Varicella Zoster Virus Varicella Zoster Virus

Epidemiology and risk factors

Herpes zoster is caused by the reactivation of the varicella zoster virus (VZV).1

Primary varicella infection

Primary varicella infection: Chickenpox

90% of adults in the UK are infected with the Varicella Zoster Virus which causes chickenpox.2

Latency

Latency

Following primary VZV infection, VZV lies dormant in the sensory dorsal root ganglia.1

Reactivation

Reactivation: Herpes zoster

Reactivation of dormant VZV leads to herpes zoster. It is associated with deterioration of the immune system seen with aging or suppression of the immune system due to disease or therapy.1

The risk of herpes zoster increases with a decline in immune system function3

Older age

Age-related decline in immune function (immunosenescence)3,5

The risk of herpes zoster increases with ageing, beginning around 50 years of age.4

Compromised immune system

Immunocompromised (IC)

Patients with conditions (or those who are receiving medication/therapy) which cause immunosuppression or immunocompromise have an increased risk of herpes zoster.1

Retrospective cohort study: Herpes zoster burden in 16 specific immunocompromised (IC) populations6

  • In England, a retrospective cohort study was conducted using data (2000 to 2012) from the Clinical Practice Research Datalink (CPRD) and linked Hospital Episodes Statistics.
  • The CPRD contains data for approximately 4.4 million individuals registered with general practitioner practices.
  • The aim of the study was to estimate the Herpes Zoster incidence rate in individuals with common IC conditions in England and compare with an IC-free cohort.
  • The cohort was comprised of 621,588 individuals with 16 selected IC conditions and a gender/age matched cohort of individuals who were considered 'IC-free'. (Note that whilst the individuals in the 'IC-free' cohort did not have any of the 16 immunocompromised conditions being studied, they were not necessarily immunocompetent)
  • The study found that the overall incidence rate varied across IC conditions, ranging from 5.3/1000 person-years (PY) in patients with psoriasis to 41.7/1000 PY in patients who have had a haematopoietic stem cell transplant (HSCT) vs 6.21/1000 PY in the IC-free cohort:
IC Status N = Total number of Individuals Overall Incidence per 1000 person-years (confidence intervals)
IC-free cohort 621,588 6.21 (95% CI: 6.12 to 6.30)
IC- cohort
(see IC conditions included in the study below)		 621,588 7.77 (95% CI: 7.67 to 7.88)
IC Condition n = Total number of Individuals Overall Incidence per 1000 person-years (PY) 
Haematopoietic stem cell transplant 1,312 41.70 (95% CI: 35.72 to 48.40)
Haematological malignancies 26,959 15.19 (95% CI: 14.45 to 15.97)
Polymyalgia rheumatica 26,868 12.79 (95% CI: 12.18 to 13.42)
End-stage renal disease 38,134 12.25 (95% CI: 11.58 to 12.95)
Solid organ transplant 4,759 12.13 (95% CI: 10.74 to 13.66)
Other immunodeficiency conditions 41,484 11.83 (95% CI: 11.29 to 12.38)
Human Immunodeficiency Virus 2,522 11.78 (95% CI: 9.54 to 14.38)
Systemic lupus erythematosus 5,041 10.95 (95% CI: 9.75 to 12.26)
Rheumatoid arthritis 35,326 10.58 (95% CI: 10.11 to 11.07)
Solid organ malignancies 210,259 8.81 (95% CI: 8.61 to 9.02)
Other immunosuppressive therapies 12,594 8.49 (95% CI: 7.25 to 9.89)
Corticosteroids exposure 183,646 7.46 (95% CI: 7.23 to 7.69)
Inflammatory bowel disease 31,884 7.02 (95% CI: 6.63 to 7.42)
Multiple sclerosis 9,210 5.69 (95% CI: 5.07 to 6.36)
Autoimmune thyroiditis 7,140 5.42 (95% CI: 4.70 to 6.22)
Psoriasis 117,760 5.33 (95% CI: 5.15 to 5.51)

CI: confidence interval

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Varicella Zoster Virus

Herpes Zoster: Impact and Associated Complications

Click here to learn more about herpes zoster burden of disease and complications

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Varicella Zoster Virus

Herpes Zoster: Management

Click here to learn about the management of patients with herpes zoster

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References

  1. DH Green Book ch. 28a - Shingles. August 2021
  2. DH Green Book ch. 34 Varicella pg 422. June 2019
  3. Kimberlin DW, et al. N Engl J Med. 2007 Mar;356(13):1338-43.
  4. Gauthier A, Breuer J, Carrington D et al. (2009) Epidemiol Infect 137(1): 38-47.
  5. UK NICE Clinical Knowledge Summaries, Shingles. June 2022
  6. Yanni EA, Ferreira G, Guennec M, et al; BMJ Open 2018;8:e020528.

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.

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February 2023 | NX-GB-AVX-WCNT-220001 (V1.0)