OBJECTIVE
To present population-based estimates of herpes zoster (HZ) recurrence rates among
adults.
PATIENTS AND METHODS
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.
RESULTS
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.
CONCLUSION
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.
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Article info
Footnotes
This work was funded by grants from Merck Research Laboratories, North Wales, PA; the National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR30582); and the National Institute on Aging (AG034676).
An earlier version of this article appeared Online First.
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© 2011 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
