Epidemiology of herpes zoster (shingles)

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Varicella-zoster virus causes two distinct syndromes. Primary infection

presents as varicella (or chickenpox), a contagious and usually benign

illness that occurs in epidemics among susceptible children. Subsequent

reactivation of latent varicella-zoster virus in dorsal-root ganglia

results in a localized cutaneous eruption termed " herpes zoster " (or

" shingles " ). Declining virus-specific cell-mediated immune responses,

which occur naturally as a result of aging or are induced by

immunosuppressive illness or medical treatments, increase the risk of

shingles.1

Over 90 percent of adults in the United States have serologic evidence

of varicella-zoster virus infection and are at risk for herpes zoster.2

The annualized incidence of herpes zoster is about 1.5 to 3.0 cases per

1000 persons.3,4 An incidence of 2.0 cases per 1000 persons would

translate into more than 500,000 cases annually in the United States.

Increasing age is a key risk factor for the development of herpes

zoster; the incidence of shingles among persons older than 75 years of

age exceeds 10 cases per 1000 person-years.3 The lifetime risk of herpes

zoster is estimated to be 10 to 20 percent.4

The other well-defined risk factor for herpes zoster is altered

cell-mediated immunity. Patients with neoplastic diseases (especially

lymphoproliferative cancers), those receiving immunosuppressive drugs

(including corticosteroids), and organ-transplant recipients are at

increased risk for shingles. However, a search for an underlying cancer

is not warranted in otherwise healthy patients in whom herpes zoster

develops.5

Herpes zoster occurs with higher frequency among persons who are

seropositive for human immunodeficiency virus (HIV) than among those who

are seronegative. A longitudinal study demonstrated an incidence of 29.4

cases of herpes zoster per 1000 person-years among HIV-seropositive

persons, as compared with 2.0 cases per 1000 person-years among

HIV-seronegative controls.6 Since herpes zoster may occur in

HIV-infected persons who are otherwise asymptomatic, serologic testing

may be appropriate in patients without apparent risk factors for

shingles (e.g., healthy persons who are younger than 50 years of age).

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org