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Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study

European Journal of Clinical Microbiology & Infectious Diseases volume 33, pages 1653–1659 (2014)Cite this article

An Erratum to this article was published on 01 May 2014

Abstract

Chronic fatigue syndrome (CFS) is a complex disorder accompanied by unexplainable persistent fatigue, in which several etiological factors exist, such as viral infections. Using the National Health Insurance Research Database (NHIRD) of Taiwan, this study evaluated the association between herpes zoster (HZ) infection and the risk of CFS, and examined the possibility of patients developing postviral fatigue effects, including the possibility of developing other unexplainable chronic fatigue conditions. In this prospective cohort study using the NHIRD, we identified 9,205 patients with HZ infection [ICD-9 (International Classification of Disease, Ninth Revision), code 053] and 36,820 patients without HZ infection (non-HZ) from 2005 to 2007, and followed up to the end of 2010. The incidence rate of CFS was higher in the HZ cohort than in the non-HZ cohort (4.56 vs. 3.44 per 1,000 person-years), with an adjusted hazard ratio of 1.29 [95 % confidence interval (CI) = 1.09–1.53]. It was shown that the risk of CFS without comorbidity for each patient increased from 1.25- to 1.36-fold between the CFS and non-CFS cohorts; with long-term follow-up, the HZ cohort showed a significantly higher cumulative incidence rate of developing CFS than the non-HZ patients. We propose that patients with chronic fatigue might exist in a subset of patients that would be associated with HZ infection. The actual mechanism of development of CFS that is attributed to HZ infection remains unclear. The findings of this population cohort study provide pivotal evidence of postviral fatigue among patients with HZ infection.

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Acknowledgments

This work was supported by the study projects DMR-102-023 and DMR-103-020 in our hospital; Taiwan Ministry of Health and Welfare Clinical Trial and Research Center for Excellence (DOH102-TD-B-111-004); Taiwan Ministry of Health and Welfare Cancer Research Center for Excellence (MOHW103-TD-B-111-03); and International Research-Intensive Centers of Excellence in Taiwan (I-RiCE) (NSC101-2911-I-002-303). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Conflict of interest

The authors individually or collectively have no significant conflicts of interest or financial disclosures.

Author contributions

Conception/design: Shin-Yi Tsai, Tse-Yen Yang, and Chia-Hung Kao.

Provision of study material or patient identification/selection: Shin-Yi Tsai, Chih-Sheng Chen, Chua-Nan Kuo, and Hsuan-Ju Chen.

Collection and/or assembly of data: Chih-Sheng Chen, Chia-Hung Kao, and Hsuan-Ju Chen.

Data analysis and interpretation: Wei-Chih Shen, Shin-Yi Tsai, Chih-Sheng Chen, Chia-Hung Kao, and Wei-Ming Lin.

Manuscript writing: all authors.

Final approval of manuscript: all authors.

Author information

Authors and Affiliations

  1. Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan

    S.-Y. Tsai

  2. Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    S.-Y. Tsai

  3. Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Taiwan

    T.-Y. Yang

  4. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    H.-J. Chen

  5. Department of Public Health, China Medical University, Taichung, Taiwan

    H.-J. Chen

  6. Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung, Taiwan

    C.-S. Chen

  7. Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    W.-M. Lin

  8. Chang Gung University, Tao Yuan, Taiwan

    W.-M. Lin

  9. Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan

    W.-C. Shen

  10. Kau-Tang Traditional Medical Hospital, Taichung, Taiwan

    C.-N. Kuo

  11. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    C.-H. Kao

  12. Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan

    C.-H. Kao

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  1. S.-Y. Tsai
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  2. T.-Y. Yang
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  3. H.-J. Chen
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  4. C.-S. Chen
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  5. W.-M. Lin
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  6. W.-C. Shen
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  7. C.-N. Kuo
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  8. C.-H. Kao
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Corresponding author

Correspondence to C.-H. Kao.

Additional information

S.-Y. Tsai and T.-Y. Yang contributed equally to this work.

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Tsai, SY., Yang, TY., Chen, HJ. et al. Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study. Eur J Clin Microbiol Infect Dis 33, 1653–1659 (2014). https://doi.org/10.1007/s10096-014-2095-x

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  • DOI: https://doi.org/10.1007/s10096-014-2095-x

Keywords

  • Chronic Fatigue Syndrome
  • Herpes Zoster
  • Varicella Zoster Virus
  • Antiviral Treatment
  • Chronic Fatigue Syndrome Patient