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== Risk Factors ==
== Risk Factors ==
Only people who were previously infected with VZV (through natural infection that caused varicella or varicella vaccination) can develop shingles. Although many people do not remember, approximately 99.5% of people born in the United States who are 40 years of age and older have had varicella. As a result, all older adults in the United States are at risk for herpes zoster.
*Shingels are developed in patients who were previously infected with [[VZV]] (through natural infection that caused [[varicella]] or [[varicella vaccination]]).<ref name=Shingels> CDC http://www.cdc.gov/shingles/hcp/clinical-overview.html (August 2016) Accessed on October 24,2016</ref>
*All older adults in the United States are at risk for herpes zoster as approximately 99.5% of people born in the United States who are 40 years of age and older have had varicella.


The reasons why VZV reactivates and causes herpes zoster are not well understood. However, a person's risk for herpes zoster may increase as their VZV-specific cell-mediated immunity declines. This decline in immunity can result from increasing age and/or immunosuppressive medical conditions and medications.
Risk factors include:
*Previous varicella virus infection
*Varicella vaccination
*Decline in cell mediated immunity
:*Increasing age >50 yrs
:*Immunosupression
:**Malignancy, especially leukemia and lymphoma
:**HIV
:**Organ transplant (bone marrow or solid organ transplant)
:**Medications ( steroids, chemotherapy or transplant related immunosupression medications)
*Stress


A person's risk for herpes zoster increases sharply after 50 years of age. About 50% of people who live to 85 years of age will have had an episode of herpes zoster. A person’s risk for PHN also increases sharply with age. The oldest adults with herpes zoster are most likely to be hospitalized for complications from the disease and to develop PHN.


People with compromised or suppressed immune systems who have an increased risk for herpes zoster include those:
*Other potential risk factors include:  
*with cancer, especially leukemia and lymphoma,
*Women > men<ref name="pmid18528318">{{cite journal| author=Harpaz R, Ortega-Sanchez IR, Seward JF, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC)| title=Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). | journal=MMWR Recomm Rep | year= 2008 | volume= 57 | issue= RR-5 | pages= 1-30; quiz CE2-4 | pmid=18528318 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18528318  }} </ref><ref name="pmid14720565">{{cite journal| author=Thomas SL, Hall AJ| title=What does epidemiology tell us about risk factors for herpes zoster? | journal=Lancet Infect Dis | year= 2004 | volume= 4 | issue= 1 | pages= 26-33 | pmid=14720565 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14720565  }} </ref>; the reason for a possible difference between women and men is not known.
*with human immunodeficiency virus,
*Whites > African Americans (by at least 50%) <ref name="pmid21224457">{{cite journal| author=Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ| title=Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. | journal=JAMA | year= 2011 | volume= 305 | issue= 2 | pages= 160-6 | pmid=21224457 | doi=10.1001/jama.2010.1983 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21224457  }} </ref>.
*who have undergone bone marrow or solid organ (renal, cardiac, liver, and lung) transplantation, or
*who are taking immunosuppressive medications, including steroids, chemotherapy, or transplant-related immunosuppressive medications.


Other potential risk factors for herpes zoster have been identified but the findings are not consistent in all studies. For example-
*Some studies found that more women than men develop herpes zoster, but other studies did not find a difference <ref name="pmid18528318">{{cite journal| author=Harpaz R, Ortega-Sanchez IR, Seward JF, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC)| title=Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). | journal=MMWR Recomm Rep | year= 2008 | volume= 57 | issue= RR-5 | pages= 1-30; quiz CE2-4 | pmid=18528318 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18528318  }} </ref><ref name="pmid14720565">{{cite journal| author=Thomas SL, Hall AJ| title=What does epidemiology tell us about risk factors for herpes zoster? | journal=Lancet Infect Dis | year= 2004 | volume= 4 | issue= 1 | pages= 26-33 | pmid=14720565 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14720565  }} </ref>; the reason for a possible difference between women and men is not known.
*Some studies conducted in the United States and elsewhere found that herpes zoster is less common in African Americans (by at least 50%) than in whites<ref name="pmid21224457">{{cite journal| author=Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ| title=Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. | journal=JAMA | year= 2011 | volume= 305 | issue= 2 | pages= 160-6 | pmid=21224457 | doi=10.1001/jama.2010.1983 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21224457  }} </ref>.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 13:51, 24 October 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD;Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Yamuna Kondapally, M.B.B.S[3]

Overview

Risk Factors

  • Shingels are developed in patients who were previously infected with VZV (through natural infection that caused varicella or varicella vaccination).[1]
  • All older adults in the United States are at risk for herpes zoster as approximately 99.5% of people born in the United States who are 40 years of age and older have had varicella.

Risk factors include:

  • Previous varicella virus infection
  • Varicella vaccination
  • Decline in cell mediated immunity
  • Increasing age >50 yrs
  • Immunosupression
    • Malignancy, especially leukemia and lymphoma
    • HIV
    • Organ transplant (bone marrow or solid organ transplant)
    • Medications ( steroids, chemotherapy or transplant related immunosupression medications)
  • Stress


  • Other potential risk factors include:
  • Women > men[2][3]; the reason for a possible difference between women and men is not known.
  • Whites > African Americans (by at least 50%) [4].

References

  1. ↑ CDC http://www.cdc.gov/shingles/hcp/clinical-overview.html (August 2016) Accessed on October 24,2016
  2. ↑ Harpaz R, Ortega-Sanchez IR, Seward JF, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC) (2008). "Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Recomm Rep. 57 (RR-5): 1–30, quiz CE2-4. PMID 18528318.
  3. ↑ Thomas SL, Hall AJ (2004). "What does epidemiology tell us about risk factors for herpes zoster?". Lancet Infect Dis. 4 (1): 26–33. PMID 14720565.
  4. ↑ Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ (2011). "Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease". JAMA. 305 (2): 160–6. doi:10.1001/jama.2010.1983. PMID 21224457.


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