Ten-year tertiary-care herpes zoster cohort shows high hospitalization and cranial involvement

A ten-year retrospective cohort study at University Hospital Regensburg found that 786 herpes zoster cases among 780 patients were characterized by frequent hospitalization, substantial cranial involvement and a high proportion of immunocompromised patients. Researchers manually reviewed records for cases diagnosed from January 2014 through December 2023, clinically validating the cases and extracting information on demographics, comorbidities, immune status, anatomical location, complications, hospitalization and vaccination status. The median age was 60 years, with 398 cases in women and 388 in men.

Herpes zoster results from reactivation of latent varicella-zoster virus and can cause severe pain and serious complications. The study examined the clinical and epidemiological profile of patients treated at the tertiary care center and compared the findings with published population-based studies. Overall, 13.5% of cases were classified as immunocompromised.

Compared with the population-based studies, immunocompromised patients and cranial manifestations were markedly overrepresented in the hospital cohort, indicating a concentrated risk profile for severe disease in the population examined. Trigeminal nerve involvement was recorded in 50.1% of cases, and herpes zoster ophthalmicus was present in 41.3%. Most cases did not develop complications: 72.8% proceeded without complications, while postherpetic neuralgia was the most common complication, affecting 8.4% of cases.

The observed complication rate was comparable to that reported in published population-based studies despite the greater representation of immunocompromised patients and cranial disease in the Regensburg cohort. Hospitalization was common, with 57.6% of cases requiring inpatient care. The authors suggested that early intravenous antiviral therapy during hospitalization may have contributed to the comparable complication rate, but the retrospective design and the absence of evidence establishing causation mean that the treatment cannot be credited with the outcome on the basis of this study alone.

Prospective research would be needed to test that hypothesis. The findings also show that a tertiary care population can differ markedly from population-based cohorts in underlying risk characteristics even when the measured complication rate is similar. Vaccination documentation was nearly absent: status was recorded in fewer than 1% of cases.

The investigators identified this as a significant documentation gap and said it underscores the need for systematic vaccination counselling and documentation in tertiary care centers. Because vaccination history was recorded for so few cases, the available records cannot establish whether patients had received herpes zoster vaccination. Overall, the cohort documents frequent hospitalization, ophthalmic involvement and immunosuppression at a tertiary care center, alongside a complication rate comparable to published population-based findings and very limited recording of vaccination status.

Subject of Research: Clinical and epidemiological characteristics of herpes zoster in a tertiary care cohort

Article Title: Clinical and epidemiological characteristics of herpes zoster at a tertiary care center compared to population-based data: a ten-year retrospective cohort study

Article References: Lenz, J., Niller, H. H., & Haferkamp, S. (2026). Clinical and epidemiological characteristics of herpes zoster at a tertiary care center compared to population-based data: a ten-year retrospective cohort study. BMC Infectious Diseases, 26(1), Article 1596. https://doi.org/10.1186/s12879-026-14185-7

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14185-7

Keywords: herpes zoster, shingles, varicella-zoster virus, tertiary care, retrospective cohort, hospitalization, immunosuppression, herpes zoster ophthalmicus, postherpetic neuralgia, vaccination documentation, Clinical, epidemiological