The epidemiology of herpes zoster in immunocompetent, unvaccinated adults ≥50 years old: Incidence, complications, hospitalization, mortality, and recurrence

Academic Article


  • Background. Data on the epidemiology of herpes zoster (HZ), particularly in the unvaccinated immunocompetent population, are needed to assess disease burden and the potential impact of vaccination. Methods. The study at a large health care organization comprised: (1) incidence estimated from immunocompetent adults aged ≥50 years unvaccinated with zoster vaccine live who had incident HZ in 2011-2015; (2) proportion of HZ-related nonpain complications assessed by double abstraction of electronic health records (EHRs) of 600 incident patients 2011-2015; (3) HZ-related hospitalizations among HZ patients diagnosed in 2015; (4) HZ-related death determined from automated data and EHRs; and (5) recurrent HZ identified from a cohort initially diagnosed with HZ in 2007-2008 and followed through 2016. Results. HZ incidence rate was 9.92/1000 person-years (95% confidence interval [CI], 9.82-10.01). Proportions of cutaneous, neurologic, and other complications were 6.40% (95% CI,1.73%-11.07%), 0.77% (95% CI,.00%-2.36%), and 1.01% (95% CI,.00%-2.93%), respectively. Only 0.86% of patients had an HZ-related hospitalization. The case-fatality rate was 0.04%. Recurrence rate was 10.96/1000 person-years (95% CI, 10.18-11.79) with 10-year recurrence risk of 10.26% (95% CI, 9.36%-11.23%). Conclusions. These recent HZ epidemiology data among an immunocompetent, unvaccinated population measure real-world disease burden.
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    Digital Object Identifier (doi)

    Author List

  • Tseng HF; Bruxvoort K; Ackerson B; Luo Y; Tanenbaum H; Tian Y; Zheng C; Cheung B; Patterson BJ; van Oorschot D
  • Start Page

  • 798
  • End Page

  • 806
  • Volume

  • 222
  • Issue

  • 5