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Risk of Stroke Following Herpes Zoster: A Self-Controlled Case-Series Study
Open accessAbstract
BACKGROUND: Herpes zoster is common and vaccine preventable. Stroke risk may be increased following zoster, but evidence is sparse and could be explained by differences between people with and without zoster. Our objective was to determine if stroke risk is increased following zoster. METHODS: Within-person comparisons were undertaken using the self-controlled case-series method and data from the UK Clinical Practice Research Datalink (1987-2012). Participants had a first-ever diagnosis of zoster and stroke within the study period. Stroke incidence in periods following zoster was compared with incidence in other time periods. Age-adjusted incidence ratios (IRs) and 95% confidence intervals (CIs) were calculated. RESULTS: A total of 6584 individuals were included. Stroke rate was increased following zoster compared with the baseline unexposed period, then gradually reduced over 6 months: weeks 1-4 (age-adjusted IR, 1.63; 95% CI, 1.32-2.02), weeks 5-12 (IR, 1.42; 95% CI, 1.21-1.68), and weeks 13-26 (IR, 1.23; 95% CI, 1.07-1.42), with no increase thereafter. A stronger effect was observed for individuals with zoster ophthalmicus, rising to a >3-fold rate 5-12 weeks after zoster. Oral antivirals were given to 55% of individuals: IRs for stroke were lower among those receiving antivirals compared with those not treated, suggesting a protective effect. CONCLUSIONS: We have established an increased stroke rate within 6 months following zoster. Findings have implications for zoster vaccination programs, which may reduce stroke risk following zoster. The low antiviral prescribing rate needs to be improved; our data suggest that antiviral therapy may lead to a reduced stroke risk following zoster.
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The SCCS approach has been successfully applied in other epidemiological studies, including studies of herpes zoster and stroke, and methylphenidate treatment with suicide attempts, psychosis, and seizures.
“This approach has been successfully applied in other epidemiological studies which, for example, explore the association between herpes zoster and stroke [37], or the association between methylphenidate treatment with suicide attempts [16], psychosis [17] and seizures [18].”
From Understanding the Association Between Antidepressants and the Risk of Being Diagnosed with Dementia in Older People: A Self-Controlled Case Series Study (2020) · cites this paper as [37]
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Self-citationRecommendations for the management of herpes zoster
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Hiragi, S., Yamada, H., Tsukomoto, T., Yoshida, K., Kondo, N., Matsubara, T., Yanagita, M., Tamura, H., & Kuroda, T. (2018) · Clinical Epidemiology · doi:10.2147/clep.s158110 · Cited by 35
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Metadata
- Authors
- Langan, S. M., Minassian, C., Smeeth, L., & Thomas, S. L.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Langan, Sinéad M.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-04-02
- Volume
- 58
- Issue
- 11
- Pages
- 1497-1503
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC4017889
- OpenAlex
- W2102440817
- Cited by
- 163
- References
- 2
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 11 · 2023: 8 · 2022: 10 · 2021: 6 · 2020: 12 · 2019: 12 · 2018: 13 · 2017: 23 · 2016: 16 · 2015: 22 · 2014: 8
- FWCI
- 15.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Clinical Infectious Diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- Wellcome Trust (098504/Z/12/Z, 098504)
- National Institute for Health and Care Research (NIHR/CS/010/014, CDF-2010-03-32)
- Medical Research Council (MR/K006584/1)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
- Keywords
- herpes zoster, stroke, herpes zoster ophthalmicus, antiviral therapy, stroke risk, herpes zoster vaccination, incidence ratio
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Antiviral Agents, Female, United Kingdom, Herpes Zoster, Humans, Male, Time Factors, Incidence, Risk Assessment, Stroke
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