Disease Burden of Herpes Zoster in China: A Meta-analysis and Evidence Quality Assessment

Abstract

Abstract Background: This review aimed to estimate the disease burden of herpes zoster (HZ) in China and explore the application of the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach in observational studies of disease incidence. Methods: We searched for the literature for observational studies analysing HZ incidence in populations of all ages in China and assessed the quality of each study using the guidelines for the evaluation of incidence studies. Meta-analysis models were constructed to calculate the pooled incidence of HZ and pooled risks of postherpetic neuralgia (PHN), HZ recurrence, and hospitalisation. The studies were divided into subgroups according to sex, age, and quality assessment score and analysed. The quality of evidence for incidence was rated using the GRADE system. Results: Twelve studies with a total of 25,928,408 participants were included in this meta-analysis. The pooled incidence for all ages was 4.28‰ (95% confidence interval [CI]: 1.22–7.35). It increased by age group and increased significantly in those aged ≥60 years, which was 11.69‰ (95% CI: 6.56–16.81). The pooled risks of PHN, recurrence, and hospitalisation were 12.6% (95% CI: 10.1–15.1), 9.7% (95% CI: 3.2–16.2) and 6.0/100,000 population (95% CI: 2.3–14.2), respectively. The quality of the evidence assessment of the pooled incidence for all ages was ‘very low’, which was rated down by one category in limitations and one category in publication bias, with no categories rating it up. The result of the quality of evidence assessment for the ≥60 years old subgroup was ‘low’. Conclusions: HZ is a serious public health problem in China and is more significant in individuals older than 60 years. Therefore, an immunisation strategy for the zoster vaccine should be considered. The GRADE approach can be applied to the rating quality of evidence in disease incidence studies, but the process needs to be more specific and operable.