Hospitalization burden related to herpes zoster among adults with kidney transplants in Spain (2010 –2021)

Hospitalization burden related to herpes zoster among adults with kidney transplants in Spain (2010 –2021) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hospitalization burden related to herpes zoster among adults with kidney transplants in Spain (2010 –2021) R Olivenza-Antón, Rodríguez-Caravaca Gil, Cárdenas-Soriano Pilar, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8822816/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background There is a consensus on herpes zoster (HZ) vaccination in at-risk groups of all ages, including solid organ transplant (SOT)-pretransplant and posttransplant groups. The aim of this study was to analyse the burden of hospitalization and its complications due to HZ in patients who had previously undergone kidney transplantation in Spain. Methods We conducted a nationwide retrospective descriptive observational study. The Spanish National Hospital Data Information System (CMBD) was used to collect all cases of hospital admissions for kidney transplant patients with a diagnosis related to HZ during the period 2010–2021 in Spain. The annual hospitalization rate, mortality rate and case fatality rate were calculated. Results A total of 818 cases of HZ were reported among kidney transplant patients, of which 59% were men and 55% were complicated with HZ. The hospitalization rate was 0.15 hospitalizations per 100,000 inhabitants (CI: 95% 0,14–0,16). This rate increased with age, reaching a maximum in the population aged 60–69 years (0.45 per 100,000 inhabitants). The total case fatality rate was 2,81% (CI: 95% 1,84 − 4,12). Conclusions It is necessary to maintain the epidemiological surveillance of herpes zoster infection in patients who receive renal transplants to determine the hospitalization burden and comorbidities, track their evolution, and evaluate preventive measures whose effectiveness should be assessed. Herpes zoster renal transplant CMBD Hospital burden Health system Epidemiological study Spain Figures Figure 1 Figure 2 Introduction Herpes zoster (HZ) results from the reactivation of latent varicella zoster virus (VZV). After primary infection, the virus establishes lifelong latency in the dorsal root neural ganglia ( 1 , 2 ). Viral reactivation occurs when the immune system is suppressed. An increased incidence of HZ is observed in elderly patients; patients with malignancy, HIV infection, or immunodeficiency; in patients who use immunosuppressive medication and especially in those who have undergone solid organ transplantation (SOT)( 3 – 7 ). At the European level, the annual incidence of HZ in the general population is between 2 and 4.6 per 1000 people per year ( 7 ). In Spain, a hospitalization rate for HZ of 17.74 per 100,000 in the general population between 2016–2019 was recently described. This ratio increases significantly with age, peaking in the population aged ≥ 80 years ( 8 ). Although the mortality rate for HZ is low, the burden of disease associated with HZ and other complications for these patients and the health care system is significant, and the trend is increasing ( 9 ). There are populations that are more susceptible to developing HZ, such as those with impaired cellular immunity or underlying malignancy. These susceptible populations may also have an increased risk of neuralgia and other complications of HZ ( 2 , 5 ). Specifically, solid organ transplant (SOT) patients belong to this population group. The immunosuppression treatment they undergo posttransplantation to avoid possible organ rejection puts them in this risk group ( 5 – 7 ). Three main factors are associated with the development of HZ in solid organ transplant recipients: type of organ transplant, age ≥ 50 years at transplantation, induction therapy and antiviral drug exposure other than prolonged cytomegalovirus (CMV) prophylaxis during the posttransplant course ( 10 – 13 ). In Spain, 5861 SOTs were performed in 2023 (3688 kidney, 1262 liver and 479 lung). The number of kidney transplants (KT) has increased by 8%, and living kidney donation has largely contributed to this increase. Interestingly, the waiting list for kidney transplantation is by far the highest (3977 KT followed by 332 for liver transplantation) ( 14 ). People with SOT require permanent immunosuppressive treatment to prevent possible rejection, resulting in a decrease in humoral and cellular immunity, which increases the risk of infection ( 15 ). SOT recipients have an increased risk of developing HZ compared with those in the general population ( 10 – 13 ). Compared with that of healthy individuals, the incidence of HZ after kidney transplantation remains significantly greater ( 12 ). In 2018, the Interterritorial Council of the National Health System (CISNS) agreed on HZ vaccination in at-risk groups of all ages, including solid organ transplant (SOT)-pretransplant and posttransplant groups ( 16 ). The aim of this study was to analyse the burden of hospitalization and its complications due to HZ between 2010 and 2021 in patients who had previously undergone kidney transplantation in Spain. Methods Study Design In this nationwide retrospective descriptive cohort study, we analysed hospital admissions in KT patients with a diagnosis of HZ between 2010 and 2021 in Spain. Data were obtained from the Spanish National Hospital Data Information System (Minimum Basic Data Set; MBDS) of the Spanish Ministry of Health, an administrative database of hospitalizations that has been described previously by Corcuera-Munguia M ( 8 ). Briefly, the MBDS includes hospitalizations from public hospitals covering the majority of the Spanish population, and is routinely validated by the Spanish Ministry of Health. Diagnosis was coded according to the Spanish adaptations of the International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM), before 2016and the International Classification of Disease, 10th revision, Clinical Modification (ICD-10-CM), from 2016 onwards. All hospital discharges of KT patients with HZ recorded in any diagnostic position (primary or secondary) were included. For each hospitalization, demographic variables (age, sex), length of stay, and in-hospital outcome were extracted. HZ cases were categorized as uncomplicated or complicated according to ICD-9-CM and ICD-10-CM codes. Uncomplicated HZ was defined by codes 053.9 (ICD-9-CM) and B02 (ICD-10-CM), whereas all the remaining specific HZ codes were considered complicated. Complicated HZ included neurological involvement (encephalitis, meningitis or other nervous system complications), ophthalmic involvement, disseminated disease and other unspecified complications (Supplementary Table 1). All analysis were stratified by sex and age group and were performed separately for uncomplicated and complicated HZ hospitalizations. Statistical Analysis The primary outcomes were: total hospitalization rates, in-hospital mortality, case fatality rates, length of stay and hospitalization costs among KT recipients with HZ. Hospitalization rates were expressed per 100.000 inhabitants using national population as denominators. The mortality rate was defined as the number of deaths at hospital per 100,000 population and the fatality rate, was considered as the proportion of in-hospital deaths among total HZ-related admissions. The average length of stay (ALOS) was calculated as the total length of hospital days divided by the total number of hospitalizations. r.. Finally, the total and average costs per hospitalization for HZ was estimated as the total annual cost divided by the total number of hospitalizations per year, in euros. These measures were calculated for the overall study period (2010–2021) and annually when appropriate. All analyses were performed by sex and age and were performed separately for complicated and uncomplicated HZ cases. Age groups were defined according to Spanish HZ vaccination recommendations as follows: ≤50, 50–59, 60–69 and ≥ 70 years. Poisson regression model was used to compare hospitalization rates. Logistic regression was applied to analyse case fatality rates. Differences in the mean length of hospital stay was assessed using ANOVA. Statistical analysis was performed using The Statistical Package for Social Sciences (SPSS/PASW, version 27), and a p value < 0.05 was considered statistically significant. All data were analysed in anonymized form, and no information allowing patient identification was available to the investigators. The study was performed in accordance with the Helsinki Declaration (1964 and subsequent amendments). In line with national regulations governing research based on secondary anonymized administrative data, The Rey Juan Carlos University Ethics Committee determined that formal ethical approval and patient informed consent were not required. Results A total of 818 cases of HZ were reported among kidney transplant patients during the period 2010–2021, of which 86% were patients > 50 years old and 34% were individuals ≥70 years old. Fifty-nine percent of the cases were men, and 55% were related to complicated HZ in kidney transplantation patients (Table 2). The hospitalization rate for kidney transplant patients during the study period was 0,15 hospitalizations per 100,000 inhabitants (CI 95% 0,14–0,16). This rate increased with age, reaching a maximum in the population aged 60–69 years (0,45 per 100,000 inhabitants). Higher rates were also observed among men in both uncomplicated and complicated HZ. This can be found in all age groups except for the total group, which becomes significant when age-adjusted rates are compared (Table 2). During the study period, despite the low hospitalization rates, we observed an increase over time for both complicated and uncomplicated HZ (Fig. 1) (p value <0,05). An increase in hospitalization rates by age group was also observed, especially among kidney transplant