{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:32:15Z","timestamp":1771331535149,"version":"3.50.1"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Incidence of herpes zoster (HZ) is increasing worldwide, imposing significant burden on healthcare resources. In Saudi Arabia, local epidemiological studies are limited, and HZ burden is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multi-center, hospital-based, retrospective medical chart review was conducted at five National Guard hospitals and affiliated primary care centers. Patients included military personnel, healthcare workers, and family dependents, in addition to non-eligible individuals via referral from other healthcare systems. Data were retrospectively collected from electronic medical records of documented cases of HZ or related complications from January 2017\u2013December 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>1,019 HZ cases were identified, with the number of cases increasing annually (2017: 89; 2022: 279). Estimated HZ prevalence over the study period was 0.12%. Mean age of patients was 52.8\u202fyears and &amp;gt;50% were females. Most (73.9%) patients had \u22651 comorbidity, most commonly hypertension (38.9%) and diabetes (37.7%). HZ-related complications were detected in 31.3% of cases; post-herpetic neuralgia was diagnosed in 17.6% and disseminated HZ in 5.6% of patients. In total, 12.5% of patients were hospitalized; 1.2% required intensive care unit admission. Mean hospital stay was 10.1\u202fdays. Use of antiviral medications was reported in most cases (87.5%). Significant predictors of complicated HZ, identified via multivariable logistic regression analyses, were age \u226560\u202fyears (odds ratio=1.42; <jats:italic>p<\/jats:italic>=0.03), autoimmune disease (2.45; <jats:italic>p<\/jats:italic>&amp;lt;0.01), depression (2.68; <jats:italic>p<\/jats:italic>=0.02), and chronic lung disease (1.95; <jats:italic>p<\/jats:italic>=0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study provides updated insights into HZ epidemiology in Saudi Arabia. A high proportion of patients identified in a hospital setting with HZ had comorbidities and a substantial proportion experienced complications.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1479640","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T06:38:07Z","timestamp":1740033487000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Epidemiology of herpes zoster in National Guard Hospitals in Saudi Arabia: a 6-year retrospective chart review study"],"prefix":"10.3389","volume":"12","author":[{"given":"Fayssal","family":"Farahat","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"AlZunitan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asim","family":"Alsaedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wafa","family":"Al Nassir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Elgammal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed","family":"Nazeer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majid","family":"Althaqafy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiman","family":"El-Saed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nouf","family":"Al Enizi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sulafah","family":"Hakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zainab","family":"Alsharef","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana","family":"Guzman-Holst","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majid","family":"Alshamrani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"612","DOI":"10.2340\/00015555-0729","article-title":"Epidemiological features and costs of herpes zoster in Taiwan: a national study 2000 to 2006","volume":"89","author":"Jih","year":"2009","journal-title":"Acta Derm Venereol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1111\/ddg.14013_g","article-title":"S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia","volume":"18","author":"Gross","year":"2020","journal-title":"J Dtsch Dermatol Ges"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e004833","DOI":"10.1136\/bmjopen-2014-004833","article-title":"Systematic review of incidence and complications of herpes zoster: towards a global perspective","volume":"4","author":"Kawai","year":"2014","journal-title":"BMJ Open"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s12889-015-1514-y","article-title":"The humanistic, economic and societal burden of herpes zoster in Europe: a critical review","volume":"15","author":"Gater","year":"2015","journal-title":"BMC Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2606","DOI":"10.1080\/21645515.2017.1368600","article-title":"Risk and impact of herpes zoster on patients with diabetes: a population-based study, 2009-2014","volume":"13","author":"Mu\u00f1oz-Quiles","year":"2017","journal-title":"Hum Vaccin Immunother"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1080\/21645515.2020.1847582","article-title":"A systematic literature review of herpes zoster incidence worldwide","volume":"17","author":"van Oorschot","year":"2021","journal-title":"Hum Vaccin Immunother"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"CD008858","DOI":"10.1002\/14651858.CD008858.pub3","article-title":"Vaccines for preventing herpes zoster in older adults","volume":"3","author":"Gagliardi","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1186\/1471-2334-13-463","article-title":"Herpes zoster surveillance using electronic databases in the Valencian community (Spain)","volume":"13","author":"Morant-Talamante","year":"2013","journal-title":"BMC Infect Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1007\/s15010-007-6347-x","article-title":"Diabetes as a risk factor for herpes zoster infection: results of a population-based study in Israel","volume":"36","author":"Heymann","year":"2008","journal-title":"Infection"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/ofid\/ofaa005","article-title":"Risk factors for herpes zoster infection: a meta-analysis.","volume":"7","author":"Marra","year":"2020","journal-title":"Open forum Infect Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e002562","DOI":"10.1136\/rmdopen-2022-002562","article-title":"Facilitators and barriers of vaccine