Despite the availability of two vaccines, the incidence of herpes zoster (HZ) has been increasing in recent decades. Yet, little research has been conducted on what has happened to incidence rates of HZ and postherpetic neuralgia (PHN) since their introduction.

To remedy that, a study published in Clinical Infectious Diseases focused on incidence rates of HZ and PHN from 1994 to 2018 in the United States to determine if they have continued to increase since HZ vaccines became available.

To that end, University of California San Francisco–led researchers used a de-identified longitudinal administrative claims database, the OptumLabs Data Warehouse, to assess incidence rates among individuals continuously enrolled in the database for a year or more with no prior history of HZ or PHN. 

Overall, 610,766 HZ patients were identified; they had a median age of 56.3 years [IQR: 43.0, 68.7], 59.8% were women, and 70.6% were white. Results indicate that, from 1994 to 2018, the incidence of HZ increased from 286.0 (95% CI: 259.1, 312.8) to 579.6 (95% CI: 554.2, 605.0) cases per 100,000 person-years, an annual increase of 3.1% (95% CI: 2.5, 3.6). 

On the other hand, since 2007, annual HZ incidence rates have decreased in individuals aged 20 years and younger and age 60 years and older. The overall incidence rate of PHN was 57.5 (95% CI: 56.0, 59.0) cases per 100 000 person-years. Researchers report that the proportion of individuals with HZ who developed PHN was higher from 2007 to 2018 than from 1994 to 2006, however.

“Herpes zoster incidence rates have continued to increase in age groups for which HZ vaccines are not currently recommended, warranting a review of current vaccine recommendations,” the authors write.

Since licensing of the recombinant zoster vaccine Shingrix in 2017, that has been the preferred vaccine, according to CDC. The CDC recommends that healthy adults aged 50 years and older get two doses of Shingrix, 2 to 6 months apart. 

In patients receiving Zostavax, zoster vaccine live, the CDC recommends a single dose for people aged 60 years old or older, whether or not the person reported a prior episode of HZ.
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