Shingles burden of disease study

Watch a video summary of this study from Professor Azeem Majeed, Professor of Primary Care and Public Health at Imperial College London.

Insights from a large (N=29,292,141) retrospective cohort study of adults in England^1-3

A study in England by Yanni et al. investigated shingles incidence in adults with 16 immunocompromising conditions using Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases (January 2000–March 2012). The overall shingles incidence rate was higher in adults with immunocompromising conditions (7.8 per 1,000 person-years [PY]; 95% confidence interval [CI], 7.7–7.9 ) than in those without (6.2 per 1,000 PY; 95% CI, 6.1–6.3), highlighting an elevated burden in these vulnerable groups.⁴

The retrospective cohort study presented here aimed to provide up-to-date data on the burden of shingles faced by these at-risk groups and others. The primary objective was to estimate the annual incidence rate from 2012 to 2019 and the overall incidence rate in adults with immunocompromising conditions.¹

Secondary objectives included estimating the annual (2012–2019) and overall shingles incidence rates in adults with certain chronic conditions, as well as adults without immunocompromising conditions, and adults without both immunocompromising or chronic conditions.²

This retrospective cohort study used electronic medical record (EMR) data from CPRD, with linkage to HES and the Office for National Statistics in England
Adults with a CPRD-HES database record of conditions of interest and who met the patient eligibility criteria were identified from 2012 to 2018 and followed up until 31 December 2019
Patients were followed up from index date (diagnosis of immunocompromising or chronic condition or registration in the CPRD) until the earliest of death, study end, transfer out of GP practice, last data collection at GP practice, or vaccination with the live zoster vaccine (ZVL) or recombinant zoster vaccine (RZV)

Study design¹

*Patients were followed up from the index date until the earliest of the following dates: death, transfer out of the GP practice, last data collection in the GP practice, HZ vaccination, 31 December 2019.

Figure adapted from Mahmood A, et al. Poster presented at ESCMID Global 2025.

Those with immunocompromising conditions had at least one recorded CPRD code for:

Haematological malignancies (including leukaemia, lymphoma, myeloma)
Haematopoietic stem cell transplantation (HSCT)
Solid organ transplant (SOT)
Solid organ malignancies (SOM)
Human immunodeficiency virus (HIV)
Autoimmune diseases (including autoimmune thyroiditis [AT], inflammatory bowel disease [IBD], rheumatoid arthritis [RA], multiple sclerosis [MS], psoriasis/psoriatic arthritis, polymyalgia rheumatica [PR], systemic lupus erythematosus [SLE])

Those with chronic conditions had at least one recorded CPRD MedCode and/or ICD-10 code for:

Asthma
Chronic obstructive pulmonary disease (COPD)
Chronic kidney disease (CKD) (including end-stage renal disease and dialysis patients)
Diabetes mellitus
Coronary artery disease
Heart failure
Chronic liver disease
Depression and/or anxiety

The gender distribution, mean age in each age group, and mean follow-up are presented below:

Baseline characteristics

		Immunocompromising conditions (N=1,764,900)	Immunocompromising condition free (N=12,867,750)	Chronic condition (N=6,423,633)	Immunocompromising and chronic condition free (N=8,235,858)
Gender, n (%)	Female	984,454 (55.78)	6,471,755 (50.29)	3,488,236 (54.30)	3,893,079 (47.27)
Gender, n (%)	Male	780,446 (44.22)	6,395,955 (49.71)	2,935,397 (45.70)	4,342,779 (52.73)
Age group (years) at index data, n (%)	18–49 years	605,856 (34.33)	9,232,133 (71.75)	3,562,279 (55.46)	6,468,194 (78.54)
	50–59 years	301,263 (17.07)	1,511,801 (11.75)	936,607 (14.58)	859,970 (10.44)
	60–64 years	174,723 (9.90)	607,755 (4.72)	437,108 (6.80)	315,190 (3.83)
	65–69 years	186,480 (10.57)	497,503 (3.87)	409,646 (6.38)	236,392 (2.87)
	70–79 years	277,394 (15.72)	604,817 (4.70)	589,487 (9.18)	236,776 (2.87)
	≥80 years	219,184 (12.42)	413,741 (3.22)	488,506 (7.60)	119,336 (1.45)
Time from population index date to end of follow-up (years)	Mean (SD)	4.23 (2.86)	4.33 (2.93)	4.36 (2.88)	3.91 (2.86)

Findings

Incidence rates of shingles in adults with immunocompromising conditions increase with age and are reasonably stable over time¹

Annual shingles incidence rates in adults with immunocompromising conditions by age group (2012–2019)¹

Figure showing the annual shingles incidence rates per 1000 person years in adults with immunocompromising conditions by age group (2012-2019)

Figure adapted from Mahmood A, et al. Poster presented at ESCMID Global 2025.

