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ORIGINAL ARTICLE| Volume 86, ISSUE 2, P88-93, February 2011

Herpes Zoster Recurrences More Frequent Than Previously Reported


      To present population-based estimates of herpes zoster (HZ) recurrence rates among adults.


      To identify recurrent cases of HZ, we reviewed the medical records (through December 31, 2007) of all Olmsted County, Minnesota, residents aged 22 years or older who had an incident case of HZ between January 1, 1996, and December 31, 2001. Kaplan-Meier curves and Cox regression models were used to describe recurrences by age, immune status, and presence of prolonged pain at the time of the incident HZ episode.


      Of the 1669 persons with a medically documented episode of HZ, 95 had 105 recurrences (8 persons with >1 recurrence) by December 31, 2007, an average follow-up of 7.3 years. The Kaplan-Meier estimate of the recurrence rate at 8 years was 6.2%. With a maximum follow-up of 12 years, the time between HZ episodes in the same person varied from 96 days to 10 years. Recurrences were significantly more likely in persons with zoster-associated pain of 30 days or longer at the initial episode (hazard ratio, 2.80; 95% confidence interval, 1.84-4.27; P<.001) and in immunocompromised individuals (hazard ratio, 2.35; 95% confidence interval, 1.35-4.08; P=.006). Women and anyone aged 50 years or older at the index episode also had a greater likelihood of recurrence.


      Rates of HZ recurrence appear to be comparable to rates of first HZ occurrence in immunocompetent individuals, suggesting that recurrence is sufficiently common to warrant investigation of vaccine prevention in this group.
      CI (confidence interval), HZ (herpes zoster)
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        • Chien AJ
        • Olerud JE
        Why do so many clinicians believe that recurrent zoster is common?.
        Dermatol Online J. 2007; 13: 2
        • Heskel NS
        • Hanifin JM
        “Recurrent herpes zoster”: an unproved entity?.
        J Am Acad Dermatol. 1984; 10: 486-490
        • Horiuchi Y
        Recurrent herpes zoster.
        J Dermatol. 1998; 25: 347-348
        • Burkhart CN
        Recurrent herpes zoster revisited [letter].
        Int J Dermatol. 2002; 41: 528
        • Bansal R
        Recurrent herpes zoster.
        Int J Dermatol. 2001; 40: 542-543
        • Cerny Z
        Recurrent eruptions of herpes zoster [in Czech].
        Bratisl Lek Listy (Tlacene Vyd). 1999; 100: 515-518
        • Schwickert M
        • Saha J
        Recurrent herpes zoster with neuralgia [in German].
        Forsch Komplement Med. 2006; 13: 184-186
        • Bruning AH
        • Samie MH
        Recurrent herpes zoster and high-dose inhaled steroids for asthma [letter].
        S Afr Med J. 1994; 84: 873
        • Cvjetković D
        • Jovanović J
        • Hrnjaković-Cvjetković I
        • Brkić S
        • Bogdanović M
        Reactivation of herpes zoster infection by varicella-zoster virus [in Croatian].
        Med Pregl. 1999; 52: 125-128
        • Epstein E
        Recurrences in herpes zoster.
        Cutis. 1980; 26: 378-379
        • Hope-Simpson RE
        The nature of herpes zoster: a long-term study and a new hypothesis.
        Proc R Soc Med. 1965; 58: 9-20
        • Ragozzino MW
        • Melton LJ
        • Kurland LT
        • Chu CP
        • Perry HO
        Population-based study of herpes zoster and its sequelae.
        Medicine (Baltimore). 1982; 61: 310-316
        • Donahue JG
        • Choo PW
        • Manson JE
        • Platt R
        The incidence of herpes zoster.
        Arch Intern Med. 1995; 155: 1605-1609
        • Bowsher D
        The lifetime occurrence of Herpes zoster and prevalence of post-herpetic neuralgia: a retrospective survey in an elderly population.
        Eur J Pain. 1999; 3: 335-342
        • Helgason S
        • Sigurdsson JA
        • Gudmundsson S
        The clinical course of herpes zoster: a prospective study in primary care.
        Eur J Gen Pract. 1996; 2: 12-15
        • Oxman MN
        • Levin MJ
        • Johnson GR
        • et al.
        A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
        N Engl J Med. 2005; 352: 2271-2284
        • Yawn BP
        • Saddier P
        • Wollan PC
        • St Sauver JL
        • Kurland MJ
        • Sy LS
        A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.
        Mayo Clin Proc. 2007; 82: 1341-1349
        • Giehl KA
        • Müller-Sander E
        • Rottenkolber M
        • Degitz K
        • Volkenandt M
        • Berking C
        Identification and characterization of 20 immunocompetent patients with simultaneous varicella zoster and herpes simplex virus infection.
        J Eur Acad Dermatol Venereol. 2008; 22: 722-728
        • Harbecke R
        • Oxman M
        • Arnold B
        • et al.
        A real-time PCR assay to identify and discriminate among wild-type and vaccine strains of varicella-zoster virus and herpes simplex virus in clinical specimens, and comparison with the clinical diagnoses.
        J Med Virol. 2009; 81: 1310-1322
        • Kalman C
        • Laskin O
        Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults.
        Am J Med. 1986; 81: 775-778
        • Harpaz R
        • Ortega-Sanchez IR
        • Seward JF
        Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2008; 57: 1-30
        • Melton III, LJ
        History of the Rochester Epidemiology Project.
        Mayo Clin Proc. 1996; 71: 266-274
        • Kurland LT
        • Molgaard CA
        The patient record in epidemiology.
        Sci Am. 1981; 245: 54-63
        • Yawn BP
        • Wollan P
        Interrater reliability: completing the methods description in medical records review studies.
        Am J Epidemiol. 2005; 161: 974-977
        • Grambsch PM
        • Therneau TM
        Proportional hazards tests and diagnostics based on weighted residuals.
        Biometrika. 1994; 81 (Accessed November 11, 2010.): 515-526
        • Dworkin RH
        • Johnson RW
        • Breuer J
        • et al.
        Recommendations for the management of herpes zoster.
        Clin Infect Dis. 2007; 44: S1-S26
        • Russell ML
        • Schopflocher DP
        • Svenson L
        • Virani SN
        Secular trends in the epidemiology of shingles in Alberta.
        Epidemiol Infect. 2007; 135: 908-913
        • Hicks LD
        • Cook-Norris RH
        • Mendoza N
        • Madkan V
        • Arora A
        • Tyring SK
        Family history as a risk factor for herpes zoster: a case-control study.
        Arch Dermatol. 2008; 144: 603-608