uptake in patients with autoimune inflammatory rheumatic disease: a scoping review","volume":"8","author":"Neusser","year":"2022","journal-title":"RMD Open"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12931-022-02305-1","article-title":"Risk factors for herpes zoster: should people with asthma or COPD be vaccinated?","volume":"24","author":"Safonova","year":"2023","journal-title":"Respir Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2123","DOI":"10.3390\/ijerph20032123","article-title":"Herpes zoster risk in patients with rheumatoid arthritis and its association with medications used","volume":"20","author":"Dlamini","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1086\/514342","article-title":"Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults","volume":"44","author":"Rothberg","year":"2007","journal-title":"Clin Infect Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e82","DOI":"10.1016\/S2468-2667(17)30234-7","article-title":"Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study","volume":"3","author":"Amirthalingam","year":"2018","journal-title":"Lancet Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.jinf.2022.01.011","article-title":"Impact of a national immunisation program on herpes zoster incidence in Australia","volume":"84","author":"Lin","year":"2022","journal-title":"J Infect"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"25151355221084535","DOI":"10.1177\/25151355221084535","article-title":"Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review","volume":"10","author":"Pan","year":"2022","journal-title":"Ther Adv Vaccines Immunother"},{"key":"ref18","year":""},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e58360","DOI":"10.7759\/cureus.58360","article-title":"Public perception in Saudi Arabia toward herpes zoster and its vaccination: a cross-sectional study","volume":"16","author":"AlKhowailed","year":"2024","journal-title":"Cureus"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e53572","DOI":"10.7759\/cureus.53572","article-title":"Assessment of the level of knowledge and attitude towards herpes zoster and its vaccination among individuals at risk in Saudi Arabia","volume":"16","author":"Al Shanbari","year":"2024","journal-title":"Cureus"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s40794-023-00202-z","article-title":"Herpes zoster vaccine awareness and acceptance among adults in Saudi Arabia: a survey-based cross-sectional study","volume":"9","author":"AlMuammar","year":"2023","journal-title":"Trop Dis Travel Med Vaccines"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e33508","DOI":"10.7759\/cureus.33508","article-title":"A cross-sectional study of the knowledge, practice, and attitude towards herpes zoster vaccination among the general population in the western region of Saudi Arabia","volume":"15","author":"Alhothali","year":"2023","journal-title":"Cureus"},{"key":"ref23","year":"2023"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s40121-022-00715-8","article-title":"Epidemiology of varicella zoster virus and herpes zoster virus in gulf cooperation council countries: a review of the literature","volume":"12","author":"Badur","year":"2023","journal-title":"Infect Dis Ther"},{"key":"ref25","year":""},{"key":"ref26","author":"Xe","year":"2024"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/s15010-013-0550-8","article-title":"Incidence of herpes zoster in patients with altered immune function","volume":"42","author":"Chen","year":"2014","journal-title":"Infection"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1093\/cid\/ciq077","article-title":"Herpes zoster incidence among insured persons in the United States, 1993-2006: evaluation of impact of varicella vaccination","volume":"52","author":"Leung","year":"2011","journal-title":"Clin Infect Dis"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1016\/j.coi.2012.06.002","article-title":"Immune senescence and vaccines to prevent herpes zoster in older persons","volume":"24","author":"Levin","year":"2012","journal-title":"Curr Opin Immunol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1186\/1471-2334-13-170","article-title":"Similar herpes zoster incidence across Europe: results from a systematic literature review","volume":"13","author":"Pinchinat","year":"2013","journal-title":"BMC Infect Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"6433","DOI":"10.4103\/jfmpc.jfmpc_933_22","article-title":"Clinical and epidemiological aspects of herpes zoster disease in a primary care setting in Riyadh, Saudi Arabia: a retrospective cohort study","volume":"11","author":"Binsaeedu","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1200353","DOI":"10.3389\/fpubh.2023.1200353","article-title":"COVID-19 and herpes zoster: a call to action","volume":"11","author":"Noushad","year":"2023","journal-title":"Front Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1001\/jama.2012.7304","article-title":"Association between vaccination for herpes zoster and risk of herpes zoster infection among older patients with selected immune-mediated diseases","volume":"308","author":"Zhang","year":"2012","journal-title":"JAMA"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1016\/j.vaccine.2005.09.026","article-title":"The burden of herpes zoster: a prospective population based study","volume":"24","author":"Scott","year":"2006","journal-title":"Vaccine"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1017\/S0950268807007893","article-title":"Secular trends in the epidemiology of shingles in Alberta","volume":"135","author":"Russell","year":"2007","journal-title":"Epidemiol Infect"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2271","DOI":"10.1056\/NEJMoa051016","article-title":"A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults","volume":"352","author":"Oxman","year":"2005","journal-title":"NEJM"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"7598","DOI":"10.1016\/j.vaccine.2007.07.049","article-title":"Epidemiology and costs of herpes zoster: background data to estimate the impact of vaccination","volume":"25","author":"Di Legami","year":"2007","journal-title":"Vaccine"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"651","DOI":"10.3390\/vaccines11030651","article-title":"Acceptability