Herpes zoster risk factors
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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]
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.
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.
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:
- with cancer, especially leukemia and lymphoma,
- with human immunodeficiency virus,
- 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 [1][2]; 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[3].
Can you get Chickenpox if you've been Vaccinated?
Yes. About 15%–20% of people who have received one dose of chickenpox vaccine do still get chickenpox if they are exposed, but their disease is usually mild. Vaccinated persons who get chickenpox generally have fewer than 50 spots or bumps, which may resemble bug bites more than typical, fluid-filled chickenpox blisters. In 2006, the Advisory Committee on Immunization Practices (ACIP) voted to recommend routine two-dose varicella vaccination for children. In one study, children who received two doses of the chickenpox vaccine were three times less likely to get chickenpox than individuals who have had only one dose.
Can a Healthy Person who gets Varicella Die from the Disease?
Yes. Many of the deaths and complications from chickenpox occur in previously healthy children and adults. From 1990 to 1994, before a vaccine was available, about 50 children and 50 adults died from chickenpox every year; most of these persons were healthy or did not have a medical illness (such as cancer) that placed them at higher risk of getting severe chickenpox. Since 1999, states have been encouraged to report chickenpox deaths to CDC. These reports have shown that some deaths from chickenpox continue to occur in healthy, unvaccinated children and adults. Most of the healthy adults who died from chickenpox contracted the disease from their unvaccinated children.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.