Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 2;73(9):e3210-e3217.
doi: 10.1093/cid/ciaa1185.

Herpes Zoster and Postherpetic Neuralgia: Changing Incidence Rates From 1994 to 2018 in the United States

Ryan R Thompson  1 , Christina L Kong  1 , Travis C Porco  1   2   3 , Eric Kim  1 , Caleb D Ebert  1 , Nisha R Acharya  1   2   3   4
Affiliations

Herpes Zoster and Postherpetic Neuralgia: Changing Incidence Rates From 1994 to 2018 in the United States

Ryan R Thompson et al. Clin Infect Dis. .

Abstract

Background: The incidence of herpes zoster (HZ) has been increasing in recent decades. Although 2 vaccines for HZ are available, there have been few studies on the incidence rates of HZ and postherpetic neuralgia (PHN) since their introduction. This study examined the incidence rates of HZ and PHN from 1994 to 2018 in the United States to determine if they have continued to increase since introduction of the HZ vaccines.

Methods: A de-identified longitudinal administrative claims database, the OptumLabs Data Warehouse, was used to assess incidence rates among individuals continuously enrolled in the database for ≥365 days with no prior history of HZ or PHN. Unstandardized and standardized incidence rates were calculated by year, 10-year age groups, sex, and race/ethnicity.

Results: There were 610 766 individuals with HZ (median age, 56.3; interquartile range, 43.0-68.7 years; 59.8% women; 70.6% white). From 1994 to 2018, the incidence of HZ increased from 286.0 (95% confidence interval [CI], 259.1-312.8) to 579.6 (95% CI, 554.2-605.0) cases per 100 000 person-years, an annual increase of 3.1% (95% CI, 2.5-3.6%). Since 2007, annual HZ incidence rates have decreased in individuals ≤20 and >60 years old. The overall incidence rate of PHN was 57.5 (95% CI, 56.0-59.0) cases per 100 000 person-years. The proportion of individuals with HZ who developed PHN was higher from 2007 to 2018 than from 1994 to 2006.

Conclusions: HZ incidence rates have continued to increase in age groups for which HZ vaccines are not currently recommended, warranting a review of current vaccine recommendations.

Keywords: epidemiology; herpes zoster; infectious disease; postherpetic neuralgia; varicella zoster virus.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Incidence rate of HZ by age, 1994 to 2018. Note: From 1994 to 2000, the 61- to 70-year-old age group included individuals over 70 years old. In OLDW, age is capped at 89 years old to maintain patient privacy. Individuals ages 71 and older from 1994 to 2000 cannot be differentiated from those younger than 70 because birth years earlier than 1930 were assigned the year 1930. Abbreviations: HZ, herpes zoster; OLDW, OptumLabs Data Warehouse.
Figure 2.
Figure 2.
Annual change in herpes zoster incidence rate by sex, 1994 to 2006 versus 2007 to 2018. Note: From 1994 to 2000, the 61- to 70-year-old age group included individuals over 70 years old. In OLDW, age is capped at 89 years old to maintain patient privacy. Individuals ages 71 and older from 1994 to 2000 cannot be differentiated from those younger than 70 because birth years earlier than 1930 were assigned the year 1930. Abbreviation: OLDW, OptumLabs Data Warehouse.
Figure 3.
Figure 3.
Annual change in herpes zoster incidence rate by race/ethnicity, 1994 to 2006 versus 2007 to 2018. Note: From 1994 to 2000, the 61- to 70-year-old age group included individuals over 70 years old. In OLDW, age is capped at 89 years old to maintain patient privacy. Individuals aged 71 and older from 1994 to 2000 cannot be differentiated from those younger than 70 because birth years earlier than 1930 were assigned the year 1930. Abbreviation: OLDW, OptumLabs Data Warehouse.
Figure 4.
Figure 4.
Proportion of HZ cases with PHN by age, 1994 to 2006 versus 2007 to 2018. Note: From 1994 to 2000, the 61- to 70-year-old age group included individuals over 70 years old. In OLDW, age is capped at 89 years old to maintain patient privacy. Individuals ages 71 and older from 1994 to 2000 cannot be differentiated from those younger than 70 because birth years earlier than 1930 were assigned the year 1930. Abbreviations: HZ, herpes zoster; OLDW, OptumLabs Data Warehouse; PHN, postherpetic neuralgia.
See this image and copyright information in PMC

Comment in

References

    1. Lal H, Cunningham AL, Godeaux O, et al. ; ZOE-50 Study Group . Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 2015; 372:2087–96. - PubMed
    1. Leung J, Harpaz R, Molinari NA, Jumaan A, Zhou F. Herpes zoster incidence among insured persons in the united states, 1993–2006: evaluation of impact of varicella vaccination. Clin Infect Dis 2011; 52:332–40. - PubMed
    1. Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med 2005; 20:748–53. - PMC - PubMed
    1. Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008; 57:1–30. - PubMed
    1. Schutzer-Weissmann J, Farquhar-Smith P. Post-herpetic neuralgia—a review of current management and future directions. Expert Opin Pharmacother 2017; 18:1739–50. - PubMed

Publication types

Substances