recipients older than 60 years. In particular, from 2015 onwards, an increase in hospitalization rates was observed among kidney transplant patients in the 70+ age group (Fig. 2). The total mortality rates were 0,01 and 0,02 per 100,000 inhabitants (95% CI) in patients aged 60–69 and above 70, respectively. There were 23 in-hospital deaths among kidney transplant patients due to HZ, 52% of which were related to complicated HZ. More deaths were observed among individuals ≥ 70 years of age and among men than among women for all age groups (Table 2). The total case fatality rate was 2,81% (CI 95% 1.84–4.12). Compared with females, males in all age groups had a higher case fatality rate. Kidney transplant patients who were hospitalized with uncomplicated HZ aged ≥ 70 years and complicated HZ aged ≥ 60 years had higher case fatality rates. There were no overall differences in hospitalization, mortality or case fatality rates for complicated or uncomplicated HZ among the KT patients (Table 2). The total average length of hospital stay was 7 days (Table 2). Hospitalizations for HZ among KT patients were estimated to generate a total cost of €4,227,463 and an annual expenditure of €352,289 for the health care system. The mean cost per patient was €5,168 (Table 3). Discussion The main objective of this study was to describe and analyse the burden of hospitalizations related to HZ in Spain between 2010 and 2021 among kidney transplant patients. When the total number of hospitalizations among kidney transplant recipients per 100,000 individuals in the general population is calculated, the resulting values may appear disproportionately low, as we identified 818 hospitalizations related to HZ infection among kidney transplant patients during this period, and the hospitalization rate for HZ was 0,15 hospitalizations among KT recipients (per 100,000 population). However, this study is in line with other previously published single-centre retrospective cohort studies on the overall incidence rate of HZ among KT patients. Rodriguez-Moreno et al. performed 812 adult kidney transplants between 1995 and 2004 in a single centre in Madrid, Spain. Only 7 patients required hospital admission, ( 17 ). Similar results were reported by Fernadez Ruiz; in another single-centre study, which was also based in Madrid, the incidence rate of HZ, which involved monitoring 444 patients who underwent kidney transplantation between 2008 and 2013, was 0,057 episodes per 1000 renal transplant days. A total of 35 episodes of posttransplant HZ, of which only 8 were hospitalized ( 18 ); Gourishankar and colleagues, performed a retrospective analysis at the University of Alberta Hospital, Edmonton, Canada. They reported 434 kidney transplants between 1994 and 1999; 32 cases of HZ developed, but only 1 patient needed hospitalization ( 4 ). A single cohort study centre in Athens, Greece, carried out by Pavlopoulou and colleagues, reviewed 450 patients who underwent kidney transplants between 2004–2008, and only 29 patients (6,4%) developed HZ, only 3 of whom required hospitalization ( 19 ); in Seoul, South Korea, Kwon et al., who followed 2300 kidney transplant patients between January 2001 and December 2019, a total of 222 cases of HZ were observed, from which only 10 had serious complications ( 20 ). In a recent Danish study from Nishida et al. (2024), the global incidence of HZ infection in kidney transplant recipients was 12,6% (13/103 patients) and no cases required hospitalization ( 21 ). A more informative approach might be to analyse the total hospitalization ratio specifically within the cohort of kidney transplant recipients. This method provides a clearer estimate of the proportion of transplant patients who experience hospital admissions related to HZ. Age has been identified as one of the main important risk factors for HZ, with 86% of the hospitalizations reported in kidney transplant patients older than 50 years and 34,4% of them reported in kidney transplant patients over the age of 70 years according to similar studies ( 9 , 11 , 17 , 20 , 22 , 23 ). It should be noted that there is no age limit for receiving an organ transplant according to the OPTN (Organ Procurement & Transplantation Network). In 2023, approximately 64% of all people receiving an organ transplant were aged 50 years or older ( 24 ). As mentioned previously, there is an increased risk of suffering from HZ in ageing people because of a decline in specific cell-mediated immunity, which appears to be the cause of HZ development as a result of VZV reactivation ( 8 – 10 , 19 ). Another important risk factor is the immunosuppressive regimen used in SOT, which alters the immune response ( 10 – 13 , 18 ). Since 2015, we have observed an increase in hospitalization rates among kidney transplant patients in the 70 + age group, which can be attributed to both increased life expectancy and the absence of an age limit for kidney organ transplantation and immunosuppressive therapy. We found that hospitalization in kidney transplant patients was slightly greater in men (59,2%), with particularly marked differences in older adults (≥ 70 years). In the meta-analysis conducted by Kwon et al., which included 5435 kidney transplant recipients from 6 different studies, sex was not found to be a risk factor for HZ ( 20 ). In Spain, a previous study carried out by Corcuera-Munguia et al. revealed that 52% of the general female population was hospitalized with HZ between 2016 and 2019 ( 8 ). In another Spanish study specifically in the Greater Madrid area, which focused on primary care and was performed by Esteban-Vasallo and colleagues, higher hospitalization rates were observed in men 60 years of age and older than in those younger than 15 years ( 22 ). An increase in hospitalization rates with age was observed, as mentioned above, but no differences were found between complicated and uncomplicated hospitalization rates in kidney transplant patients. The estimated cost to the health care system was 352.289€ per year, with an average length of stay of 7 days, which would be higher if indirect costs were also taken into account. The total case fatality rate for HZ was 2,81%, almost half that of the general population ( 8 , 9 ), in patients who had undergone kidney transplantation. The mortality rate due to HZ in kidney transplant individuals ≥ 60 years was 0.01/0.02. Other studies have shown higher mortality rates but not for specific kidney transplant populations ( 8 , 9 , 30 ). It is important to acknowledge that there are several limitations up to this point. MBDS is a powerful and robust way to study the epidemiology of a disease because it provides a large representative sample size that gives the study great statistical strength. However, this study has several limitations because of its nature. First, we considered hospitalizations related to HZ in kidney posttransplant patients, and we could not know whether these kidney transplant patients were hospitalized due to HZ itself or developed HZ during their hospital stay. Most cases of HZ in transplant patients are managed as outpatients, but hospitalization is prompted by the clinical severity of HZ, not by unrelated hospital admissions ( 19 , 20 , 26 ). Second, the MBDS cannot provide information on when hospitalization occurred. The median time to onset of HZ in SOT patients is approximately 16–18 months after transplantation, with most cases occurring within the first 1–4 years ( 11 , 12 , 27 , 28 ). The risk persists over time, but the majority of subjects develop zoster specifically in the first year after SOT ( 6 , 11 , 12 , 19 , 28 ). KT recipients with microbiological or serological confirmation of prior VZV infection remain at significant risk for HZ after transplantation because of immunosuppression. While pretransplant VZV immunity reduces the risk of primary varicella, it does not eliminate the risk of HZ reactivation ( 12 , 20 , 29 ). Third, the MBDS does not include useful data on disease severity or microbiological confirmation (VZV seronegative) before transplantation. Notably, in clinical practice, routine antiviral prophylaxis (valganciclovir, ganciclovir, valacyclovir, or acyclovir) is the standard for preventing CMV disease in SOT recipients and reduces the incidence of HZ ( 18 , 31 – 33 ). Furthermore, some studies suggest that the delayed mean time of onset is the result of prolonged exposure to antiviral therapy; however, once prophylaxis ends, the risk of HZ increases, leading to a delayed but not eliminated incidence of HZ ( 27 , 34 ). On the other hand, immunosuppressive therapy is the cornerstone of both the prophylaxis and treatment of kidney transplant rejection. It is used to prevent the immune system from attacking the transplanted kidney, thereby reducing the risk of acute and chronic rejection ( 35 – 38 ). Unfortunately, the MBDS does not allow us to know which specific immunosuppressive treatment was used in these KT patients. Finally, we could not analyse renal function after kidney transplantation because of limitations of the MBDS itself. Patients with end-stage renal disease (ESKD) exhibit premature ageing of the T-cell system ( 39 ), and the incidence of HZ is higher in patients with chronic renal failure ( 40 – 43 ). The greatest strength of our study is that the nationwide data were collected over 11 years. In Spain, in 2018, the Interterritorial Council of the National Health System (CISNS) already recommended and prioritized vaccination against HZ in SOT recipients over 18 years of age, estimating an incidence rate of HZ infection of 27–55 cases/1000 person-years for this specific population. In May 2020, it was agreed to start vaccinating these SOT patients ( 16 ). The HZ subunit vaccine (HZ/Su) was recommended because it significantly reduces the incidence of HZ and the incidence of postherpetic neuralgia in immunocompromised patients, and compared with zoster live vaccines (ZLV), its