Elsevier

Mayo Clinic Proceedings

Volume 86, Issue 2, February 2011, Pages 88-93
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Herpes Zoster Recurrences More Frequent Than Previously Reported

https://doi.org/10.4065/mcp.2010.0618Get rights and content

OBJECTIVE

To present population-based estimates of herpes zoster (HZ) recurrence rates among adults.

PATIENTS AND METHODS

To identify recurrent cases of HZ, we reviewed the medical records (through December 31, 2007) of all Olmsted County, Minnesota, residents aged 22 years or older who had an incident case of HZ between January 1, 1996, and December 31, 2001. Kaplan-Meier curves and Cox regression models were used to describe recurrences by age, immune status, and presence of prolonged pain at the time of the incident HZ episode.

RESULTS

Of the 1669 persons with a medically documented episode of HZ, 95 had 105 recurrences (8 persons with >1 recurrence) by December 31, 2007, an average follow-up of 7.3 years. The Kaplan-Meier estimate of the recurrence rate at 8 years was 6.2%. With a maximum follow-up of 12 years, the time between HZ episodes in the same person varied from 96 days to 10 years. Recurrences were significantly more likely in persons with zoster-associated pain of 30 days or longer at the initial episode (hazard ratio, 2.80; 95% confidence interval, 1.84-4.27; P<.001) and in immunocompromised individuals (hazard ratio, 2.35; 95% confidence interval, 1.35-4.08; P=.006). Women and anyone aged 50 years or older at the index episode also had a greater likelihood of recurrence.

CONCLUSION

Rates of HZ recurrence appear to be comparable to rates of first HZ occurrence in immunocompetent individuals, suggesting that recurrence is sufficiently common to warrant investigation of vaccine prevention in this group.

Section snippets

PATIENTS AND METHODS

We reviewed the medical records of a community population–based cohort of people with a confirmed episode of HZ followed up for recurrence for as long as 12 years after the index episode. Recurrence rates were expressed by time from the index episode to the first recurrence and stratified by sex, age, and immune status (immunocompromised or immunocompetent) as assessed at the time of the initial or index episode of HZ. Data from the Rochester Epidemiology Project22, 23 made it possible to

RESULTS

Of the 1669 adults with an index episode of HZ between January 1, 1996, and December 31, 2001, 1005 (60.2%) were women and 139 (8.3%) were immunocompromised at the time of the index HZ episode; median age was 59.4 years (mean, 59.4 years; range, 22-100 years). Additional description of the cohort has been published previously.17

For the recurrence study, the 1669 incident HZ cases were followed forward for a mean of 7.3 years (range, 1 day to 11.7 years) through December 31, 2007, looking for HZ

DISCUSSION

In a cohort of adults in Olmsted County, Minnesota, with an initial HZ episode from January 1, 1996, through December 31, 2001, the population-based recurrence rate of HZ was 6.2% after 8 years of follow-up. For many people, HZ is not a once-in-a-lifetime event, demonstrating that having HZ does not ensure protection against future HZ episodes. Indeed, after adjustment for age and sex, the rate of recurrent episodes was similar to the incidence rate of HZ episodes in the same population,17

CONCLUSION

During an average of 7 years of follow-up, HZ recurrences were as common as HZ incident occurrences in the studied population, when matching for age, sex, and immune status. Zoster vaccine is recommended for prevention of incident cases of HZ. Our high HZ recurrence rates suggest that zoster vaccination should be offered in people who have had an HZ episode to prevent potential recurrences.

REFERENCES (28)

  • M Schwickert et al.

    Recurrent herpes zoster with neuralgia [in German]

    Forsch Komplement Med

    (2006)
  • AH Bruning et al.

    Recurrent herpes zoster and high-dose inhaled steroids for asthma [letter]

    S Afr Med J

    (1994)
  • D Cvjetković et al.

    Reactivation of herpes zoster infection by varicella-zoster virus [in Croatian]

    Med Pregl

    (1999)
  • E Epstein

    Recurrences in herpes zoster

    Cutis

    (1980)
  • Cited by (0)

    This work was funded by grants from Merck Research Laboratories, North Wales, PA; the National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR30582); and the National Institute on Aging (AG034676).

    An earlier version of this article appeared Online First.

    View full text