The study’s main finding was that shingles incidence rates in adults with immunocompromising conditions increased with age and were reasonably stable over time.¹ Across the entire study period, women with immunocompromising conditions had consistently higher overall incidence rates than men (8.19 [95% CI, 8.11–8.28] vs 6.55 [95% CI, 6.46–6.64] per 1,000 PY).¹ A similar trend was seen in the immunocompromising condition-free group (women, 4.04 [95% CI, 4.01–4.06] vs men, 2.67 [95% CI, 2.65–2.69] per 1,000 PY).⁵

Shingles incidence rates are higher in adults with immunocompromising conditions than in those without in all age groups^{1, 5}

Shingles incidence rates by age group in adults with and without immunocompromising conditions across the entire study period⁵

Graph showing shingles incidence rates per 1000 person years by age group in adults with and without immunocompromising conditions (2012-2019)

Across all age groups, a higher proportion of adults with immunocompromising conditions experienced postherpetic neuralgia compared with adults without immunocompromising conditions.⁶

Find out more

Complications

Read more about the potential complications of shingles

Shingles incidence rate varies by immunocompromising condition¹

Shingles incidence rates by first immunocompromising condition across the entire study period^{1, 5}

Graph showing shingles incidence rates per 1000 person years by first immunocompromising condition (2012-2019)

Figure adapted from Mahmood A, et al. Poster presented at ESCMID Global 2025.

Reported shingles incidence rates for the entire study period were high across immunocompromising conditions and highest in adults with the following conditions:¹

Haematological malignancies (13.32 per 1,000 PY), followed by:
Polymyalgia rheumatica (12.15 per 1,000 PY)
Solid organ transplant (10.70 per 1,000 PY)
Systemic lupus erythematosus (10.19 per 1,000 PY)

For the entire study period, the incidence rate of shingles in adults with any immunocompromising condition of interest was 7.49 per 1,000 PY (95% CI, 7.43–7.55), compared with 3.33 per 1,000 PY (95% CI, 3.31–3.34) in adults without immunocompromising conditions.¹

Find out more

Infection, latency and reactivation

Read more about the factors that contribute to a high risk of shingles

Incidence rates of shingles in adults with chronic conditions increase with age and are reasonably stable over time²

Annual shingles incidence rates in adults with at least one chronic condition by age group²

Graph showing annual incidence rates from 2012-2019 per 1000 person years in adults with at least once chronic condition by age group

Figure adapted from Mahmood A, et al. Poster presented at RCGP 2025.

Another key finding of the study was that shingles incidence rates in adults with chronic conditions increased with age and were stable over time. Women with at least one chronic condition had consistently higher incidence rates than men (5.88 [95% CI: 5.85–5.92] vs 4.30 [4.26–4.34] per 1,000 PY).²

The incidence rate of shingles varies by chronic condition²

Shingles incidence rates by first chronic condition across the entire study period²

Graph showing shingles incidence rates per 1000 person years by first chronic condition across the entire study period

Figure adapted from Mahmood A, et al. Poster presented at RCGP 2025.

The overall incidence rate of shingles in adults with at least one chronic condition across the entire study period was 5.16 per 1,000 PY (95% CI: 5.14–5.19) compared with 2.47 per 1,000 PY (95% CI: 2.45–2.49) in adults without any chronic or immunocompromising condition.²

Reported overall shingles incidence rates were highest in adults with CKD, COPD, heart failure and coronary artery disease.²

Dive deeper with charts on shingles incidence rates in specific immunocompromising and chronic conditions^{1, 2}

The incidence rate of shingles in adults with CKD, haematological malignancies and certain cardiovascular conditions was high, increased with age and remained consistent over time.^{1-3, 7}

CKD

Shingles incidence rates in adults with CKD by age group across the entire study period²

Figure adapted from Mahmood A, et al. Poster presented at RCGP 2025.

