Global herpes zoster burden in adults with COPD: a systematic review and meta-analysis

Background COPD is associated with an increased risk of infections, such as herpes zoster, potentially leading to greater morbidity and mortality. This systematic review assessed the evidence on herpes zoster burden in COPD. Methods A global systematic literature review and meta-analysis was conducted (MEDLINE/Embase, 2003–2024) on herpes zoster burden (incidence, risk, complications, impact on COPD and healthcare resources) in adults aged ≥18 years with COPD. Results 22 studies on herpes zoster burden in COPD were included. The pooled herpes zoster incidence rate per 1000 person-years in adults with COPD aged ≥18 years was 10.98 (95% CI 8.28–14.56), increasing to 13.95 (10.80–18.02) in adults aged ≥50 years. The pooled risk ratio of developing herpes zoster was 1.49 (1.17–1.89) in adults aged ≥18 years with COPD and 1.86 (1.28–2.69) in COPD treated with corticosteroids. The pooled rate ratio of developing post-herpetic neuralgia (persistent pain lasting ≥90 days) was 1.50 (1.10–2.04) in adults with herpes zoster and COPD versus with herpes zoster alone. Herpes zoster was linked to higher healthcare costs and resource use, and may be associated with COPD exacerbations. Study designs, settings, case definitions, sample sizes and study periods differed, resulting in heterogeneity. Conclusions Adults with COPD have an increased risk of herpes zoster and complications and an associated burden on healthcare systems, with higher risks in those on corticosteroids. Herpes zoster vaccines offer effective protection, including for adults with COPD, and could help reduce the disease and its economic burden.