efficacy is not age dependent ( 16 , 25 , 44 ). On the other hand, ZLV is a live HZ vaccine, which is contraindicated in immunocompromised populations because it can cause disseminated viral infection and death ( 16 ). Conclusions In this study, we estimated the burden of hospitalization for HZ after kidney transplantation in Spain from 2010–2021. Despite the low rates of hospitalization for HZ among kidney transplant patients, hospitalization increases with age, particularly in men and in both complicated and uncomplicated HZ. These hospitalizations in kidney transplant patients continue to represent a high cost, estimated at 352,289 euros per year for The National Health System (not including indirect costs). The Spanish National Recommendation for Herpes Zoster Vaccination in patients with SOT will reduce the overall incidence of HZ among transplanted patients and therefore hospitalizations. Abbreviations ANOVA Analysis of Variance CISNS Interterritorial Council of the National Health System CMV Cytomegalovirus CMBD Conjunto Mínimo Básico de Datos ESKD End-Stage Renal Disease HZ Herpes Zoster HZ/Su vaccine Herpes Zoster Subunit Vaccine ICD International Classification of Disease KT Kidney Transplant OPTN Organ Procurement & Transplantation Network SOT Solid Organ Transplant SPSS Statistical Package for the Social Sciences VZV varicella zoster virus ZLV Zoster Live Vaccines. Declarations Ethics approval and consent to participate This study was conducted using fully anonymized and de-identified administrative hospital discharge data from a national secondary database. No identifiable personal data or biological samples were accessed. In accordance with national regulations and the principles of the Declaration of Helsinki (1964 and subsequent amendments), the Rey Juan Carlos University Ethics Committee determined that no formal ethics approval was required for this study. Informed consent from individual participants was not required due to the retrospective design and the use of anonymized data. This study does not constitute a clinical trial; therefore, trial registration is not applicable. Consent for publication Not applicable Availability of data and materials The datasets analysed during the current study were obtained from the Spanish CMBD and are not publicly available due to confidentiality agreements. Data may be available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Contribution of the authors Raquel Olivenza Antón: Conception and design of the study, analysis and interpretation of data, drafting of the article, critical revision of the article, and final approval of the version submitted. Gil Rodríguez Caravaca: Conception and design of the study, acquisition of data, interpretation of data, drafting of the article, critical revision of the article, and final approval of the version submitted. Pilar Cárdenas-Soriano: Acquisition of data, analysis and interpretation of data, critical revision of the article, and final approval of the version submitted. Valentín Hernández-Barrera: Conception and design of the study, analysis and interpretation of data, and final approval of the version submitted. Ángel Gil de Miguel: Conception and design of the study, analysis and interpretation of data, critical revision of the article, and final approval of the version submitted. Acknowledgements The authors thank the Spanish Ministry of Health for providing access to the CMBD database. References Zerboni L, Sen N, Oliver SL, Arvin AM. Molecular mechanisms of varicella zoster virus pathogenesis. Nat Rev Microbiol. 2014;12(3):197-210. Blumberg EA, Molavi A. Herpes zoster. 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Quantification of risk factors for herpes zoster: population-based case-control study. BMJ 2014; 348: g2911 Wu MY, Hsu YH, Su CL, Lin YF, Lin HW. Risk of herpes zoster in CKD: a matched-cohort study based on administrative data. Am J Kidney Dis. 2012;60(4):548-52. Vink P, Torrell JMR, Fructuoso ASS, Kim SJ, Kim S il, Zaltzman J, et al. Immunogenicity and Safety of the Adjuvanted Recombinant Zoster Vaccine in Chronically Immunosuppressed Adults Following Renal Transplant: A Phase 3, Randomized Clinical Trial. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2019; 70:181-90. Kumar D, Jorga A, Yun H, Williams C. #2434 Literature review on the burden of herpes zoster in patients with kidney disease—a need for earlier prevention. Nephrology Dialysis Transplantation, Volume 39, Issue Supplement_1, May 2024, gfae069–0524–2434. Prevencion/vacunaciones/programasDeVacunacion/riesgo/docs/tabla_13,14, 15.pdf. Available at: https://www.sanidad.gob.es/areas/promocionPrevencion/vacunaciones/programasDeVacunacion/riesgo/docs/tabla_13,14,15.pdf Tables Table 2. Hospitalization rate, mortality rate and case fatality rate due to herpes zoster: total and by age group, sex and presence of complications Age group (years) Patients (N) Hospitalization rate (cases*100,000/95% CI) Mortality rate (cases*100,000/95% CI) Male Female Total Male Female Total Male Female Total Total ≤ 50 81 37 118 0,05 (0,04-0,06) 0,02 (0,01-0,03) 0,03 (0,02-0,04) 0 (0-0) 0 (0-0) 0 (0-0) 50-59 79 73 152 0,2 (0,16-0,24) 0,19 (0,15-0,23) 0,2 (0,17-0,23) 0 (0-0) 0 (0-0) 0 (0-0) 60-69 149 118 267 0,52 (0,44-0,6) 0,38 (0,31-0,45) 0,45 (0,4-0,5) 0,02 (0-0,04) 0,01 (0-0,02) 0,01 (0-0,02) ≥ 70 175 106 281 0,55 (0,47-0,63) 0,24 (0,19-0,29) 0,37 (0,33-0,41) 0,03 (0,01-0,05) 0,01 (0-0,02) 0,02 (0,01-0,03) Total 484 334 818 0,18 (0,16-0,2) 0,12 (0,11-0,13) 0,15 (0,14-0,16) 0,01 (0,01-0,01) 0 (0-0) 0 (0-0) Uncomplicated ≤ 50 48 15 63 0,03 (0,02-0,04) 0,01 (0,01-0,01) 0,02 (0,02-0,02) 0 (0-0) 0 (0-0) 0 (0-0) 50-59 46 33 79 0,12 (0,09-0,15) 0,08 (0,05-0,11) 0,1 (0,08-0,12) 0 (0-0) 0 (0-0) 0 (0-0) 60-69 81 56 137 0,28 (0,22-0,34) 0,18 (0,13-0,23) 0,23 (0,19-0,27) 0,01 (0-0,02) 0 (0-0) 0,01 (0-0,02) ≥ 70 65 55 120 0,21 (0,16-0,26) 0,12 (0,09-0,15) 0,16 (0,13-0,19) 0,02 (0-0,04) 0,01 (0-0,02) 0,01 (0-0,02) Total 240 159 399 0,09 (0,08-0,1) 0,06 (0,05-0,07) 0,07 (0,06-0,08) 0 (0-0) 0 (0-0) 0 (0-0) Complicated ≤ 50 33 22 55 0,02 (0,01-0,03) 0,01 (0,01-0,01) 0,02 (0,02-0,02) 0 (0-0) 0 (0-0) 0 (0-0) 50-59 33 40 73 0,09 (0,06-0,12) 0,1 (0,07-0,13) 0,09 (0,07-0,11) 0 (0-0) 0 (0-0) 0 (0-0) 60-69 68 62 130 0,24 (0,18-0,3) 0,2 (0,15-0,25) 0,22 (0,18-0,26) 0,01 (0-0,02) 0 (0-0) 0,01 (0-0,02) ≥ 70 110 51 161 0,35 (0,28-0,42) 0,11 (0,08-0,14) 0,21 (0,18-0,24) 0,01 (0-0,02) 0 (0-0) 0,01 (0-0,02) Total 244 175 419 0,09 (0,08-0,1) 0,06 (0,05-0,07) 0,07 (0,06-0,08) 0 (0-0) 0 (0-0) 0 (0-0) Age group (years) Deaths (N) Case fatality rate (%/95% CI) Median length (days/IQR) Male Female Total Male Female Total Male Female Total Total ≤ 50 1 0 1 1,23 (0,13-5,62) 0 (0-0) 0,85 (0,09-3,89) 6 (4-8) 7 (4-9) 6 (4-9) 50-59 1 0 1 1,27 (0,14-5,76) 0 (0-0) 0,66 (0,07-3,03) 7 (4-11) 8 (4-12) 7 (4-12) 60-69 5 2 7 3,36 (1,29-7,2) 1,69 (0,35-5,33) 2,62 (1,18-5,08) 8 (5-13) 7 (4-11) 7 (4-12) ≥ 70 9 5 14 5,14 (1,87-8,41) 4,72 (0,68-8,76) 4,98 (2,44-7,52) 8 (5-14) 7 (5-13) 8 (5-14) Total 16 7 23 3,31 (1,98-5,19) 2,1 (0,94-4,07) 2,81 (1,84-4,12) 7 (4-12) 7 (4-12) 7 (4-12) Uncomplicated ≤ 50 0 0 0 0 (0-0) 0 (0-0) 0 (0-0) 6 (3-8) 6 (3-7) 6 (3-8) 50-59 0 0 0 0 (0-0) 0 (0-0) 0 (0-0) 6 (4-9) 8 (4-11) 6 (4-11) 60-69 2 1 3 2,47 (0,52-7,68) 1,79 (0,19-8,04) 2,19 (0,62-5,73) 6 (4-9) 6 (4-12) 6 (4-10) ≥ 70 5 3 8 7,69 (1,21-14,17) 5,45 (-0,55-11,45) 6,67 (2,21-11,13) 7 (4-11) 7 (4-13) 7 (4-13) Total 7 4 11 2,92 (1,31-5,64) 2,52 (0,85-5,87) 2,76 (1,47-4,72) 6 (4-9,5) 7 (4-12) 6 (4-11) Complicated ≤ 50 1 0 1 3,03 (0,33-13,3) 0 (0-0) 1,82 (0,2-8,18) 7 (5-10) 7,5 (5-13) 7 (5-10) 50-59 1 0 1 3,03 (0,33-13,3) 0 (0-0) 1,37 (0,15-6,22) 7 (5-14) 8 (5-15,5) 8 (5-14) 60-69 3 1 4 4,41 (1,26-11,31) 1,61 (0,17-7,29) 3,08 (1,05-7,15) 10 (5,5-15) 7 (3-11) 8 (5-13) ≥ 70 4 2 6 3,64 (0,14-7,14) 3,92 (-1,41-9,25) 3,73 (0,8-6,66) 9 (5-15) 7 (5-14) 8 (5-14) Total 9 3 12 3,69 (1,84-6,62) 1,71 (0,49-4,5) 2,86 (1,57-4,8) 8 (5-14) 7 (5-12) 8 (5-14) Table 3. Total and average cost in kidney transplant patients per Herpes Zoster total hospitalization Total and average cost in kidney transplant patients per Herpes Zoster total hospitalization Average Cost (€) Total Cost (2010-2021) (€) Total Annual Cost (€) Total 5.168 4.227.463 352.289 Uncomplicated 4.967 1.981.684 165.140 Complicated 5.360 2.245.778 187.148 Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 04 May, 2026 Reviews received at journal 28 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviews received at journal 31 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers invited by journal 03 Mar, 2026 Editor invited by journal 03 Mar, 2026 Editor assigned by journal 03 Mar, 2026 Submission checks completed at journal 02 Mar, 2026 First submitted to journal 02 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8822816","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":601412384,"identity":"ff29d63a-fb63-4907-b5c2-aaea283d740c","order_by":0,"name":"R Olivenza-Antón","email":"data:image/png;base64,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","orcid":"","institution":"King Juan Carlos University","correspondingAuthor":true,"prefix":"","firstName":"R","middleName":"","lastName":"Olivenza-Antón","suffix":""},{"id":601412385,"identity":"9f6bf0fe-947b-4595-9fed-6f39d9e7ae8f","order_by":1,"name":"Rodríguez-Caravaca Gil","email":"","orcid":"","institution":"Hospital Universitario Fundación Alcorcón","correspondingAuthor":false,"prefix":"","firstName":"Rodríguez-Caravaca","middleName":"","lastName":"Gil","suffix":""},{"id":601412386,"identity":"c664ecf7-e673-4f6b-95c1-7fa923326356","order_by":2,"name":"Cárdenas-Soriano Pilar","email":"","orcid":"","institution":"Hospital Universitario Fundación Alcorcón","correspondingAuthor":false,"prefix":"","firstName":"Cárdenas-Soriano","middleName":"","lastName":"Pilar","suffix":""},{"id":601412387,"identity":"749e478e-f608-48ee-baa9-22a2e2cc6add","order_by":3,"name":"V Hernández-Barrera","email":"","orcid":"","institution":"King Juan Carlos University","correspondingAuthor":false,"prefix":"","firstName":"V","middleName":"","lastName":"Hernández-Barrera","suffix":""},{"id":601412388,"identity":"f7eb69b5-7956-4aa6-90ba-742b412ca24e","order_by":4,"name":"A Gil-de-Miguel","email":"","orcid":"","institution":"King Juan Carlos University","correspondingAuthor":false,"prefix":"","firstName":"A","middleName":"","lastName":"Gil-de-Miguel","suffix":""}],"badges":[],"createdAt":"2026-02-08 15:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8822816/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8822816/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104342729,"identity":"c3878784-a7c1-4840-aabb-b7921dd9d15a","added_by":"auto","created_at":"2026-03-10 17:07:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60085,"visible":true,"origin":"","legend":"\u003cp\u003eHospitalization rate due to herpes zoster among kidney transplant patients in Spain (2010–2021).