ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Global Burden of Varicella and Herpes Zoster Across 204 Countries, 1990 – 2021: A Temporal Trend Analysis in the Era of the COVID-19 Pandemic and Projections to 2036
Provisionally accepted
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Objective: To assess the temporal trends and regional disparities of the disease burden of varicella and herpes zoster across 204 countries from 1990 to 2021, analyze the impact of the COVID-19 pandemic era, and project sex-specific incidence trends to 2036. Methods: Utilizing data from the Global Burden of Disease (GBD) 2021 study, we analyzed the incidence, mortality, and disability-adjusted life years (DALYs) of varicella and herpes zoster.Joinpoint regression analysis identified significant shifts in temporal trends, treating 2019 as a key inflection point to observe the pandemic's impact. A Bayesian Age-Period-Cohort (BAPC) model was used to project future incidence trends. Analyses were stratified by region, sex, age, and Socio-demographic Index (SDI), and frontier analysis was applied to evaluate the efficiency of health burden management. Results: From 1990 – 2021, global varicella and herpes zoster cases increased by 19.0% (72.8 to 86.7 million), while age-standardized incidence rates (ASIR) remained stable. Mortality and DALYs declined significantly, with age-standardized mortality rates (ASMR) and DALYs rates (ASDR) decreasing by 50.0% and 36.3%, respectively. A stark disparity remains, with low-SDI regions accounting for over 67% of deaths and DALYs.High-SDI regions, conversely, exhibited a resurgence in varicella and herpes zoster (ASIR: 1,300/100,000) driven by aging populations. The burden followed a U-shaped curve by age, with children <5 years having the highest incidence and adults ≥45 years facing elevated mortality. BAPC modeling projected gradual declines in ASIR for both sexes by 2036. Conclusion: The dual burdens of varicella and herpes zoster in low-SDI regions and aging-driven herpes zoster resurgence in high-SDI areas necessitate targeted strategies. These include prioritizing pediatric varicella immunization and equitable vaccine distribution in developing nations while enhancing adult herpes zoster booster programs and surveillance in developed ones to meet WHO 2030 targets.
Keywords: Varicella and herpes zoster, Global burden of disease, sociodemographic index, Vaccination, Regional disparities, Joinpoint regression, Post-COVID-19
Received: 26 Jun 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Wu, Zhang, Wei, Huang, Xu, Wu and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Meirong Jiang, 820634534@qq.com
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