The impact of the COVID-19 pandemic on the incidence of herpes zoster

Abstract Background There have been several case reports of herpes zoster (HZ) following COVID-19 disease and vaccination. We conducted a non-systematic literature search to elucidate the global effects of the COVID-19 pandemic on the incidence of HZ. Methods The literature search was performed in October 2021 using PubMed and Embase. The search string was herpes zoster AND COVID-19. Publications were manually reviewed; case reports were removed. Results Three retrospective studies reported the risk of HZ following COVID-19 disease. One study (Bhavsar, 2021) used two US databases and found higher risk of HZ following COVID-19 disease (relative risk [RR]=1.15) and COVID-19 hospitalisation (RR = 1.21), respectively. A strong association between HZ and COVID-19 disease (RR = 5.27) was also reported in a study of the University of Florida patient registry (Katz, 2021). The third study (Barda, 2021) reported no association between COVID-19 disease and risk of HZ (RR = 0.82). In two of the three observational studies in Israel (Furer, 2021 and Barda, 2021), the incidence of HZ was increased following COVID-19 vaccination. The third study (Shasha, 2021) found no association (RR = 1.07). Other studies included a report in Brazil (Maia, 2021) that demonstrated a 35% increase in HZ diagnoses during the pandemic versus pre-pandemic and a published model (La, 2021) that estimated the declining uptake of recombinant zoster vaccine in the US may result in 63,117 avoidable HZ cases in those who remain unvaccinated in 2021. Conclusions Emerging data suggest that the COVID-19 pandemic may have increased the risk of HZ and negatively impacted HZ vaccine uptake. Therefore, there is an important need to increase awareness of HZ and HZ vaccination during the pandemic. Key messages • There is a need to increase awareness of HZ and HZ vaccination during the COVID-19 era. • Further studies are needed to fully understand the impact of COVID-19 on the risk of HZ.


Background:
Healthcare-associated infections (HAIs) are a frequent complication in neonatal intensive care units (NICUs). Hospital policies caused by COVID-19 pandemic may have played a role in HAIs development. The aim of this study was to describe and characterize over time the occurrence of HAIs in a NICU at the Policlinico Umberto I in Rome both before and during the COVID-19 pandemic.

Methods:
All infants of all birth weight (BW) classes with >2 days in the NICU, admitted from January 2018 to December 2021, were included. To assess the effect of the pandemic, we compared surveillance data from 2018-2019 with those from 2020-2021. Infections were defined using standard Centers for Disease Control and Prevention definitions.

Results:
We included 513 infants, 274 admitted in 2018-2019 and 239 between 2020-2021. NICU stay in days was similar in the two periods (14.4 and 15.3 respectively) but the number of patients who died in 2018-2019 (N = 13) was almost double that of 2020-2021 (N = 7). A total of 27 infections were recorded in the post-pandemic period compared to 9 recorded in the previous period, mainly central line-associated bloodstream infections (CLABSI) (7% vs 3.0%, p = 0.043), followed by ventilatorassociated pneumonias (VAP) (3.0% vs 0.4%, p = 0.019). The incidence density of device-associated infections was higher in patients with lower BW class in both periods analyzed. Different microorganisms were isolated: in 2018-2019 K. pneumoniae (33.3%) and Serratia marcescens (33.3%) were the most found, while S. aureus (29.0%) and Staphylococci coagulase negative (51.6%) were predominant in the following years.

Conclusions:
Results indicate that patient management may have influenced the occurrence of HAIs during the pandemic. This reinforces the importance of the HAI surveillance protocol in the NICU,

Background:
There have been several case reports of herpes zoster (HZ) following COVID-19 disease and vaccination. We conducted a non-systematic literature search to elucidate the global effects of the COVID-19 pandemic on the incidence of HZ.

Methods:
The literature search was performed in October 2021 using PubMed and Embase. The search string was herpes zoster AND COVID-19. Publications were manually reviewed; case reports were removed.

Results:
Three retrospective studies reported the risk of HZ following COVID-19 disease. One study (Bhavsar, 2021) used two US databases and found higher risk of HZ following COVID-19 disease (relative risk [RR] = 1.15) and COVID-19 hospitalisation (RR = 1.21), respectively. A strong association between HZ and COVID-19 disease (RR = 5.27) was also reported in a study of the University of Florida patient registry (Katz, 2021). The third study (Barda, 2021) reported no association between COVID-19 disease and risk of HZ (RR = 0.82). In two of the three observational studies in Israel (Furer, 2021 andBarda, 2021), the incidence of HZ was increased following COVID-19 vaccination. The third study (Shasha, 2021) found no association (RR = 1.07). Other studies included a report in Brazil (Maia, 2021) that demonstrated a 35% increase in HZ diagnoses during the pandemic versus pre-pandemic and a published model (La, 2021) that estimated the declining uptake of recombinant zoster vaccine in the US may result in 63,117 avoidable HZ cases in those who remain unvaccinated in 2021.

Conclusions:
Emerging data suggest that the COVID-19 pandemic may have increased the risk of HZ and negatively impacted HZ vaccine uptake. Therefore, there is an important need to increase awareness of HZ and HZ vaccination during the pandemic.

Background:
This study aimed to prospectively assess quality of life (QOL), QOL domains, and pain severity in advanced stage breast cancer patients during palliative oncology treatment in Indonesia.

Methods:
Advanced stage breast cancer patients > 18 years (n = 160) who began palliative oncology treatment were enrolled in the study using convenience sampling. They completed the EORTC QLQ-C15-PAL questionnaire and pain severity (Visual Analogue Scale, VAS) score at three-time points (baseline (T0), three-(T1) and six-months (T2) follow-up). The repeated measures analysis of variance (ANOVA) model was used to assess the QOL, QOL domains, and pain severity changes over time adjusted for age, place of residence, marital status, and Karnofsky Performance Status score at baseline. We classified the change over time in three qualitative groups (deterioration, improvement, or trivial/no difference). We considered it clinically relevant if patients had a 10-point difference.

Results:
The mean age of included patients (n = 159) was 50 years. Most lived in an urban area (72.3%), had low education (71.7%), and were married (81.8%). The repeated measures ANOVA showed that the QOL score, emotional functioning, fatigue, dyspnea, appetite loss, constipation, and VAS pain score remained stable over the 6-months period. In contrast: physical functioning declined (medium to large deterioration ) between T0 to T2), however there was an improvement in the insomnia domain (medium improvement )) between T0 to T2).

Conclusions:
Our findings indicated that advanced stage breast cancer patients adapted well to palliative oncology treatment over six months of observation. There was deterioration in physical functioning, but improvement in insomnia. However, more attention is needed from clinicians to achieve improvement in the overall QOL score and specific QOL domains.

Key messages:
Focusing on improvement overall QOL score and specific QOL domains will lead to better advanced stage breast cancer patients' satisfaction and care. Information is limited on palliative treatment satisfaction in low and lower middle-income countries, therefore this study has important impact on further policy considerations in Indonesia.