Adults with CKD aged 18–49, 50–59 and 60–64 years had higher reported overall shingles incidence rates compared with adults with other chronic condition in the same age ranges.²
Haematological malignancies³

Shingles incidence rates in adults with haematological malignancies by age group across the entire study period³

Figure adapted from Parry H, et al. Poster presented at BSH 2025.

Of the immunocompromising conditions of interest, shingles incidence rates were highest in adults with haematological malignancies.³
Cardiovascular conditions⁷

Shingles incidence rates in adults with at least one chronic condition, adults with coronary artery disease or heart failure, and adults without chronic or immunocompromising conditions, by age group across the entire study period⁷

Figure adapted from Mahmood A, et al. Poster presented at BCS 2025.

Adults with coronary artery disease or heart failure had higher shingles incidence rates than adults with no chronic or immunocompromising condition.⁷

Dive deeper with more detailed reference tables on shingles incidence rates

Full breakdown by age group for each immunocompromising condition

Although the incidence rate of shingles increases with age, rates in younger adults with certain immunocompromising conditions are comparable to those in older adults with other immunocompromising conditions.¹ For example, the shingles incidence rate was 11.62 (95% CI: 10.66–12.64) in adults aged 50–59 with haematological malignancies and 11.65 (95% CI: 11.34–11.97) in those aged ≥80 years with solid organ malignancies.¹

Shingles incidence rates by age group and first immunocompromising condition across the entire study period¹

Incidence rates of shingles per 1,000 person-years

(95% confidence interval)

Overall

18–49 years

50–59 years

60–64 years

65–69 years

70–79 years

≥80 years

7.49

(7.43–7.55)

3.34

(3.26–3.42)

6.23

(6.10–6.36)

8.02

(7.82–8.22)

8.91

(8.71–9.11)

11.82

(11.62–12.03)

12.58

(12.34–12.81)

Haematological malignancies

(n=74,197; 4.20%)

13.32

(12.90–13.76)

5.70

(5.13–6.32)

11.62

(10.66–12.64)

15.32

(13.92–16.81)

16.58

(15.28–17.95)

16.89

(15.86–17.97)

17.21

(16.01–18.46)

Polymyalgia rheumatica

(n=77,996; 4.42%)

12.15

(11.75–12.55)

4.91

(3.11–7.24)

7.04
(5.83–8.39)

9.09

(7.81–10.49)

9.42

(8.44–10.47)

12.65

(11.92–13.40)

13.93

(13.30–14.58)

Solid organ transplant

(n=19,416; 1.10%)

10.70

(9.99–11.45)

6.21

(5.38–7.12)

11.69

(10.19–13.32)

15.36

(12.77–18.26)

12.74

(10.32–15.49)

17.54

(14.65–20.77)

15.93

(12.32–20.13)

Systemic lupus erythematosus

(n=13,164; 0.75%)

10.19

(9.37–11.05)

7.98

(6.91–9.13)

11.26

(9.53–13.17)

14.48

(11.46–17.94)

10.86

(8.18–14.03)

13.43

(10.41–16.95)

9.59

(5.86–14.52)

Haematopoietic stem cell transplantation

(n=1581; 0.09%)

9.39

(7.11–12.08)

6.13

(3.75–9.29)

12.63

(7.07–20.30)

**

(4.72–26.50)

14.36

(5.27–29.60)

16.24

(6.53–31.89)

*

(2.04–26.37)

Solid organ malignancy

(n=652,458; 36.97%)

8.46

(8.35–8.58)

3.60

(3.39–3.82)

6.36

(6.11–6.62)

7.36

(7.04–7.69)

7.90

(7.61–8.19)

10.87

(10.59–11.15)

11.65

(11.34–11.97)

Rheumatoid arthritis

(n=236,500; 13.40%)

7.84

(7.68–8.00)

3.23

(3.03–3.42)

6.45

(6.16–6.75)

8.28

(7.82–8.75)

10.15

(9.65–10.66)

13.18

(12.63–13.74)

14.39

(13.62–15.18)

Multiple sclerosis

(n=34,533; 1.96%)

6.99

(6.58–7.41)

