Person:

Dommasch, Erica

Question What is the effect of vaccination on emergency department utilization for herpes zoster?

Findings In this population-based, descriptive epidemiologic study of more than 1.3 million herpes zoster–related emergency department visits from 2006 through 2013, the overall rate of visits rose by 8.3%, driven by an increased number of visits by patients aged 20 to 59 years; populations recommended for vaccination (aged <20 and ≥60 years) demonstrated a decrease in utilization. Herpes zoster annual incidence rates fell after the recommended use of the herpes zoster vaccine in 2008 in patients 60 years or older.

Meaning Vaccination may be associated with a reduction of emergency department utilization for herpes zoster.

Introduction Little is known about emergency department (ED) utilization for herpes simplex viruses (HSV) types 1 and 2 in the United States. Our goal was to determine the utilization and cost burden associated with HSV infection visits to U.S. EDs in recent years from 2006–2013.

Methods We analyzed the Nationwide Emergency Department Sample (NEDS) database, the largest national database of hospital-based ED visits in the U.S., to determine the number of visits and the cost associated with HSV visits from 2006–2013. We also analyzed trends across years.

Results From 2006–2013, there were 704,728 ED visits with a primary diagnosis of HSV infection. Of these, 658,805 (93.5%) resulted in routine discharges without inpatient admission, amounting to a total ED charge of USD 543.0 million. After adjusting for inflation, there was a doubling of total ED spending for HSV from 2006 to 2013 (USD 45.0 million to USD 90.7 million) and a 24% increase in number of visits (73,227 visits in 2006, vs. 90,627 visits in 2013). ED visits for genital herpes have increased while visits for herpes gingivostomatitis have decreased.

Conclusion HSV-associated ED use and associated costs have increased between 2006–2013. Most of these cases could likely be managed in non-emergent outpatient settings as 93.5% of visits resulted in routine discharges without admission. Our findings add to knowledge regarding HSV utilization and epidemiology in the U.S. and highlight the need for continued prevention, patient education, and emphasis of care in non-emergency settings to prevent unnecessary ED utilization.