\u003c/p\u003e\n\u003cp\u003eAnnual hospitalization rates per 100,000 inhabitants for herpes zoster among kidney transplant recipients are shown, overall and stratified by uncomplicated and complicated herpes zoster. Dashed lines represent linear trends over time.\u003c/p\u003e\n\u003cp\u003eAbbreviations: inh; inhabitants.\u003c/p\u003e","description":"","filename":"FIGURE1.png","url":"https://assets-eu.researchsquare.com/files/rs-8822816/v1/df0ece4676ec9f76d35e04f5.png"},{"id":104342728,"identity":"120faecd-14fa-4356-aaaa-71897eaaad54","added_by":"auto","created_at":"2026-03-10 17:07:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":50313,"visible":true,"origin":"","legend":"\u003cp\u003eHospitalization rate due to Herpes Zoster among kidney transplant patients by age group in Spain (2010–2021)\u003c/p\u003e\n\u003cp\u003eBars represent annual hospitalization rates due to herpes zoster among kidney transplant recipients, stratified by age group (\u0026lt;50, 50–59, 60–69 and ≥70 years). Hospitalization rates are expressed as cases per 100,000 inhabitants of the general population.\u003c/p\u003e\n\u003cp\u003eAbbreviations: inh; inhabitants.\u003c/p\u003e","description":"","filename":"FIGURE2.png","url":"https://assets-eu.researchsquare.com/files/rs-8822816/v1/0dc44fff44358b8ad0ec6020.png"},{"id":104405445,"identity":"92e959d4-dc68-4da6-917d-1b7756ee67e4","added_by":"auto","created_at":"2026-03-11 12:22:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1223971,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8822816/v1/b75bbbd6-baa2-4e01-941c-870aa2e0eea0.pdf"},{"id":104342730,"identity":"120a550b-aec5-4544-ae55-805e2fc6646a","added_by":"auto","created_at":"2026-03-10 17:07:43","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23235,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8822816/v1/5bd38694cb80b2205e38baf4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hospitalization burden related to herpes zoster among adults with kidney transplants in Spain (2010 –2021)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHerpes zoster (HZ) results from the reactivation of latent varicella zoster virus (VZV). After primary infection, the virus establishes lifelong latency in the dorsal root neural ganglia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Viral reactivation occurs when the immune system is suppressed. An increased incidence of HZ is observed in elderly patients; patients with malignancy, HIV infection, or immunodeficiency; in patients who use immunosuppressive medication and especially in those who have undergone solid organ transplantation (SOT)(\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAt the European level, the annual incidence of HZ in the general population is between 2 and 4.6 per 1000 people per year (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In Spain, a hospitalization rate for HZ of 17.74 per 100,000 in the general population between 2016\u0026ndash;2019 was recently described. This ratio increases significantly with age, peaking in the population aged\u0026thinsp;\u0026ge;\u0026thinsp;80 years (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Although the mortality rate for HZ is low, the burden of disease associated with HZ and other complications for these patients and the health care system is significant, and the trend is increasing (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are populations that are more susceptible to developing HZ, such as those with impaired cellular immunity or underlying malignancy. These susceptible populations may also have an increased risk of neuralgia and other complications of HZ (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Specifically, solid organ transplant (SOT) patients belong to this population group. The immunosuppression treatment they undergo posttransplantation to avoid possible organ rejection puts them in this risk group (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Three main factors are associated with the development of HZ in solid organ transplant recipients: type of organ transplant, age\u0026thinsp;\u0026ge;\u0026thinsp;50 years at transplantation, induction therapy and antiviral drug exposure other than prolonged cytomegalovirus (CMV) prophylaxis during the posttransplant course (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Spain, 5861 SOTs were performed in 2023 (3688 kidney, 1262 liver and 479 lung). The number of kidney transplants (KT) has increased by 8%, and living kidney donation has largely contributed to this increase. Interestingly, the waiting list for kidney transplantation is by far the highest (3977 KT followed by 332 for liver transplantation) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). People with SOT require permanent immunosuppressive treatment to prevent possible rejection, resulting in a decrease in humoral and cellular immunity, which increases the risk of infection (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). SOT recipients have an increased risk of developing HZ compared with those in the general population (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Compared with that of healthy individuals, the incidence of HZ after kidney transplantation remains significantly greater (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2018, the Interterritorial Council of the National Health System (CISNS) agreed on HZ vaccination in at-risk groups of all ages, including solid organ transplant (SOT)-pretransplant and posttransplant groups (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe aim of this study was to analyse the burden of hospitalization and its complications due to HZ between 2010 and 2021 in patients who had previously undergone kidney transplantation in Spain.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cem\u003eStudy Design\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn this nationwide retrospective descriptive cohort study, we analysed hospital admissions in KT patients with a diagnosis of HZ between 2010 and 2021 in Spain. Data were obtained from the Spanish National Hospital Data Information System (Minimum Basic Data Set; MBDS) of the Spanish Ministry of Health, an administrative database of hospitalizations that has been described previously by Corcuera-Munguia M (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Briefly, the MBDS includes hospitalizations from public hospitals covering the majority of the Spanish population, and is routinely validated by the Spanish Ministry of Health. Diagnosis was coded according to the Spanish adaptations of the International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM), before 2016and the International Classification of Disease, 10th revision, Clinical Modification (ICD-10-CM), from 2016 onwards.\u003c/p\u003e \u003cp\u003eAll hospital discharges of KT patients with HZ recorded in any diagnostic position (primary or secondary) were included. For each hospitalization, demographic variables (age, sex), length of stay, and in-hospital outcome were extracted. HZ cases were categorized as uncomplicated or complicated according to ICD-9-CM and ICD-10-CM codes. Uncomplicated HZ was defined by codes 053.9 (ICD-9-CM) and B02 (ICD-10-CM), whereas all the remaining specific HZ codes were considered complicated.\u003c/p\u003e \u003cp\u003eComplicated HZ included neurological involvement (encephalitis, meningitis or other nervous system complications), ophthalmic involvement, disseminated disease and other unspecified complications (Supplementary Table\u0026nbsp;1). All analysis were stratified by sex and age group and were performed separately for uncomplicated and complicated HZ hospitalizations.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStatistical Analysis\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe primary outcomes were: total hospitalization rates, in-hospital mortality, case fatality rates, length of stay and hospitalization costs among KT recipients with HZ. Hospitalization rates were expressed per 100.000 inhabitants using national population as denominators. The mortality rate was defined as the number of deaths at hospital per 100,000 population and the fatality rate, was considered as the proportion of in-hospital deaths among total HZ-related admissions. The average length of stay (ALOS) was calculated as the total length of hospital days divided by the total number of hospitalizations. r.. Finally, the total and average costs per hospitalization for HZ was estimated as the total annual cost divided by the total number of hospitalizations per year, in euros. These measures were calculated for the overall study period (2010\u0026ndash;2021) and annually when appropriate.