European ADULT IMMUNISATION HUB

What is Herpes Zoster?

Herpes zoster is a serious disease in older people and in the immunocompromised. In the absence of antiviral therapy, up to 45% of patients over 60 years of age experience considerable pain for 6–12 months [Scott et al, 2006; Wareham and Breuer 2007], seve­rely affecting their quality of life [Drolet 2010].

Herpes Zoster (Shingles)

  • A painful, blistering skin rash caused by the va­ricella-zoster virus, which also causes chickenpox
  • After a chickenpox infection, the virus remains inactive in certain nerves in the body [Harpaz 2008]
  • Shingles occurs when the virus becomes active again years later
  • Symptoms include severe pain, tingling or burning and the appearance of a rash and small blisters that may burst and crust over
  • The triggers for viral reactivation are unknown, and it is impossible to predict if and when shingles will occur [Harpaz 2008]

Epidemiology

  • Herpes Zoster is common in people ≥50 years of age.
  • People ≥50 years of age account for 70% of the estimated 1 million new cases per year seen in the US [Harpaz 2008]
  • The incidence in people >60 years of age is 10 cases per 1000 population per year [Thomas and Hall 2007]
  • The lifetime risk of developing shingles is ap­proximately 1 in 3 [Harpaz 2008]
  • By the age of 85 years, 50% of people will have had shingles [Thomas and Hall 2007]
  • The disease can recur more than once [Harpaz 2008]

Transmission

Shingles is considerably less contagious than chickenpox but can be transmitted to non-immune people, resulting in a primary varicella infection [CDC 2013].

Complications

Postherpetic neuralgia (nerve pain) is the most common complication of shingles. A variety of other complications can occur [Harpaz 2008]:

  • Neurologic (nervous system)
  • Ophthalmic (vision)
  • Cutaneous (skin)
  • Visceral (gut; rare)
  • Complications such as pneumonia and encephalitis rarely occur, but may lead to persistent complications or even death.

Hospitalisation [WHO European Hospital Morbi­dity Database]

Hospitalisation rates are very low in EU-27.

  • Austria has much higher reported rates of hospita­lisations (~0.3 per 1000) than any other reporting country

Mortality [WHO Detailed European Mortality Database]

Mortality rates are very low in EU-27.

  • In 2010 the mortality rates had fallen to an average of 0.03 per 100,000
  • The Netherlands had the highest morta­lity rate at 0.09 per 100,000, followed by Sweden and the UK at 0.05 per 100,000

Vaccination and Control Strategies

  • It is difficult to eradicate varicella-zoster because of its ability to establish latency (i.e. the virus can lie dormant).
  • In the US, universal varicella vaccination was adopted for children in 1995. The vaccinationprogramme produced a 90-95% decline in chicken pox in children aged 1-9 years of age and reduced the incidence of zoster in children aged 10 years by 55%. Live attenuated varicella-zoster vaccina­tion is recommended for healthy adults aged 60 or more and at risk groups [CDC, US children and adult schedules 2012].
  • In Europe, recommendations cover people aged over 50.

 Herpes Zoster: Summary of Key Points

  • Herpes Zoster is extremely painful and serious in older adults and the immunocompromised
  • Up to 45% of >60 year olds with shingles experience pain for 6-12 months
  • By the age of 85 years, 50% of people will have had shingles
  • Hospitalisation and mortality rates are low