché Médical) and Sanofi-Pasteur MSD.

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Citation Excerpt :
The median age of the cases in the study was 67 years. About 37% of the cases and 20.4% of the controls reported having at least one relative with a history of HZ (Lasserre et al., 2012). On the other hand, Gatti et al., who used PHN cases in their study, reported no evidence of family history as a risk factor for HZ, as a considerable proportion of the cases (28.4%) and a similar percentage of the controls (29.6%) reported a family history of HZ.
Studies have investigated a possible association between family history of HZ and the occurrence of HZ. However, the results were inconclusive and susceptible to bias. We evaluated this association in an elderly population.
The matched case-control study conducted at Kaiser Permanente Southern California in 2012-2015 included 656 incident HZ patients ≥60 whose skin lesion tested positive for varicella zoster virus by polymerase chain reaction. Half of the HZ patients were vaccinated with zoster vaccine as achieved by stratified sampling. The controls were randomly selected and 1:1 matched to the cases on sex, age (±1 year), and zoster vaccination (±3 months of the case’s vaccination date). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI).
Having any blood relative with a history of HZ was associated with a slightly increased risk of HZ (adjusted OR = 1.37, 95% CI 1.05–1.79). The adjusted OR associated with having one and two categories of first-degree blood relatives with a history of HZ was 1.30 (95% CI: 0.97–1.73) and 2.53 (95% CI: 1.17–5.44), respectively.
Our results suggested a weak association between the development of HZ and a positive family history of HZ among the elderly population.

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Herpes zoster: Family history and psychological stress—Case–control study

Abstract

Background

Objectives

Study design

Results

Conclusions

Section snippets

Study design

Results

Discussion

Funding

Competing interests

Ethical approval

Acknowledgements

Vaccine

Vaccine

Lancet Infect Dis

Vaccine

Ann Epidemiol

Addict Behav

Brain Behav Immunity

Pain

Lancet

Vaccine

Virtual surveillance of communicable diseases: a 20-year experience in France

Stat Methods Res

The management of post-herpetic neuralgia

Br Med J

Epidemiology of varicella zoster virus infection in Canada and in the United Kingdom

Epidemiol Infect

Clinical practice herpes zoster

New Engl J Med

Herpes zoster in Germany: quantifying the burden of disease

BMC Infect Dis

The nature of herpes zoster: a long-term study and a new hypothesis

Herpes zoster and progression to AIDS in a cohort of individuals who seroconverted to human immunodeficiency virus Italian HIV seroconversion study

Clin Infect Dis