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Shingles Risk Factors

Summary and Comment |
June 2, 2014

Shingles Risk Factors

  1. Stephen G. Baum, MD

Several diseases both increase the risk for clinical zoster and contraindicate use of the currently available vaccine.

  1. Stephen G. Baum, MD

Herpes zoster (shingles) is caused by the reactivation of latent varicella zoster virus. The lifetime risk for this condition is 30%, rising to 50% in individuals surviving to age 85. The most dreaded sequella — postherpetic neuralgia — develops in ≤12% of zoster patients aged ≥50. A live-virus vaccine (Zostavax) is effective in preventing or lessening the severity of zoster and postherpetic neuralgia and is approved for patients aged ≥50.

In a recent case-control study of risk factors for zoster, researchers used U.K. Clinical Practice Research Datalink records to compare 144,959 adults with zoster between 2000 and 2011 with 549,336 age-, sex-, and practice-matched controls who had no history of zoster or postherpetic neuralgia at the index date of their corresponding case-patient (but could go on to develop zoster and therefore also be considered a case-patient).

The median age at zoster diagnosis was 62 for both groups, but about 45% of cases occurred in individuals aged ≤60. Major immunosuppressive conditions such as HIV infection, myeloma, and lymphoma strongly increased risk. Other factors related to increased risk included rheumatoid arthritis, inflammatory bowel disease, chronic obstructive pulmonary disease, asthma, chronic kidney disease, diabetes (type 1 only), and depression. Although systemic lupus erythematosus carried one of the strongest relative risks, it was rare enough to have little overall effect. The effects of many risk factors were larger in younger patients.

Comment

Although the increased risk associated with the above conditions comes as no surprise, this study has quantified risk factors in a large number of patients. The authors emphasize that many of the conditions that increase zoster risk contraindicate use of live-virus preparations such as the zoster vaccine, highlighting the need for new preventive strategies.

  • Disclosures for Stephen G. Baum, MD at time of publication Editorial boards Medical Letter

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