Herpes Zoster Risk Higher in Patients With Cancer

In immunocompromised patients, herpes zoster virus can lead to serious complications including postherpetic neuralgia and, in severe cases, death. Individuals with cancer have about a 40% higher risk of developing herpes zoster compared with healthy individuals, according to the results of a new study.

Investigators from Australia used data from the 45 and Up Study—the largest ongoing study of aging in the Southern Hemisphere—to prospectively analyze the relationship between cancer diagnosis, chemotherapy treatment, and herpes zoster risk in a cohort of 241,497 adults, 45 years and older (median age 62.0 years) with and without cancer.

Between 2006 and 2015, 16,350 (6.8%) participants had a herpes zoster event and 20,286 (8.4%) had a new cancer diagnosis.

Using proportional hazard models, the investigators determined that individuals with cancer were more likely to develop herpes zoster than healthy individuals (adjusted hazard ratio [aHR]: 1.41 [95% CI, 1.31-1.52]).

When analyzing different types of cancers, investigators observed that the risk of developing herpes zoster was greater among individuals with hematological cancers (aHR, 3.74 [95% CI, 3.11-4.51]) compared with those with solid organ cancers (aHR, 1.30 [95% CI, 1.21-1.40]).

The investigators also noted that among individuals receiving treatment for solid organ cancers, the risk was substantially higher when chemotherapy was administered (aHR, 1.83 [95% CI, 1.60-2.09]).

Furthermore, the investigators determined that for both hematological and solid organ cancers, the risk for developing herpes zoster was the highest during the first year post-diagnosis and decreased following that period.

At the 3-year post diagnosis point, individuals with solid cancers had a risk similar to those without cancer. In individuals with hematological cancers, the risks continued to remain elevated at this time point and beyond.

Although hematological cancers were associated with elevated risks for developing herpes zoster for a longer period of time, the investigators also observed an elevated risk prior to cancer diagnosis.

“Among those with hematological cancers, there appeared to be an increased risk of zoster in the 2 years prior to the cancer diagnosis,” the authors wrote in the article.

According to the investigators, more recommendations are needed for the prevention of herpes zoster in patients with cancer, especially those with solid organ cancers, for which explicit guidelines are not available.

A new viable option for prevention could be the Shingrix vaccine, approved by the US Food and Drug Administration in October 2017.

“Given that a new recombinant vaccine for herpes zoster has been reported to be safe and immunogenic in those with [HIV] and in autologous [hematopoietic stem cell transplant] recipients in phase 1 / 2 trials, and another non-live vaccine to prevent zoster is being developed that is safe and efficacious in immunocompromised patients, zoster vaccination now holds promise as a preventive strategy considered for cancer patients, particularly those expected to receive chemotherapy,” the authors concluded.

In an accompanying editorial commentary, Kosuke Kawai, ScD, senior biostatistician and epidemiologist, Biostatistics and Research Design, assistant professor of otolaryngology, Harvard Medical School, and Barbara P Yawn, MD, MSc, FAAFP, adjunct professor, department of Family and Community Health, University of Minnesota, stated that because the Shingrix vaccine contains a single viral protein that is unable to replicate, it is likely to be safe for severely immunocompromised individuals.

Furthermore, in a randomized phase 3 trial of 1721 participants who had received an autologous hematopoietic stem cell transplant, the vaccine was found to be safe and reduced the risk of herpes zoster by 68%. Additionally, according to data presented at IDWeek 2018 in San Francisco, California, the Shingrix vaccine reduced the incidence of herpes zoster by 87% in individuals with hematological cancers.

Dr. Kawai and Dr. Yawn concluded that the vaccine “appear[s] to offer great promise in preventing [herpes zoster] and its complications in patients with cancer.”

The new study and accompanying editorial commentary were published in The Journal of Infectious Diseases.