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Herpes zoster associated with increased risk for multiple sclerosis
Kang JH. J Infect Dis. 2011;doi:10.1093/infdis/jir239.
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Patients with herpes zoster were at higher risk for multiple sclerosis at 1-year follow-up when compared with otherwise healthy controls, according to new findings published in The Journal of Infectious Diseases.
“Although we found that the risk for [multiple sclerosis (MS)] in patients with herpes zoster is increased compared with that of controls, the frequency of MS following herpes zoster is still low,” the researchers wrote in the study. “However, from a public health point of view, the overall burden of herpes zoster–associated MS should not be overlooked.”
Previous research has indicated that herpes zoster is associated with the pathogenesis of MS; however, the data are insufficient, according to background information in the study. For this reason, Herng-Ching Lin, PhD, at Taipei Medical University in Taiwan, and colleagues pooled epidemiological data from the Taiwan National Health Insurance Research Database to determine the frequency and risk for MS following a herpes zoster attack.
The cohort included 315,550 patients with herpes zoster compared with 946,650 randomly selected participants without herpes zoster (controls). Cox proportional hazard regression was used to determine the MS-free survival rate at 1 year.
At follow-up, 0.009% of participants with herpes zoster had MS compared with 0.003% of controls. After monthly income and geographic region adjustments, the study group was 3.96 times more likely to develop MS when compared with controls (95% CI, 2.22 -7.07).
In an accompanying editorial, Teresa Corona, MD, and José Flores, MD, both of the National Institute of Neurology and Neurosurgery in Mexico City, wrote: “The evidence provided in this study allows us to better understand the role of these viral factors as an MS risk among certain genetically susceptible individuals. These epidemiological findings should be corroborated in other parts of the world to further clarify the role of varicella zoster virus and other herpes viruses in the pathogenesis of MS.”
Disclosure: The researchers report no relevant financial disclosures.
The observed increased risk of MS following herpes zoster is likely due to increased physician (neurologist) visits after herpes zoster allowing MS to be diagnosed. MS is a chronically progressive disease; the real onset of MS could be way before the episode of herpes zoster. The study used a dataset without chart review of onset date of MS, oversimplifying the complexity of MS. It's very likely there is no causal link between herpes zoster and MS.
– Hung Fu Tseng, PhD
Kaiser Permanente
Disclosure: Dr. Tseng reports no relevant financial disclosures.
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