June 9, 1997

The Sequelae of Herpes Zoster

Author Affiliations

From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital (Drs Galil, Choo, Donahue, and Platt), and Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (Dr Platt), Boston, Mass. Dr Galil is now with the Centers for Disease Control and Prevention, Atlanta, Ga.

Arch Intern Med. 1997;157(11):1209-1213. doi:10.1001/archinte.1997.00440320105010

Background:  The last 40 years was a period during which the incidence of herpes zoster appears to have increased substantially.

Objective:  To determine whether the risk of complications of herpes zoster has changed during the last 40 years.

Methods:  The automated medical records of a health maintenance organization were screened for diagnosis codes suggesting herpes zoster and potentially complicated cases of zoster. The predictive value of a herpes zoster diagnosis was calculated from sampling full-text records. Records of all patients with codes suggesting complications were reviewed in full.

Results:  Of 859 individuals with herpes zoster who met the eligibility criteria, 101 were identified who experienced at least 1 complication, corresponding to a 60-day risk of 12%. Corrected for the sensitivity of the complication-finding strategy, the risk estimate was 14%. Risk increased markedly with age, with those older than 64 years having more than 6 times the risk of complications of those younger than 25 years (odds ratio, 8.3; 95% confidence interval, 2.5-29.3). Trigeminal distribution of rash and the presence of certain conditions associated with immune compromise appeared to increase risk.

Conclusions:  The apparent increase in the incidence of herpes zoster was not accompanied by a change in the risk of specific or overall complications in a population-based sample. Advanced age and other conditions associated with waning cellular immunity may confer an increased risk of experiencing a complicated course of herpes zoster.Arch Intern Med. 1997;157:1209-1213