Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysis
Herpes zoster (HZ) is a neurotropic virus. We aimed to evaluate the association of HZ infection, protective effects of antiviral treatment or vaccination on dementia. A systematic search of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane CENTRAL was performed from January 1, 19...
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Taylor & Francis Group
2025-12-01
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| Series: | Human Vaccines & Immunotherapeutics |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/21645515.2025.2546741 |
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| author | Fawziah Marra Kyle Gomes Emily Liu Nirma Khatri Vadlamudi Kathryn Richardson Jacquelyn J. Cragg |
| author_facet | Fawziah Marra Kyle Gomes Emily Liu Nirma Khatri Vadlamudi Kathryn Richardson Jacquelyn J. Cragg |
| author_sort | Fawziah Marra |
| collection | DOAJ |
| description | Herpes zoster (HZ) is a neurotropic virus. We aimed to evaluate the association of HZ infection, protective effects of antiviral treatment or vaccination on dementia. A systematic search of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane CENTRAL was performed from January 1, 1996, to October 31, 2024. Observational studies evaluating HZ infection, antivirals, or vaccination and dementia risk were selected. Risk of bias was examined with the Newcastle-Ottawa scale. A random-effects meta-analysis was performed, with the rate ratio (RR) and corresponding 95% confidence intervals (CIs) being pooled for dementia. Presence of heterogeneity was assessed with I2, and differences by study-level characteristics were estimated using subgroup meta-analysis and meta-regression. Eighteen studies (N = 9.4 million) were included. Infection was associated with elevated risk of dementia (RR 1.14; 95% CI: 1.04, 1.25, I2 = 98%); this remained significant in the sensitivity analysis when the two case-control studies were removed (RR 1.17; 95% CI: 1.06, 1.30, I2 = 98%). Subgroup analysis based on sex, age, study population, bias scores, type of dementia or HZO did not show statistically significant differences in risk. Treatment with antivirals showed a small effect (RR 0.84; 95% CI: 0.71, 0.99, I2 = 73%), but prophylaxis with HZ vaccination was associated with a significantly lower risk (RR 0.68; 95% CI: 0.56, 0.83, I2 = 99%). We report a slightly raised dementia risk after HZ infection and reduced risks after antiviral treatment and prevention with vaccination. However, results should be interpreted with caution due to significant heterogeneity in pooled analyses. |
| format | Article |
| id | doaj-art-4e1b53f5285f46cd91a686d6382b0d3e |
| institution | Kabale University |
| issn | 2164-5515 2164-554X |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
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| series | Human Vaccines & Immunotherapeutics |
| spelling | doaj-art-4e1b53f5285f46cd91a686d6382b0d3e2025-08-20T03:47:13ZengTaylor & Francis GroupHuman Vaccines & Immunotherapeutics2164-55152164-554X2025-12-0121110.1080/21645515.2025.2546741Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysisFawziah Marra0Kyle Gomes1Emily Liu2Nirma Khatri Vadlamudi3Kathryn Richardson4Jacquelyn J. Cragg5Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaFaculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaFaculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaDepartment of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USANorwich Epidemiology Centre, University of East Anglia, Norwich, UKFaculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, CanadaHerpes zoster (HZ) is a neurotropic virus. We aimed to evaluate the association of HZ infection, protective effects of antiviral treatment or vaccination on dementia. A systematic search of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane CENTRAL was performed from January 1, 1996, to October 31, 2024. Observational studies evaluating HZ infection, antivirals, or vaccination and dementia risk were selected. Risk of bias was examined with the Newcastle-Ottawa scale. A random-effects meta-analysis was performed, with the rate ratio (RR) and corresponding 95% confidence intervals (CIs) being pooled for dementia. Presence of heterogeneity was assessed with I2, and differences by study-level characteristics were estimated using subgroup meta-analysis and meta-regression. Eighteen studies (N = 9.4 million) were included. Infection was associated with elevated risk of dementia (RR 1.14; 95% CI: 1.04, 1.25, I2 = 98%); this remained significant in the sensitivity analysis when the two case-control studies were removed (RR 1.17; 95% CI: 1.06, 1.30, I2 = 98%). Subgroup analysis based on sex, age, study population, bias scores, type of dementia or HZO did not show statistically significant differences in risk. Treatment with antivirals showed a small effect (RR 0.84; 95% CI: 0.71, 0.99, I2 = 73%), but prophylaxis with HZ vaccination was associated with a significantly lower risk (RR 0.68; 95% CI: 0.56, 0.83, I2 = 99%). We report a slightly raised dementia risk after HZ infection and reduced risks after antiviral treatment and prevention with vaccination. However, results should be interpreted with caution due to significant heterogeneity in pooled analyses.https://www.tandfonline.com/doi/10.1080/21645515.2025.2546741Cognitive disordersdementiavaricella zoster virus infectionchickenpoxherpes zostershingles |
| spellingShingle | Fawziah Marra Kyle Gomes Emily Liu Nirma Khatri Vadlamudi Kathryn Richardson Jacquelyn J. Cragg Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysis Human Vaccines & Immunotherapeutics Cognitive disorders dementia varicella zoster virus infection chickenpox herpes zoster shingles |
| title | Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysis |
| title_full | Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysis |
| title_fullStr | Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysis |
| title_full_unstemmed | Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysis |
| title_short | Effects of herpes zoster infection, antivirals and vaccination on risk of developing dementia: A systematic review and meta-analysis |
| title_sort | effects of herpes zoster infection antivirals and vaccination on risk of developing dementia a systematic review and meta analysis |
| topic | Cognitive disorders dementia varicella zoster virus infection chickenpox herpes zoster shingles |
| url | https://www.tandfonline.com/doi/10.1080/21645515.2025.2546741 |
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