Incidence and clinical profile of herpes zoster in primary care in Bahrain - A cross-sectional study.

Background: Herpes zoster (HZ) is a secondary viral infection that results from the reactivation of latent varicella zoster virus, characterized by dermatological manifestations and neurological sequelae. The incidence of HZ increases with age and is higher among immunocompromised individuals. While the global literature extensively documents HZ disease and its impact, there is a paucity of data in regional studies. Despite the availability of vaccines, HZ poses a public health challenge, especially in regions with limited healthcare access, underscoring the need for better surveillance and management strategies globally, regionally, and nationally.The study aims to estimate the incidence of HZ among attendees of primary healthcare facilities in the Kingdom of Bahrain, analyze the demographic distribution of patients based on age, sex, and risk factors, and gain insights into the clinical presentation and the most common complications within the local society.

Methods: This study used a retrospective cross-sectional design, targeting all patients who visited governmental healthcare facilities and were reported to have been diagnosed with HZ in 2021, according to electronic medical records. Patients were contacted via phone to collect specific information related to the episodes they experienced, while additional information was retrieved from electronic health records (EHR). Informed consent was obtained from all participants. During the calls, five patients declined to provide details about the episodes; their decision was respected, and only the information available in their EHR was used. All collected data were systematically recorded in an Excel spreadsheet for analysis.

Results: The total incidence of HZ was 59.09 per 100,000 population. The median age was 42.8 ±19 years, with a higher prevalence observed in males (53.4%). Of the study participants 79.1% were Bahrainis, 22.3% had diabetes, and 3% had other comorbidities. The most frequently reported clinical manifestations were rash (79.9%) and pain (15.8%). The trunk (30.5%), back (19.5%), and abdomen (13.9%) were the most commonly reported locations affected by HZ. Antiviral treatment was administered to 65.2% of the patients. The most commonly reported complications included post-herpetic neuralgia (6.7%) and cellulitis (4.4%).

Conclusion: Individuals in older age groups exhibit a significantly higher likelihood of developing HZ infection along with the associated post-infection complications. This finding aligns with those from other studies. It is recommended to implement interventions aimed at reducing both the incidence and morbidity of HZ, particularly targeting those at higher risk.