Increasing Incidence of Herpes Zoster Over a 60-year Period From a Population-based Study

Abstract

Background: Temporal increases in the incidence of herpes zoster (HZ) have been reported but studies have examined short study periods, and the cause of the increase remains unknown. We examined the long-term trend of HZ.

Methods: A population-based cohort study was conducted in Olmsted County, Minnesota, using data from 1945-1960 and 1980-2007. Medical records review of possible cases was performed to confirm incident cases of HZ, the patient's immune status, and prescribing of antivirals for HZ. We examined the relative change in the temporal trend in the incidence rates before and after the introduction of the varicella vaccination program.

Results: Of the 8017 patients with HZ, 58.7% were females and 6.6% were immunocompromised. The age- and sex-adjusted incidence rate of HZ increased from 0.76 per 1000 person-years (PY) (95% confidence interval [CI], .63-.89) in 1945-1949 to 3.15 per 1000 PY (95% CI, 3.04-3.26) in 2000-2007. The rate of increase across the time period was 2.5% per year after adjusting for age and sex (adjusted incidence rate ratio, 1.025 [95% CI, 1.023-1.026]; P < .001). The incidence of HZ significantly increased among all age groups and both sexes. We found no change in the rate of increase before vs after the introduction of the varicella vaccination program.

Conclusions: The incidence of HZ has increased >4-fold over the last 6 decades. This increase is unlikely to be due to the introduction of varicella vaccination, antiviral therapy, or change in the prevalence of immunocompromised individuals.

Keywords: epidemiology; herpes zoster; shingles.

Figure 1.

Incidence of herpes zoster in Olmsted County, Minnesota, 1945–2007, showing the temporal trend beginning prior to the introduction of antiviral medications (mid-1980s) and extending beyond the introduction of childhood varicella vaccinations (1996).