4.69

(4.15–5.28)

7.27

(6.49–8.11)

7.10

(5.95–8.39)

8.92

(7.57–10.40)

11.24

(9.54–13.11)

12.20

(9.35–15.53)

Inflammatory bowel disease (n=136,527; 7.74%)

6.92

(6.71–7.13)

4.37

(4.12–4.63)

6.28

(5.84–6.73)

8.40

(7.65–9.19)

9.89

(9.08–10.74)

12.63

(11.73–13.57)

12.03

(10.90–13.23)

Human immunodeficiency virus

(n=22,946; 1.30%)

6.49

(5.97–7.04)

5.91

(5.30–6.56)

7.04

(5.96–8.22)

7.16

(4.83–10.08)

13.08

(8.69–18.63)

11.51

(6.44–18.51)

0
(N/A)

Autoimmune thyroiditis

(n=39,585; 2.24%)

6.03

(5.66–6.42)

3.40

(3.01–3.83)

6.95

(6.16–7.81)

7.45

(6.14–8.93)

8.43

(6.92–10.14)

13.32

(11.24–15.63)

12.90

(10.13–16.10)

Psoriasis or psoriatic arthritis

(n=462,131; 26.18%)

5.05

(4.96–5.15)

2.45

(2.35–2.54)

4.83

(4.62–5.04)

7.14

(6.76–7.53)

7.86

(7.46–8.28)

11.03

(10.55–11.51)

11.80

(11.16–12.47)

*Masked for confidentiality and data protection reasons (<5 cases); **Masked to prevent back-calculation of smallest value.

Full breakdown by age group for each chronic condition

The incidence rate of shingles increases with age across chronic conditions²

Shingles incidence rates by age group in adults with at least one chronic condition across the entire study period²

Overall

(N=6,423,633)

Age group (years)

18–49 years

(n=3,562,279)

50–59 years

(n=936,607)

60–64 years

(n=437,108)

65–69 years

(n=409,646)

70–79 years

(n=589,487)

≥80 years

(n=488,506)

Incidence rates of shingles per 1,000 person-years

(95% confidence interval)

5.16

(5.14–5.19)

2.45

(2.42–2.48)

4.92

(4.86–4.98)

6.67

(6.56–6.77)

7.59

(7.48–7.70)

10.40

(10.28–10.52)

11.54

(11.40–11.68)

Condition

Chronic kidney disease

(n=307,023; 4.78%)

8.77

(8.61–8.93)

3.36

(3.07–3.66)

5.66

(5.27–6.06)

7.23

(6.71–7.77)

7.70

(7.25–8.16)

10.29

(9.93–10.66)

11.37

(11.05–11.69)

Chronic obstructive pulmonary disease

(n=174,410; 2.72%)

8.74

(8.51–8.97)

2.50

(2.10–2.94)

5.33

(4.87–5.81)

6.92

(6.36–7.50)

8.61

(8.08–9.15)

11.18

(10.68–11.69)

12.31

(11.69–12.96)

Heart failure

(n=79,152; 1.23%)

8.60

(8.23–8.99)

2.41

(1.79–3.16)

4.66

(3.86–5.56)

6.40

(5.31–7.62)

6.56

(5.61–7.60)

9.82

(8.96–10.72)

11.54

(10.85–12.27)

Coronary artery disease

(n=402,518; 6.27%)

8.56

(8.42–8.70)

2.34

(2.02–2.70)

4.23

(3.96–4.51)

6.16

(5.80–6.53)

6.97

(6.64–7.30)

10.19

(9.89–10.49)

11.80

(11.49–12.11)

Diabetes mellitus

(n=648,734; 10.10%)

5.80

(5.71–5.89)

2.29

(2.16–2.41)

4.18

(4.02–4.34)

5.52

(5.28–5.77)

6.35

(6.10–6.61)

8.91

(8.65–9.18)

10.00

(9.66–10.35)

Depression and/or anxiety

(n=2,946,398; 45.87%)

4.76

(4.72–4.80)

2.50

(2.47–2.54)

5.05

(4.97–5.14)

6.88

(6.73–7.04)

7.91

(7.73–8.09)

10.80

(10.58–11.02)

11.89

(11.59–12.20)

Chronic liver disease

(n=111,453; 1.74%)