\u003c/p\u003e \u003cp\u003eAll analyses were performed by sex and age and were performed separately for complicated and uncomplicated HZ cases. Age groups were defined according to Spanish HZ vaccination recommendations as follows: \u0026le;50, 50\u0026ndash;59, 60\u0026ndash;69 and \u0026ge;\u0026thinsp;70 years. Poisson regression model was used to compare hospitalization rates. Logistic regression was applied to analyse case fatality rates. Differences in the mean length of hospital stay was assessed using ANOVA. Statistical analysis was performed using The Statistical Package for Social Sciences (SPSS/PASW, version 27), and a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eAll data were analysed in anonymized form, and no information allowing patient identification was available to the investigators. The study was performed in accordance with the Helsinki Declaration (1964 and subsequent amendments). In line with national regulations governing research based on secondary anonymized administrative data, The Rey Juan Carlos University Ethics Committee determined that formal ethical approval and patient informed consent were not required.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 818 cases of HZ were reported among kidney transplant patients during the period 2010\u0026ndash;2021, of which 86% were patients \u0026gt; 50 years old and 34% were individuals \u0026ge;70 years old. Fifty-nine percent of the cases were men, and 55% were related to complicated HZ in kidney transplantation patients (Table 2).\u003c/p\u003e\n\u003cp\u003eThe hospitalization rate for kidney transplant patients during the study period was 0,15 hospitalizations per 100,000 inhabitants (CI 95% 0,14\u0026ndash;0,16). This rate increased with age, reaching a maximum in the population aged 60\u0026ndash;69\u0026nbsp;years (0,45 per 100,000 inhabitants). Higher rates were also observed among men in both uncomplicated and complicated HZ. This can be found in all age groups except for the total group, which becomes significant when age-adjusted rates\u0026nbsp;are compared\u0026nbsp;(Table 2).\u003c/p\u003e\n\u003cp\u003eDuring the study period, despite the low hospitalization rates, we observed an increase over time for both complicated and uncomplicated HZ (Fig. 1) (p value \u0026lt;0,05). An increase in hospitalization rates by age group was also observed, especially among kidney transplant recipients older than 60 years. In particular, from 2015 onwards, an increase in hospitalization rates was observed among kidney transplant patients in the 70+ age group (Fig. 2).\u003c/p\u003e\n\u003cp\u003eThe total mortality rates were 0,01 and 0,02 per 100,000 inhabitants (95% CI) in patients aged 60\u0026ndash;69 and above 70, respectively. There were 23 in-hospital deaths among kidney transplant patients due to HZ, 52% of which were related to complicated HZ. More deaths were observed\u0026nbsp;among\u0026nbsp;individuals \u0026ge; 70 years\u0026nbsp;of age\u0026nbsp;and\u0026nbsp;among\u0026nbsp;men than\u0026nbsp;among\u0026nbsp;women for all age groups (Table 2).\u003c/p\u003e\n\u003cp\u003eThe total case fatality rate was 2,81% (CI 95% 1.84\u0026ndash;4.12). Compared with females, males in all age groups had a higher case fatality rate. Kidney transplant patients who were hospitalized with uncomplicated HZ aged \u0026ge; 70 years and complicated HZ aged \u0026ge; 60 years had higher case fatality rates. There were no overall differences in hospitalization, mortality or case fatality rates for complicated or uncomplicated HZ among the KT patients (Table 2). \u0026nbsp;The total average length of hospital stay was 7 days (Table 2). Hospitalizations for HZ among KT patients were estimated to generate a total cost of \u0026euro;4,227,463 and an annual expenditure of \u0026euro;352,289 for the health care system. The mean cost per patient was \u0026euro;5,168 (Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main objective of this study was to describe and analyse the burden of hospitalizations related to HZ in Spain between 2010 and 2021 among kidney transplant patients.\u003c/p\u003e \u003cp\u003eWhen the total number of hospitalizations among kidney transplant recipients per 100,000 individuals in the general population is calculated, the resulting values may appear disproportionately low, as we identified 818 hospitalizations related to HZ infection among kidney transplant patients during this period, and the hospitalization rate for HZ was 0,15 hospitalizations among KT recipients (per 100,000 population). However, this study is in line with other previously published single-centre retrospective cohort studies on the overall incidence rate of HZ among KT patients. Rodriguez-Moreno et al. performed 812 adult kidney transplants between 1995 and 2004 in a single centre in Madrid, Spain. Only 7 patients required hospital admission, (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Similar results were reported by Fernadez Ruiz; in another single-centre study, which was also based in Madrid, the incidence rate of HZ, which involved monitoring 444 patients who underwent kidney transplantation between 2008 and 2013, was 0,057 episodes per 1000 renal transplant days. A total of 35 episodes of posttransplant HZ, of which only 8 were hospitalized (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e); Gourishankar and colleagues, performed a retrospective analysis at the University of Alberta Hospital, Edmonton, Canada. They reported 434 kidney transplants between 1994 and 1999; 32 cases of HZ developed, but only 1 patient needed hospitalization (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A single cohort study centre in Athens, Greece, carried out by Pavlopoulou and colleagues, reviewed 450 patients who underwent kidney transplants between 2004\u0026ndash;2008, and only 29 patients (6,4%) developed HZ, only 3 of whom required hospitalization (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e); in Seoul, South Korea, Kwon et al., who followed 2300 kidney transplant patients between January 2001 and December 2019, a total of 222 cases of HZ were observed, from which only 10 had serious complications (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In a recent Danish study from Nishida et al. (2024), the global incidence of HZ infection in kidney transplant recipients was 12,6% (13/103 patients) and no cases required hospitalization (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). A more informative approach might be to analyse the total hospitalization ratio specifically within the cohort of kidney transplant recipients. This method provides a clearer estimate of the proportion of transplant patients who experience hospital admissions related to HZ.\u003c/p\u003e \u003cp\u003eAge has been identified as one of the main important risk factors for HZ, with 86% of the hospitalizations reported in kidney transplant patients older than 50 years and 34,4% of them reported in kidney transplant patients over the age of 70 years according to similar studies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). It should be noted that there is no age limit for receiving an organ transplant according to the OPTN (Organ Procurement \u0026amp; Transplantation Network). In 2023, approximately 64% of all people receiving an organ transplant were aged 50 years or older (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). As mentioned previously, there is an increased risk of suffering from HZ in ageing people because of a decline in specific cell-mediated immunity, which appears to be the cause of HZ development as a result of VZV reactivation (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Another important risk factor is the immunosuppressive regimen used in SOT, which alters the immune response (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Since 2015, we have observed an increase in hospitalization rates among kidney transplant patients in the 70\u0026thinsp;+\u0026thinsp;age group, which can be attributed to both increased life expectancy and the absence of an age limit for kidney organ transplantation and immunosuppressive therapy.\u003c/p\u003e \u003cp\u003eWe found that hospitalization in kidney transplant patients was slightly greater in men (59,2%), with particularly marked differences in older adults (\u0026ge;\u0026thinsp;70 years). In the meta-analysis conducted by Kwon et al., which included 5435 kidney transplant recipients from 6 different studies, sex was not found to be a risk factor for HZ (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In Spain, a previous study carried out by Corcuera-Munguia et al. revealed that 52% of the general female population was hospitalized with HZ between 2016 and 2019 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In another Spanish study specifically in the Greater Madrid area, which focused on primary care and was performed by Esteban-Vasallo and colleagues, higher hospitalization rates were observed in men 60 years of age and older than in those younger than 15 years (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn increase in hospitalization rates with age was observed, as mentioned above, but no differences were found between complicated and uncomplicated hospitalization rates in kidney transplant patients. The estimated cost to the health care system was 352.289\u0026euro; per year, with an average length of stay of 7 days, which would be higher if indirect costs were also taken into account.