Elsevier

Mayo Clinic Proceedings

Volume 82, Issue 11, November 2007, Pages 1341-1349
Mayo Clinic Proceedings

ORIGINAL ARTICLE
A Population-Based Study of the Incidence and Complication Rates of Herpes Zoster Before Zoster Vaccine Introduction

https://doi.org/10.4065/82.11.1341Get rights and content

OBJECTIVE

To establish accurate, up-to-date, baseline epidemiological data for herpes zoster (HZ) before the introduction of the recently licensed HZ vaccine.

METHODS

Using data from January 1, 1996, to October 15, 2005, we conducted a population-based study of adult residents (≥22 years) of Olmsted County, MN, to determine (by medical record review) the incidence of HZ and the rate of HZ-related complications. Incidence rates were determined by age and sex and adjusted to the US population.

RESULTS

A total of 1669 adult residents with a confirmed diagnosis of HZ were identified between January 1, 1996, and December 31, 2001. Most (92%) of these patients were immunocompetent and 60% were women. When adjusted to the US adult population, the incidence of HZ was 3.6 per 1000 person-years (95% confidence interval, 3.4-3.7), with a temporal increase from 3.2 to 4.1 per 1000 person-years from 1996 to 2001. The incidence of HZ and the rate of HZ-associated complications increased with age, with 68% of cases occurring in those aged 50 years and older. Postherpetic neuralgia occurred in 18% of adult patients with HZ and in 33% of those aged 79 years and older. Overall, 10% of all patients with HZ experienced 1 or more nonpain complications.

CONCLUSIONS

Our population-based data suggest that HZ primarily affects immunocompetent adults older than 50 years; 1 in 4 experiences some type of HZ-related complication.

Section snippets

Overview

This retrospective population-based study includes information on all adult (≥22 years) residents of Olmsted County, MN, who were diagnosed by a physician as having HZ between January 1, 1996, and December 31, 2001. Potential patients for the HZ study were identified from a broad search of diagnostic and billing codes (ICD-8 [International Classification of Diseases, Eighth Revision] codes 053.xx) for HZ and HZ complications. The medical records regarding each potential patient were reviewed to

Confirmed Cases

Of the 2131 patients aged 22 years or older with new HZ diagnosis codes between January 1, 1996, and December 31, 2001, 462 were excluded after medical record review. Of those 462, 172 were excluded for “administrative reasons”: 137 (80%) were Olmsted County residents in the years after the HZ diagnosis but not at the time of the HZ diagnosis; 12 (7%) were county residents but had HZ diagnoses made outside the county; 7 (4%) had missing medical records; and 16 (9%) changed their research

DISCUSSION

Our 1669 medically confirmed new-onset cases of HZ represent the largest population-based HZ case series in the medical literature. From 1996 to 2001, the incidence of HZ increased, culminating in a rate of 4.1 per 1000 person-years by 2001. If medical record confirmation had not been required, an additional 290 cases would have been included, increasing the incidence in Olmsted County from 3.4 to 4.0 per 1000 person-years.

Two-thirds of the patients with confirmed HZ were older than 50 years,

CONCLUSIONS

Herpes zoster is common; increases with age, most markedly in those aged 50 to 59 years; and has increased in incidence in recent years. Most HZ and HZ complications occur in immunocompetent individuals. Among persons with HZ, 1 in every 4 suffers 1 or more complications, including pain that lasts longer than 30 days and nonpain complications such as ocular disease or motor neuropathies.

Acknowledgments

The authors appreciate the secretarial support of Dawn Littlefield and the data abstraction work of Linda Paradise, RN; Chris Parisi, MSW; Christine Pilon-Kacir, RN, DSN; Mary Duffy, RN; Margaret Donahue, RN; and Lilianna Rocca, MD.

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    This work was funded by grants from Merck Research Laboratories, North Wales, PA, and the National Institutes of Health (AR30582).

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