4.72

(4.53–4.92)

1.89

(1.69–2.09)

4.34

(3.98–4.72)

5.91

(5.29–6.58)

7.52

(6.78–8.31)

9.90

(8.99–10.87)

11.49

(10.05–13.05)

Asthma

(n=1,817,239; 28.29%)

4.05

(4.01–4.09)

2.40

(2.36–2.44)

5.05

(4.93–5.18)

7.23

(6.97–7.49)

8.13

(7.85–8.43)

11.50

(11.16–11.84)

12.55

(12.10–13.00)

Full breakdown by age group and year in adults with immunocompromising conditions

Overall and annual shingles incidence rates by age group in adults with immunocompromising conditions (2012–2019)¹

	Age group (years)
	18–49			50–59			60–64			65–69			70–79			≥80
	HZ N	IR	95% CI	HZ N	IR	95% CI	HZ N	IR	95% CI	HZ N	IR	95% CI	HZ N	IR	95% CI	HZ N	IR	95% CI
Overall	7,409	3.34	3.26–3.42	8,916	6.23	6.10–6.36	6,098	8.02	7.82–8.22	7,703	8.91	8.71–9.11	13,347	11.82	11.62–12.03	11,101	12.58	12.34–12.81
2012	842	3.24	3.02–3.46	934	6.12	5.73–6.52	718	7.86	7.29–8.45	898	9.19	8.60–9.81	1,769	11.01	10.50–11.53	1,467	12.32	11.69–12.96
2013	853	3.23	3.01–3.45	928	5.84	5.47–6.23	698	7.78	7.21–8.37	943	9.10	8.53–9.70	1,935	11.80	11.28–12.34	1,559	12.85	12.22–13.50
2014	897	3.33	3.12–3.56	1,101	6.63	6.25–7.03	674	7.48	6.93–8.07	1,027	9.55	8.97–10.14	1,863	11.93	11.40–12.48	1,543	12.85	12.22–13.51
2015	904	3.29	3.08–3.51	1,079	6.17	5.81–6.55	786	8.56	7.97–9.17	957	8.59	8.06–9.15	1,704	11.82	11.27–12.39	1,408	12.31	11.68–12.97
2016	923	3.28	3.07–3.50	1,151	6.23	5.88–6.60	727	7.67	7.12–8.25	972	8.53	8.00–9.08	1,610	11.72	11.15–12.30	1,349	12.29	11.64–12.96
2017	984	3.44	3.23–3.66	1,195	6.22	5.88–6.58	787	8.05	7.50–8.63	926	8.28	7.76–8.83	1,606	12.08	11.50–12.68	1,274	12.24	11.57–12.92
2018	967	3.32	3.12–3.54	1,224	6.16	5.82–6.51	823	8.13	7.58–8.70	1,041	9.46	8.90–10.05	1,474	11.93	11.33–12.55	1,305	13.15	12.45–13.88
2019	1,039	3.56	3.35–3.79	1,304	6.43	6.08–6.78	885	8.54	7.99–9.12	939	8.63	8.09–9.20	1,386	12.59	11.94–13.27	1,196	12.62	11.91–13.35

Key findings from the study

Burden of shingles increases with age, and is highest in adults over the age of 80.
Adults with immunocompromising conditions are at risk of shingles regardless of age, underscoring the importance of timely diagnosis and proactive management.
Among all immunocompromising conditions studied, adults with haematological malignancies have the highest incidence rates of shingles.
Adults with chronic conditions, such as CKD, COPD, heart failure and coronary artery disease, are at an increased risk of shingles compared with adults without chronic conditions.

