Introduction: Herpes zoster (HZ; shingles) is a painful, cutaneous disease caused by reactivation of the varicella zoster virus, which causes varicella (chickenpox) typically during childhood. The considerable healthcare burden of HZ is relatively well documented, with approximately one in three individuals experiencing at least one episode during their lifetime, debilitating symptoms including neuropathic pain, and complications such as post-herpetic neuralgia, vision loss, and rarely, stroke, and increased severity in immunocompromised individuals. However, we are not aware of a comprehensive review of literature specifically examining the burden of HZ recurrence.
Methods: We conducted a PubMed search (1 January 2003-2 February 2023) to assess available literature on the incidence, risk factors, and clinical features of HZ recurrence.
Results: The incidence of HZ recurrence reported by the studies identified was wide ranging. Studies in general populations of immunocompetent or immunocompetent/immunosuppressed (mixed) populations with an initial HZ episode estimate that approximately 1.2-9.6% of individuals may experience HZ recurrence, with an incidence rate of 1.7-16.6 cases per 1000 person-years. HZ recurrence was reported in 0.0-18.2% of immunocompromised individuals with HZ, with an incidence rate of 17.0-55 cases per 1000 person-years. Incidence rates varied according to study design, follow-up, and study populations. Recognized risk factors for HZ recurrence include immunocompromised status, female sex, family history, and comorbidities such as diabetes. Other factors that may predispose individuals to recurrence include long-lasting pain after the initial HZ episode and the presence of herpes zoster ophthalmicus.
Discussion: Our review underlines that following an initial HZ episode, individuals remain at risk of HZ recurrence, adding to the disease burden in a population. As HZ is preventable by vaccination, national HZ vaccination recommendations should include the need for and timing of vaccination in both immunocompetent and immunocompromised individuals who have a history of HZ.
Keywords: Complications; Epidemiology; Herpes zoster; Incidence; Older adults; Recurrence; Risk factors; Shingles.
Herpes zoster (HZ), also known as shingles, results from the same virus that causes chickenpox in childhood. In shingles, the chickenpox virus is reactivated, most commonly causing a painful skin rash. About one in three people have shingles at least once in their lifetime. Neuralgia (a burning, stabbing, and sometimes severe pain along a nerve pathway) may continue for months after the initial rash. Shingles may lead to loss of vision and rarely stroke. Shingles is more severe in people with weakened immunity. We reviewed published information on shingles recurrence (i.e., a second, third, or later episode of shingles), as we were not aware of a broad review of information specifically on recurrence. We focused on the rate of recurrence and factors that increase the risk of recurrence. Overall, in around one-tenth of individuals who experience shingles, the disease may reoccur after complete resolution. The rate of recurrence varied on the basis of how the studies were carried out and the type of patients included in the studies. Well-known factors that increase the risk of shingles recurrence are reduced immunity, female sex, family history, and other conditions (e.g., diabetes). Other factors that may increase the risk of shingles recurrence include pain that lasts for a long time after the first episode of shingles and having herpes zoster ophthalmicus, which leads to eye complications. Our review summarizes available data. As shingles is preventable by vaccination, strategies to prevent this disease should include those who have a history of shingles.
© 2024. The Author(s).