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Risk Factors for Shingles

Summary and Comment |
June 5, 2014

Risk Factors for Shingles

  1. Paul S. Mueller, MD, MPH, FACP

Age is most important, but many chronic conditions are associated with higher risk.

  1. Paul S. Mueller, MD, MPH, FACP

Age is an important risk factor for herpes zoster; the CDC recommends a single dose of shingles vaccine for older adults (age, ≥60). But whether younger people, especially those with chronic medical conditions, might benefit from vaccination is unclear. In this case-control study, U.K. investigators quantified the effects of potential risk factors for herpes zoster among 145,000 adults diagnosed with the condition between 2000 and 2011 and among 550,000 controls who were matched by age, sex, and practice with case patients.

The median age at diagnosis of zoster was 62; 45% of zoster cases occurred before age 60. Adjusted for multiple variables (including treatments), medical conditions associated with excess risk for shingles were HIV infection (odds ratio, 5.1), lymphoma (OR, 3.9), myeloma (OR, 2.1), leukemia (OR, 1.8), lupus (OR, 1.6), inflammatory bowel disease (OR, 1.3), type 1 diabetes (OR, 1.3), rheumatoid arthritis (OR, 1.2), chronic obstructive pulmonary disease (OR, 1.2), depression (OR, 1.2), asthma (OR, 1.1), and chronic kidney disease (OR, 1.1). Higher risk was also noted among patients with prior hematopoietic stem cell transplant (OR, 13.7) and those who took oral corticosteroids (OR, 1.5) or inhaled corticosteroids (OR, 1.1). The relative effects of these risk factors decreased with increasing age.

Comment

This study had several important findings: Many cases of shingles occur before age 60; numerous risk factors exist for shingles; and, in general, the relative effects of these risk factors are larger for younger patients. However, we don't know how effective shingles vaccination is in younger people (age, <60) with ≥1 of these risk factors, and the CDC considers some of these risk factors as contraindications to vaccination (i.e., the vaccine is not recommended for immunocompromised people, including those taking immunosuppressive drugs; MMWR Recomm Rep 2008; 57:RR-5:1).

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Vice President)

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