of herpes zoster vaccination among patients with diabetes: a cross-sectional study in Saudi Arabia","volume":"11","author":"Al-Orini","year":"2023","journal-title":"Vaccine"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e49396","DOI":"10.7759\/cureus.49396","article-title":"Public knowledge, attitude, and practice toward herpes zoster vaccination in Saudi Arabia","volume":"15","author":"Alleft","year":"2023","journal-title":"Cureus"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e50329","DOI":"10.7759\/cureus.50329","article-title":"Knowledge about the herpes zoster (HZ) vaccine and its acceptance among the population in Al-Ahsa City in the Kingdom of Saudi Arabia","volume":"15","author":"Bohamad","year":"2023","journal-title":"Cureus"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1002\/jmv.10316","article-title":"A study of shingles and the development of postherpetic neuralgia in East London","volume":"70","author":"Scott","year":"2003","journal-title":"J Med Virol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.4065\/82.11.1341","article-title":"A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction","volume":"82","author":"Yawn","year":"2007","journal-title":"Mayo Clin Proc"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.4065\/mcp.2011.0305","article-title":"Herpes zoster and postherpetic neuralgia surveillance using structured electronic data","volume":"86","author":"Klompas","year":"2011","journal-title":"Mayo Clin Proc"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1007\/s13555-021-00535-7","article-title":"Burden of herpes zoster in adult patients with underlying conditions: analysis of German claims data, 2007-2018","volume":"11","author":"Batram","year":"2021","journal-title":"Dermatol Ther"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1016\/j.cgh.2006.09.019","article-title":"Incidence and risk factors for herpes zoster among patients with inflammatory bowel disease","volume":"4","author":"Gupta","year":"2006","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.1086\/598331","article-title":"Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis","volume":"48","author":"McDonald","year":"2009","journal-title":"Clin Infect Dis"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1158\/1055-9965.EPI-12-0815","article-title":"The epidemiology of herpes zoster in patients with newly diagnosed cancer","volume":"22","author":"Habel","year":"2013","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1007\/s15010-011-0162-0","article-title":"Risk of herpes zoster in patients with underlying diseases: a retrospective hospital-based cohort study","volume":"39","author":"Hata","year":"2011","journal-title":"Infection"},{"key":"ref49","year":"2007"},{"key":"ref50","year":"2022"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5339\/qmj.2020.1","article-title":"Epidemiology of herpes zoster in the State of Qatar, 2012-2017","volume":"2020","author":"Al-Dahshan","year":"2020","journal-title":"Qatar Med J"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e035951","DOI":"10.1136\/bmjopen-2019-035951","article-title":"Factors associated with non-urgent visits to the emergency department in a tertiary care Centre, Western Saudi Arabia: cross-sectional study","volume":"10","author":"Al-Otmy","year":"2020","journal-title":"BMJ Open"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1093\/ofid\/ofz007","article-title":"The economic burden and impact on quality of life of herpes zoster and postherpetic neuralgia in individuals aged 50 years or older in Italy. Open forum","volume":"6","author":"Matthews","year":"2019","journal-title":"Infect Dis"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"3325","DOI":"10.1007\/s12325-021-01717-7","article-title":"Economic burden and impact on quality of life of herpes zoster in Spanish adults aged 50 years or older: a prospective cohort study","volume":"38","author":"D\u00edez-Domingo","year":"2021","journal-title":"Adv Ther"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12879-017-2185-3","article-title":"Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia","volume":"17","author":"Friesen","year":"2017","journal-title":"BMC Infect Dis"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"781","DOI":"10.2165\/11317560-000000000-00000","article-title":"Incremental 1-year medical resource utilizationand costs for patients with herpes zoster from a set of US health plans","volume":"27","author":"White","year":"2009","journal-title":"PharmacoEconomics"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1016\/j.vaccine.2012.01.045","article-title":"Employment related productivity loss associated withherpes zoster and postherpetic neuralgia: a 6-month prospective study","volume":"30","author":"Drolet","year":"2012","journal-title":"Vaccine"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1111\/j.1526-4637.2006.00196.x","article-title":"Health care expenditure burden of persisting herpes zoster pain","volume":"9","author":"Dworkin","year":"2008","journal-title":"Pain Med"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1086\/421942","article-title":"Acute pain in herpes zoster and its impact on health-related quality of life","volume":"39","author":"Katz","year":"2004","journal-title":"Clin Infect Dis"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.vhri.2014.08.003","article-title":"What are the challenges in conducting cost-of-illness studies?","volume":"4","author":"Greenberg","year":"2014","journal-title":"Value Health Reg Issues"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"327","DOI":"10.3350\/cmh.2014.20.4.327","article-title":"Cost-of-illness studies: concepts, scopes, and methods","volume":"20","author":"Jo","year":"2014","journal-title":"Clin Mol Hepatol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1479640\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T06:38:10Z","timestamp":1740033490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1479640\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,20]]},"references-count":61,"alternative-id":["10.3389\/fpubh.2024.1479640"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1479640","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,20]]},"article-number":"1479640"}}