\u003c/p\u003e \u003cp\u003eThe total case fatality rate for HZ was 2,81%, almost half that of the general population (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), in patients who had undergone kidney transplantation. The mortality rate due to HZ in kidney transplant individuals\u0026thinsp;\u0026ge;\u0026thinsp;60 years was 0.01/0.02. Other studies have shown higher mortality rates but not for specific kidney transplant populations (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is important to acknowledge that there are several limitations up to this point. MBDS is a powerful and robust way to study the epidemiology of a disease because it provides a large representative sample size that gives the study great statistical strength. However, this study has several limitations because of its nature. First, we considered hospitalizations related to HZ in kidney posttransplant patients, and we could not know whether these kidney transplant patients were hospitalized due to HZ itself or developed HZ during their hospital stay. Most cases of HZ in transplant patients are managed as outpatients, but hospitalization is prompted by the clinical severity of HZ, not by unrelated hospital admissions (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Second, the MBDS cannot provide information on when hospitalization occurred. The median time to onset of HZ in SOT patients is approximately 16\u0026ndash;18 months after transplantation, with most cases occurring within the first 1\u0026ndash;4 years (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The risk persists over time, but the majority of subjects develop zoster specifically in the first year after SOT (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). KT recipients with microbiological or serological confirmation of prior VZV infection remain at significant risk for HZ after transplantation because of immunosuppression. While pretransplant VZV immunity reduces the risk of primary varicella, it does not eliminate the risk of HZ reactivation (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Third, the MBDS does not include useful data on disease severity or microbiological confirmation (VZV seronegative) before transplantation. Notably, in clinical practice, routine antiviral prophylaxis (valganciclovir, ganciclovir, valacyclovir, or acyclovir) is the standard for preventing CMV disease in SOT recipients and reduces the incidence of HZ (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Furthermore, some studies suggest that the delayed mean time of onset is the result of prolonged exposure to antiviral therapy; however, once prophylaxis ends, the risk of HZ increases, leading to a delayed but not eliminated incidence of HZ (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). On the other hand, immunosuppressive therapy is the cornerstone of both the prophylaxis and treatment of kidney transplant rejection. It is used to prevent the immune system from attacking the transplanted kidney, thereby reducing the risk of acute and chronic rejection (\u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Unfortunately, the MBDS does not allow us to know which specific immunosuppressive treatment was used in these KT patients. Finally, we could not analyse renal function after kidney transplantation because of limitations of the MBDS itself. Patients with end-stage renal disease (ESKD) exhibit premature ageing of the T-cell system (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), and the incidence of HZ is higher in patients with chronic renal failure (\u003cspan additionalcitationids=\"CR41 CR42\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The greatest strength of our study is that the nationwide data were collected over 11 years.\u003c/p\u003e \u003cp\u003eIn Spain, in 2018, the Interterritorial Council of the National Health System (CISNS) already recommended and prioritized vaccination against HZ in SOT recipients over 18 years of age, estimating an incidence rate of HZ infection of 27\u0026ndash;55 cases/1000 person-years for this specific population. In May 2020, it was agreed to start vaccinating these SOT patients (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The HZ subunit vaccine (HZ/Su) was recommended because it significantly reduces the incidence of HZ and the incidence of postherpetic neuralgia in immunocompromised patients, and compared with zoster live vaccines (ZLV), its efficacy is not age dependent (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). On the other hand, ZLV is a live HZ vaccine, which is contraindicated in immunocompromised populations because it can cause disseminated viral infection and death (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, we estimated the burden of hospitalization for HZ after kidney transplantation in Spain from 2010\u0026ndash;2021. Despite the low rates of hospitalization for HZ among kidney transplant patients, hospitalization increases with age, particularly in men and in both complicated and uncomplicated HZ. These hospitalizations in kidney transplant patients continue to represent a high cost, estimated at 352,289 euros per year for The National Health System (not including indirect costs). The Spanish National Recommendation for Herpes Zoster Vaccination in patients with SOT will reduce the overall incidence of HZ among transplanted patients and therefore hospitalizations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCISNS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterterritorial Council of the National Health System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCMV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCytomegalovirus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCMBD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConjunto M\u0026iacute;nimo B\u0026aacute;sico de Datos\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnd-Stage Renal Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHZ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHerpes Zoster\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHZ/Su vaccine\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHerpes Zoster Subunit Vaccine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Classification of Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKidney Transplant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOPTN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOrgan Procurement \u0026amp; Transplantation Network\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSolid Organ Transplant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVZV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evaricella zoster virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eZLV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eZoster Live Vaccines.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted using fully anonymized and de-identified administrative hospital discharge data from a national secondary database. No identifiable personal data or biological samples were accessed. In accordance with national regulations and the principles of \u0026nbsp;the Declaration of Helsinki (1964 and subsequent amendments), the Rey Juan Carlos University Ethics Committee determined that no formal ethics approval was required for this study. Informed consent from individual participants was not required due to the retrospective design and the use of anonymized data. This study does not constitute a clinical trial; therefore, trial registration is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analysed during the current study were obtained from the Spanish CMBD and are not publicly available due to confidentiality agreements. Data may be available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eContribution of the authors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRaquel Olivenza Ant\u0026oacute;n: Conception and design of the study, analysis and interpretation of data, drafting of the article, critical revision of the article, and final approval of the version submitted.\u003c/p\u003e\n\u003cp\u003eGil Rodr\u0026iacute;guez Caravaca: Conception and design of the study, acquisition of data, interpretation of data, drafting of the article, critical revision of the article, and final approval of the version submitted.\u003c/p\u003e\n\u003cp\u003ePilar C\u0026aacute;rdenas-Soriano: Acquisition of data, analysis and interpretation of data, critical revision of the article, and final approval of the version submitted.\u003c/p\u003e\n\u003cp\u003eValent\u0026iacute;n Hern\u0026aacute;ndez-Barrera: Conception and design of the study, analysis and interpretation of data, and final approval of the version submitted.\u003c/p\u003e\n\u003cp\u003e\u0026Aacute;ngel Gil de Miguel: Conception and design of the study, analysis and interpretation of data, critical revision of the article, and final approval of the version submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the Spanish Ministry of Health for providing access to the CMBD database.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZerboni L, Sen N, Oliver SL, Arvin AM. 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J Infect. 2016;72(1):70-9. \u003c/li\u003e\n\u003cli\u003eArness T, Pedersen R, Dierkhising R, Kremers W, Patel R. Varicella zoster virus-associated disease in adult kidney transplant recipients: incidence and risk-factor analysis. Transpl Infect Dis. 2008;10(4):260-8. \u003c/li\u003e\n\u003cli\u003eManuel O, Kumar D, Singer LG, Cobos I, Humar A. Incidence and Clinical Characteristics of Herpes Zoster After Lung Transplantation. The Journal of Heart and Lung Transplantation. 2008;27(1):11-6. \u003c/li\u003e\n\u003cli\u003eKho MML, Roest S, Bov\u0026eacute;e DM, Metselaar HJ, Hoek RAS, Van Der Eijk AA, et al. Herpes Zoster in Solid Organ Transplantation: Incidence and Risk Factors. Front Immunol. 2021;12:645718. \u003c/li\u003e\n\u003cli\u003eKoo S, Gagne LS, Lee P, Pratibhu PP, James LM, Givertz MM, et al. Incidence and risk factors for herpes zoster following heart transplantation. Transpl Infect Dis.2014;16(1):17-25. \u003c/li\u003e\n\u003cli\u003eBALANCE_2023_ONT_17012024. Available at https://www.ont.es/wp-content/uploads/2024/01/BALANCE_2023_ONT_17012024.pdf\u003c/li\u003e\n\u003cli\u003eGreen M. Introduction: Infections in Solid Organ Transplantation. American Journal of Transplantation. 