References

Mahmood A, Nishimwe M, Vekria Y, et al. Herpes zoster incidence rates in immunocompromised adults aged 18 years or older in England: A large retrospective cohort study using data from the Clinical Practice Research Datalink (2012–2019). Presented at ESCMID Global 2025. P0230.
Mahmood A, Nishimwe M, Vekria Y, et al. Herpes zoster incidence in adults with chronic conditions: a large retrospective cohort study using data from Clinical Practice Research Datalink (2012-2019). Presented at RCGP 2025. P9101.
Parry H, Nishimwe M, Vekria Y, et al. Herpes zoster incidence rates in adults in England aged 18 years or older with haematological malignancies: A retrospective cohort study using data from the Clinical Practice Research Datalink (2012–2019). Presented at BSH 2025. PO102.
Yanni EA, Ferreira G, Guennec M, et al. Burden of herpes zoster in 16 selected immunocompromised populations in England: A cohort study in the Clinical Practice Research Datalink 2000–2012. BMJ Open 2018;8:e020528.
GSK. Data on file 2025.
Mahmood A, Nishimwe M, Vekria Y, et al. Post-Herpetic Neuralgia Occurrence and Herpes Zoster Recurrence in Immunocompromised Adults Aged 18 Years or Older in England: a Large Retrospective Cohort Study (Clinical Practice Research Datalink, 2012-2019). Presented at ISPOR Europe 2025.
Mahmood A, Nishimwe M, Vekria Y, et al. Herpes zoster incidence rates in adults aged 18 years or older with coronary artery disease or heart failure in England: A retrospective cohort study using data from the Clinical Practice Research Datalink (2012–2019). Presented at BCS 2025.

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January 2026 | NX-GB-HZU-WCNT-250010 (V1.0)

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Burden of herpes zoster (shingles) among adults in England with an immunocompromising or chronic condition

Insights from a large (N=29,292,141) retrospective cohort study of adults in England^1-3

Baseline characteristics

Findings

Incidence rates of shingles in adults with immunocompromising conditions increase with age and are reasonably stable over time¹

Shingles incidence rates are higher in adults with immunocompromising conditions than in those without in all age groups^{1, 5}

Shingles incidence rate varies by immunocompromising condition¹

Incidence rates of shingles in adults with chronic conditions increase with age and are reasonably stable over time²

The incidence rate of shingles varies by chronic condition²

Dive deeper with charts on shingles incidence rates in specific immunocompromising and chronic conditions^{1, 2}

CKD

Haematological malignancies³

Cardiovascular conditions⁷

Dive deeper with more detailed reference tables on shingles incidence rates

Full breakdown by age group for each immunocompromising condition

Shingles incidence rates by age group and first immunocompromising condition across the entire study period¹

Full breakdown by age group for each chronic condition

Shingles incidence rates by age group in adults with at least one chronic condition across the entire study period²

Full breakdown by age group and year in adults with immunocompromising conditions

Overall and annual shingles incidence rates by age group in adults with immunocompromising conditions (2012–2019)¹

Key findings from the study

References

Contact us

Burden of herpes zoster (shingles) among adults in England with an immunocompromising or chronic condition

Insights from a large (N=29,292,141) retrospective cohort study of adults in England1-3

Baseline characteristics

Findings

Incidence rates of shingles in adults with immunocompromising conditions increase with age and are reasonably stable over time1

Shingles incidence rates are higher in adults with immunocompromising conditions than in those without in all age groups1, 5

Shingles incidence rate varies by immunocompromising condition1

Incidence rates of shingles in adults with chronic conditions increase with age and are reasonably stable over time2

The incidence rate of shingles varies by chronic condition2

Dive deeper with charts on shingles incidence rates in specific immunocompromising and chronic conditions1, 2

Dive deeper with more detailed reference tables on shingles incidence rates

Shingles incidence rates by age group and first immunocompromising condition across the entire study period1

Shingles incidence rates by age group in adults with at least one chronic condition across the entire study period2

Overall and annual shingles incidence rates by age group in adults with immunocompromising conditions (2012–2019)1

Key findings from the study

References

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Insights from a large (N=29,292,141) retrospective cohort study of adults in England^1-3

Incidence rates of shingles in adults with immunocompromising conditions increase with age and are reasonably stable over time¹

Shingles incidence rates are higher in adults with immunocompromising conditions than in those without in all age groups^{1, 5}

Shingles incidence rate varies by immunocompromising condition¹

Incidence rates of shingles in adults with chronic conditions increase with age and are reasonably stable over time²

The incidence rate of shingles varies by chronic condition²

Dive deeper with charts on shingles incidence rates in specific immunocompromising and chronic conditions^{1, 2}

Shingles incidence rates by age group and first immunocompromising condition across the entire study period¹

Shingles incidence rates by age group in adults with at least one chronic condition across the entire study period²

Overall and annual shingles incidence rates by age group in adults with immunocompromising conditions (2012–2019)¹