{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:14:59Z","timestamp":1792451699145,"version":"4.5.0"},"reference-count":72,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"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>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the temporal trends and regional disparities of the disease burden of varicella and herpes zoster across 204 countries from 1990 to 2021, analyze the impact of the COVID-19 pandemic era, and project sex-specific incidence trends to 2036.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Utilizing data from the Global Burden of Disease (GBD) 2021 study, we analyzed the incidence, mortality, and disability-adjusted life years (DALYs) of varicella and herpes zoster. Joinpoint regression analysis identified significant shifts in temporal trends, treating 2019 as a key inflection point to observe the pandemic\u2019s impact. A Bayesian Age-Period-Cohort (BAPC) model was used to project future incidence trends. Analyses were stratified by region, sex, age, and Socio-demographic Index (SDI), and frontier analysis was applied to evaluate the efficiency of health burden management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1990 to 2021, global varicella and herpes zoster cases increased by 19.0% (72.8 to 86.7 million), while age-standardized incidence rates (ASIR) remained stable. Mortality and DALYs declined significantly, with age-standardized mortality rates (ASMR) and DALYs rates (ASDR) decreasing by 50.0 and 36.3%, respectively. A stark disparity remains, with low-SDI regions accounting for over 67% of deaths and DALYs. High-SDI regions, conversely, exhibited a resurgence in varicella and herpes zoster (ASIR: 1,300\/100,000) driven by aging populations. The burden followed a U-shaped curve by age, with children &amp;lt;5\u202fyears having the highest incidence and adults \u226545\u202fyears facing elevated mortality. BAPC modeling projected gradual declines in ASIR for both sexes by 2036.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The dual burdens of varicella and herpes zoster in low-SDI regions and aging-driven herpes zoster resurgence in high-SDI areas necessitate targeted strategies. These include prioritizing pediatric varicella immunization and equitable vaccine distribution in developing nations while enhancing adult herpes zoster booster programs and surveillance in developed ones to meet WHO 2030 targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1654535","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:29:17Z","timestamp":1764916157000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Global burden of varicella and herpes zoster across 204 countries, 1990\u20132021: a temporal trend analysis in the era of the COVID-19 pandemic and projections to 2036"],"prefix":"10.3389","volume":"13","author":[{"given":"Zilun","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinbu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahao","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenjin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weibang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meirong","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1128\/CMR.9.3.361","article-title":"Varicella-zoster virus","volume":"9","author":"Arvin","year":"1996","journal-title":"Clin Microbiol Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2263979","DOI":"10.1080\/21645515.2023.2263979","article-title":"Effectiveness and safety of recombinant zoster vaccine: a review of real-world evidence","volume":"19","author":"Parikh","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2941","DOI":"10.1007\/s11033-018-4347-9","article-title":"Deadly outbreak of chickenpox at district Faisalabad, Pakistan: possible causes, and preventive way forward","volume":"45","author":"Yousaf","year":"2018","journal-title":"Mol Biol Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"126786","DOI":"10.1016\/j.vaccine.2025.126786","article-title":"Global, regional, and national burdens of vaccine-preventable infectious diseases with high incidence among middle-aged and older adults aged 55-89 years from 1990 to 2021: results from the global burden of disease study 2021","volume":"49","author":"Jiang","year":"2025","journal-title":"Vaccine"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"126387","DOI":"10.1016\/j.vaccine.2024.126387","article-title":"A population database analysis to estimate the varicella vaccine effectiveness in children < 14 years in a high vaccination coverage area from 2004 to 2022","volume":"42","author":"Barbieri","year":"2024","journal-title":"Vaccine"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2328955","DOI":"10.1080\/21645515.2024.2328955","article-title":"Expanded spectrum of varicella disease and the need for vaccination in India","volume":"20","author":"Srikanth","year":"2024","journal-title":"Hum Vaccin Immunother"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"126519","DOI":"10.1016\/j.vaccine.2024.126519","article-title":"Report from the World Health Organization\u2019s immunization and vaccines-related implementation research advisory committee (IVIR-AC) meeting, virtual gathering, 10-13 September 2024","volume":"43","author":"Lambach","year":"2025","journal-title":"Vaccine"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"CD004407","DOI":"10.1002\/14651858.CD004407.pub5","article-title":"Vaccines for measles, mumps, rubella, and varicella in children","volume":"11","author":"Di Pietrantonj","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1186\/s13052-024-01777-9","article-title":"Post COVID-19 vaccination coverage recovery model","volume":"50","author":"Piano","year":"2024","journal-title":"Ital J Pediatr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3384","DOI":"10.1016\/j.vaccine.2024.04.021","article-title":"Low vaccine coverage and varicella outbreaks in Brazil - 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