Herpes zoster incidence in a multicenter cohort of solid organ transplant recipients

Authors

  • S.A. Pergam,

    1. Department of Medicine, University of Washington, Seattle, Washington, USA
    2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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  • C.W. Forsberg,

    1. Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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  • M.J. Boeckh,

    1. Department of Medicine, University of Washington, Seattle, Washington, USA
    2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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  • C. Maynard,

    1. Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
    2. Departments of Health Services, University of Washington, Seattle, Washington, USA
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  • A.P. Limaye,

    1. Department of Medicine, University of Washington, Seattle, Washington, USA
    2. Laboratory Medicine, University of Washington, Seattle, Washington, USA
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  • A. Wald,

    1. Department of Medicine, University of Washington, Seattle, Washington, USA
    2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
    3. Laboratory Medicine, University of Washington, Seattle, Washington, USA
    4. Epidemiology, University of Washington, Seattle, Washington, USA
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  • N.L. Smith,

    1. Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
    2. Epidemiology, University of Washington, Seattle, Washington, USA
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  • B.A. Young

    1. Department of Medicine, University of Washington, Seattle, Washington, USA
    2. Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
    3. Department of Medicine, Veteran's Affairs Puget Sound Health Care System, Seattle, Washington, USA
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Steven A. Pergam, MD, MPH, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave. North, D3-100, PO Box 19024, Seattle, WA 98109, USA
Tel: +1 206 667 6702
Fax: +1 206 667 4411
E-mail: spergam@fhcrc.org

Abstract

S.A. Pergam, C.W. Forsberg, M.J. Boeckh, C. Maynard, A.P. Limaye, A. Wald, N.L. Smith, B.A. Young. Herpes zoster incidence in a multicenter cohort of solid organ transplant recipients.
Transpl Infect Dis 2011: 13: 15–23. All rights reserved

Background. Immunosuppressed patients are at increased risk for herpes zoster (HZ), but incidence in solid organ transplant (SOT) recipients has varied in multiple studies. To assess incidence of HZ, we examined patients who underwent SOT and received follow-up care within the large multicenter US Department of Veteran's Affairs healthcare system.

Methods. Incident cases of HZ were determined using ICD-9 coding from administrative databases. A multivariable Cox proportional hazards model, adjusted for a priori risk factors, was used to assess demographic factors associated with development of HZ.

Results. Among the 1077 eligible SOT recipients, the cohort-specific incidence rate of HZ was 22.2 per 1000 patient-years (95% confidence interval [CI], 18.1–27.4). African Americans (37.6 per 1000 [95% CI, 25.0–56.6]) and heart transplants recipients (40.0 per 1000 [95% CI, 23.2–68.9]) had the highest incidence of HZ. Patients transplanted between 2005 and 2007 had the lowest incidence (15.3 per 1000 [95% CI, 8.2–28.3]). In a multivariable model, African Americans (hazard ratio [HR] 1.88; 95% CI: 1.12, 3.17) and older transplant recipients (HR 1.13; 95% CI: 1.01, 1.27 [per 5-year increment]) had increased relative hazards of HZ.

Conclusions. These data demonstrate that HZ is a common infectious complication following SOT. Future studies focused on HZ prevention are needed in this high-risk population.

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