2013;13:3-8. \u003c/li\u003e\n\u003cli\u003eVacunacion_poblacion_adulta.pdf. Available at: https://www.sanidad.gob.es/areas/promocionPrevencion/vacunaciones/programasDeVacunacion/docs/Vacunacion_poblacion_adulta.pdf\u003c/li\u003e\n\u003cli\u003eRodriguez-Moreno A, Sanchez-Fructuoso AI, Calvo N, Ridao N, Conesa J, Marques M, et al. Varicella infection in adult renal allograft recipients: experience at one center. Transplant Proc. 2006;38(8):2416-8. \u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez-Ruiz M, Orig\u0026uuml;en J, Lora D, L\u0026oacute;pez-Medrano F, Gonz\u0026aacute;lez E, Polanco N, et al. Herpes zoster in kidney transplant recipients: protective effect of anti-cytomegalovirus prophylaxis and natural killer cell count. A single-center cohort study. Transpl Int. 2018;31(2):187-97. \u003c/li\u003e\n\u003cli\u003ePavlopoulou ID, Poulopoulou S, Melexopoulou C, Papazaharia I, Zavos G, Boletis IN. Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis. BMC Infect Dis. 2015;15(1):285. \u003c/li\u003e\n\u003cli\u003eKwon DE, Lee HS, Lee KH, La Y, Han SH, Song YG. Incidence of herpes zoster in adult solid organ transplant recipients: A meta‐analysis and comprehensive review. Transplant Infectious Dis. 2021;23(4): e13674. \u003c/li\u003e\n\u003cli\u003eNishida H, Fukuhara H, Takai S, Nawano T, Takehara T, Narisawa T, et al. Herpes zoster development in living kidney transplant recipients receiving low-dose rituximab. International Journal of Urology. 2025;32(1):88-93. \u003c/li\u003e\n\u003cli\u003eEsteban-Vasallo MD, Dom\u0026iacute;nguez-Berj\u0026oacute;n MF, Gil-Prieto R, Astray-Mochales J, Gil de Miguel A. Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster: a population-based study from primary care in Madrid (Spain). Hum Vaccin Immunother. 2014;10(6):1650-60. \u003c/li\u003e\n\u003cli\u003eMasa-Calles J, L\u0026oacute;pez-Perea N, Vila Cordero B, Carmona R. Surveillance and epidemiology of Herpes Zoster in Spain. Rev Esp Salud Publica. 2021;95: e202106088. \u003c/li\u003e\n\u003cli\u003e\u0026iquest;Hay un l\u0026iacute;mite de edad para la donaci\u0026oacute;n de \u0026oacute;rganos? Available at: https://donaciondeorganos.gov/conocer/quien-puede-donar/2nud/personas-de-la-tercera-edad\u003c/li\u003e\n\u003cli\u003eBastidas A, de la Serna J, El Idrissi M, Oostvogels L, Quittet P, L\u0026oacute;pez-Jim\u0026eacute;nez J, et al. Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation: A Randomized Clinical Trial. JAMA. 2019;322(2):123-33. \u003c/li\u003e\n\u003cli\u003eAltunel CT, Seckin D, Sayin B, Sezgin A, Akdur A, Haberal MA. CLINICAL CHARACTERISTICS AND OUTCOME OF HERPES ZOSTER IN SOLID ORGAN TRANSPLANT PATIENTS: A SINGLE CENTER CASE SERIES. Transplantation. 2020;104(S3): S327. \u003c/li\u003e\n\u003cli\u003eNuran S, \u0026Ccedil;iğdem E, Tuğba YY, \u0026Ouml;zlem KA, Hande A, Emre K et al. Herpes Zoster Infections in Solid-Organ Transplant Recipients. Experimental And Clinical Transplantation (2023) 9:764-771 \u003c/li\u003e\n\u003cli\u003eHerrero JI, Quiroga J, Sangro B, Pardo F, Rotellar F, \u0026Aacute;lvarez-Cienfuegos J, et al. Herpes zoster after liver transplantation: Incidence, risk factors, and complications. Liver Transplantation. 2004;10(9):1140-3. \u003c/li\u003e\n\u003cli\u003eKho M, Weimar W, Malahe SRK, Zuijderwijk J, Kuiper R de, Boer-Verschragen MJ, et al. Boosting the VZV-Specific Memory B and T Cell Response to Prevent Herpes Zoster After Kidney Transplantation. Frontiers in Immunology. 2021, 12:645718.\u003c/li\u003e\n\u003cli\u003ePergam SA, Limaye AP. Practice the AIDC of Varicella zoster virus in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation. 2019;33(9): e13622. \u003c/li\u003e\n\u003cli\u003eLjungman P. Prophylaxis against Herpesvirus Infections in Transplant Recipients. Drugs. 2001;61(2):187-96. \u003c/li\u003e\n\u003cli\u003eMartin-Gandul C, Stampf S, H\u0026eacute;quet D, Mueller NJ, Cusini A, van Delden C, et al. Preventive Strategies Against Cytomegalovirus and Incidence of \u0026alpha;-Herpesvirus Infections in Solid Organ Transplant Recipients: A Nationwide Cohort Study. American Journal of Transplantation. 2017;17(7):1813-22. \u003c/li\u003e\n\u003cli\u003eVernooij RW, Michael M, Ladhani M, Webster AC, Strippoli GF, Craig JC, et al. Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients. Cochrane Database of Systematic Reviews. 2024 (5).\u003c/li\u003e\n\u003cli\u003eYagisawa T, Ishida H, Takagi T. Editorial Comment on \u0026ldquo;Herpes zoster development in living kidney transplant recipients receiving low‐dose rituximab\u0026rdquo;. International Journal of Urology. 2025 (32), 1:93-94\u003c/li\u003e\n\u003cli\u003eQayyum S, Shahid K. Comparative Safety and Efficacy of Immunosuppressive Regimens Post-Kidney Transplant: A Systematic Review. Cureus. 2023; 15(8): e43903.\u003c/li\u003e\n\u003cli\u003eHalloran PF. Immunosuppressive Drugs for Kidney Transplantation. New England Journal of Medicine. 2004;351(26):2715-29. \u003c/li\u003e\n\u003cli\u003eSalvadori M, Tsalouchos A, Nephrology AT. Immunosuppression in Kidney Transplantation. Salvadori M, Tsalouchos A. Immunosuppression in Kidney Transplantation. OBM Transplantation 2020; 4(1): 097. \u003c/li\u003e\n\u003cli\u003eSzumilas K, Wilk A, Wiśniewski P, Gimpel A, Dziedziejko V, Kipp M, et al. Current Status Regarding Immunosuppressive Treatment in Patients after Renal Transplantation. Int. J. Mol. Sci. 2023, 24, 10301. International Journal of Molecular Sciences. 2023; 24:10301. \u003c/li\u003e\n\u003cli\u003eBetjes MGH, Langerak AW, van der Spek A, de Wit EA, Litjens NHR. Premature aging of circulating T cells in patients with end-stage renal disease. Kidney Int. 2011; 80(2):208-17. \u003c/li\u003e\n\u003cli\u003eForbes H J, Bhaskaran K, Thomas S L, Smeeth L, Clayton T, Langan S M et al. Quantification of risk factors for herpes zoster: population-based case-control study. BMJ 2014; 348: g2911\u003c/li\u003e\n\u003cli\u003eWu MY, Hsu YH, Su CL, Lin YF, Lin HW. Risk of herpes zoster in CKD: a matched-cohort study based on administrative data. Am J Kidney Dis. 2012;60(4):548-52. \u003c/li\u003e\n\u003cli\u003eVink P, Torrell JMR, Fructuoso ASS, Kim SJ, Kim S il, Zaltzman J, et al. Immunogenicity and Safety of the Adjuvanted Recombinant Zoster Vaccine in Chronically Immunosuppressed Adults Following Renal Transplant: A Phase 3, Randomized Clinical Trial. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2019; 70:181-90. \u003c/li\u003e\n\u003cli\u003eKumar D, Jorga A, Yun H, Williams C. #2434 Literature review on the burden of herpes zoster in patients with kidney disease\u0026mdash;a need for earlier prevention. Nephrology Dialysis Transplantation, Volume 39, Issue Supplement_1, May 2024, gfae069\u0026ndash;0524\u0026ndash;2434.\u003c/li\u003e\n\u003cli\u003ePrevencion/vacunaciones/programasDeVacunacion/riesgo/docs/tabla_13,14, 15.pdf. Available at: https://www.sanidad.gob.es/areas/promocionPrevencion/vacunaciones/programasDeVacunacion/riesgo/docs/tabla_13,14,15.pdf\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 863px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Hospitalization rate, mortality rate and case fatality rate due to herpes zoster: total and by age group, sex and presence of complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization rate (cases*100,000/95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality rate (cases*100,000/95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,05 (0,04-0,06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,02 (0,01-0,03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,03 (0,02-0,04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50-59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,2 (0,16-0,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,19 (0,15-0,23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,2 (0,17-0,23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,52 (0,44-0,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,38 (0,31-0,45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,45 (0,4-0,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,02 (0-0,04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,55 (0,47-0,63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,24 (0,19-0,29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,37 (0,33-0,41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,03 (0,01-0,05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,02 (0,01-0,03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,18 (0,16-0,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,12 (0,11-0,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,15 (0,14-0,16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0,01-0,01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUncomplicated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,03 (0,02-0,04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,01 (0,01-0,01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,02 (0,02-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50-59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,12 (0,09-0,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,08 (0,05-0,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,1 (0,08-0,12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,28 (0,22-0,34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,18 (0,13-0,23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,23 (0,19-0,27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,21 (0,16-0,26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,12 (0,09-0,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,16 (0,13-0,19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,02 (0-0,04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,09 (0,08-0,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,06 (0,05-0,07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,07 (0,06-0,08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eComplicated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,02 (0,01-0,03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,01 (0,01-0,01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,02 (0,02-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50-59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,09 (0,06-0,12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,1 (0,07-0,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,09 (0,07-0,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,24 (0,18-0,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,2 (0,15-0,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,22 (0,18-0,26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,35 (0,28-0,42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,11 (0,08-0,14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,21 (0,18-0,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0,01 (0-0,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0,09 (0,08-0,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0,06 (0,05-0,07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,07 (0,06-0,08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDeaths (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCase fatality rate (%/95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian length (days/IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1,23 (0,13-5,62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,85 (0,09-3,89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (4-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50-59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1,27 (0,14-5,76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0,66 (0,07-3,03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (4-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3,36 (1,29-7,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1,69 (0,35-5,33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2,62 (1,18-5,08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (4-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5,14 (1,87-8,41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4,72 (0,68-8,76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4,98 (2,44-7,52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (5-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3,31 (1,98-5,19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2,1 (0,94-4,07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2,81 (1,84-4,12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUncomplicated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (3-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6 (3-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (3-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50-59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (4-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2,47 (0,52-7,68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1,79 (0,19-8,04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2,19 (0,62-5,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7,69 (1,21-14,17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5,45 (-0,55-11,45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6,67 (2,21-11,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (4-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (4-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (4-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2,92 (1,31-5,64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2,52 (0,85-5,87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2,76 (1,47-4,72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-9,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (4-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (4-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eComplicated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3,03 (0,33-13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1,82 (0,2-8,18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (5-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7,5 (5-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (5-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50-59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3,03 (0,33-13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1,37 (0,15-6,22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (5-15,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4,41 (1,26-11,31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1,61 (0,17-7,29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3,08 (1,05-7,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10 (5,5-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (3-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3,64 (0,14-7,14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3,92 (-1,41-9,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3,73 (0,8-6,66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e9 (5-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3,69 (1,84-6,62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1,71 (0,49-4,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2,86 (1,57-4,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (5-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8 (5-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eTotal and average cost in kidney transplant patients per Herpes Zoster total hospitalization\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal and average cost in kidney transplant patients\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eper Herpes Zoster total hospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCost (\u0026euro;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Cost\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(2010-2021)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u0026euro;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCost (\u0026euro;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.227.463\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e352.289\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUncomplicated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.981.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e165.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplicated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.245.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e187.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Herpes zoster, renal transplant, CMBD, Hospital burden, Health system, Epidemiological study, Spain","lastPublishedDoi":"10.21203/rs.3.rs-8822816/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8822816/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is a consensus on herpes zoster (HZ) vaccination in at-risk groups of all ages, including solid organ transplant (SOT)-pretransplant and posttransplant groups. The aim of this study was to analyse the burden of hospitalization and its complications due to HZ in patients who had previously undergone kidney transplantation in Spain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a nationwide retrospective descriptive observational study. The Spanish National Hospital Data Information System (CMBD) was used to collect all cases of hospital admissions for kidney transplant patients with a diagnosis related to HZ during the period 2010–2021 in Spain. The annual hospitalization rate, mortality rate and case fatality rate were calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 818 cases of HZ were reported among kidney transplant patients, of which 59% were men and 55% were complicated with HZ. The hospitalization rate was 0.15 hospitalizations per 100,000 inhabitants (CI: 95% 0,14–0,16). This rate increased with age, reaching a maximum in the population aged 60–69 years (0.45 per 100,000 inhabitants). The total case fatality rate was 2,81% (CI: 95% 1,84 − 4,12).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is necessary to maintain the epidemiological surveillance of herpes zoster infection in patients who receive renal transplants to determine the hospitalization burden and comorbidities, track their evolution, and evaluate preventive measures whose effectiveness should be assessed.\u003c/p\u003e","manuscriptTitle":"Hospitalization burden related to herpes zoster among adults with kidney transplants in Spain (2010 –2021)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-10 17:07:35","doi":"10.21203/rs.3.rs-8822816/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T08:29:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T15:56:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9027937231307344061049602807227315809","date":"2026-04-20T08:34:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339106411860485649306754729219765394334","date":"2026-04-18T15:07:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-31T13:15:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186293558177697973628859341320054220363","date":"2026-03-08T14:58:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27659138854487026776390293683964154412","date":"2026-03-05T15:35:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126250705977008194863083758502473582674","date":"2026-03-04T07:49:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296698377829515314580627826800254382197","date":"2026-03-03T14:26:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-03T14:14:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-03T05:31:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-03T05:31:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-03T01:39:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-03-02T20:27:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d8a5c627-5695-4daa-a849-7adf9279eba2","owner":[],"postedDate":"March 10th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T08:29:42+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T11:23:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-10 17:07:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8822816","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8822816","identity":"rs-8822816","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}