Changing Epidemiology of Herpes Zoster After Vaccine Adoption in the U.S.

By Will Boggs MD

December 26, 2018

NEW YORK (Reuters Health) - Shingles is becoming less common in both adults and children in the U.S., according to results from a database study.

"Many countries have withheld recommendations for universal varicella vaccination because of concerns that it may indirectly increase the risk of shingles in adults," Dr. Rafael Harpaz from the Centers for Control and Disease Prevention (CDC), in Atlanta, told Reuters Health by email. "Our results indicate this is not the case in the U.S., which introduced its varicella vaccination program over 20 years ago."

Dr. Harpaz and Jessica W. Leung, also from the CDC, used data from the Truven Health MarketScan Databases to analyze herpes zoster trends in children from the years 1998-2016 and in adults from 1993-2016. Their results were published in two reports online November 29 in Clinical Infectious Diseases.

Among children, the incidence of herpes zoster declined in all age groups by 70% to 80% after introduction of the varicella vaccination program in 1996, with absolute rates as low as 0.22 per 1,000 children in the youngest age-strata.

The excess incidence of herpes zoster in girls compared to boys before varicella vaccine licensure disappeared after the vaccine was introduced.

Among adults age 35 and older, herpes zoster incidence increased steadily through ages 50-55 without any clear accelerations or decelerations, whereas the rise in shingles incidence for older individuals has slowed since adoption of the herpes zoster vaccine program.

"Some of that deceleration was surely related to the introduction of vaccine against zoster 10 years ago, but it is unlikely that zoster vaccine could have caused all the deceleration," Dr. Harpaz said. "It remains a mystery - a good mystery."

"Varicella vaccine is effectively protecting children from chickenpox and provides some protection against shingles for adults who were vaccinated against varicella as children," he said. "That said, adults who are recommended to get the shingles vaccine should get it for even greater protection."


Clin Infect Dis 2018.