Epidemiology of Herpes Zoster in National Guard Hospitals in Saudi Arabia: a 6-year Retrospective Chart Review Study

Introduction: 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.

Methods: 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-December 2022.

Results: 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 years and >50% were females. Most (73.9%) patients had ≥1 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 days. Use of antiviral medications was reported in most cases (87.5%). Significant predictors of complicated HZ, identified via multivariable logistic regression analyses, were age ≥60 years (odds ratio=1.42; =0.03), autoimmune disease (2.45; <0.01), depression (2.68; =0.02), and chronic lung disease (1.95; =0.04).

Conclusion: 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.