Shingles in Adults Not Linked to Varicella Vaccination in Kids

Janis C. Kelly

December 05, 2013

The increased incidence of herpes zoster (HZ, shingles) resulting from the reactivation of latent varicella zoster virus (VZV) in US adults began before the use of routine varicella vaccination of children. Rising HZ rates thus do not appear to result from a decrease in VZV-specific immune "boosts" for adults with latent VZV that might have resulted from natural exposure to unvaccinated children with chickenpox.

In an article published in the December 3 issue of the Annals of Internal Medicine, researchers from the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, report that the age-specific increase in HZ incidence began before 1996, when the childhood varicella vaccination program was introduced; that HZ prevalence did not vary by state vaccination coverage; and that the mean age of HZ diagnosis did not decrease, as would be expected if natural external "boosting" had been helping keep latent VZV suppressed.

Lead author Craig M. Hales, MD, MPH, and colleagues reviewed Medicare claims for more than 2.8 million elderly patients from 1992 through 2010 to determine whether the varicella vaccination program influenced trends in HZ incidence in the US population older than 65 years.

The hypothesis that exposure to varicella would decrease HZ risk by boosting VZV-specific immunity had emerged from observations suggesting decreased zoster risk in some adults who live with children or who have known varicella contacts. According to the authors, "The U.K. Health Protection Agency has raised concerns that adding the varicella vaccine to their childhood immunization program would lead to an increase in HZ in adults."

"Our findings suggest that, although HZ incidence has increased in elderly persons, routine varicella vaccination has not influenced this increase," the authors conclude.

They note that nearly all US adults who were not vaccinated as children harbor latent VZV, and recommend wider use of shingles vaccination (Zostavax, Merck & Co) in the elderly population.

The authors have disclosed no relevant financial relationships.

Ann Intern Med. 2013;159:739-745. Abstract

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