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Medical News & Perspectives
August 7, 2019

Increasing Cases of Shingles in the Eye Raise Key Questions

JAMA. 2019;322(8):712-714. doi:10.1001/jama.2019.10743

At first look, Nakul Shekhawat, MD, MPH, thought the explanation for his research results was obvious. Shekhawat and his colleagues at the University of Michigan found that the incidence of herpes zoster ophthalmicus (HZO)—shingles of the eye—had tripled in the United States from 2004 to 2016. He chalked it up to the aging US population. “That’s what you would think,” he said.

It’s a reasonable assumption. Virtually every US-born adult aged 40 years or older has been infected with varicella zoster virus, which causes chickenpox. Although universal varicella vaccination was introduced in 1995, millions of older adults have waning cell-mediated immunity that leaves them vulnerable to reactivation of varicella virus, which causes shingles. Older age is a prominent risk factor for the condition, which usually causes a painful, itching unilateral rash on the chest and back. Shekhawat’s data showed that older age is a risk factor for HZO, too.