Herpes zoster on the rise in younger adults

Since universal varicella vaccination for children began in 1996, more younger adults, especially females, are developing herpes zoster ophthalmicus (HZO) in the United States.

Data presented in this retrospective study suggests the possibility that adult vaccination efforts should increase and the recommended age of adult inoculation should decrease. As physicians, our suspicion for zoster in younger age groups should be heightened.

It’s commonly thought that universal vaccination of children might increase the incidence of zoster from the loss of exogenous immunity boosting. To test this theory, the authors reviewed the records of patients who developed HZO, comparing the time period of 1996-2004 to 2005-2012.

The authors did find a decreasing trend in the age of onset from 2001 to 2007, which seemed to stabilize after 2007. The percentage of patients under 50 who developed zoster increased from 16.2% in the earlier period to almost 30% in the later period (P = 0.004). The percentage of patients with zoster younger than 60 grew from 32.3% to 44.8% (P = 0.017).  

The mean onset age fell most dramatically among females, developing 9.3 years younger in the later time period (P < 0.0001), while the age of onset among men was similar between the 2 periods.

This is also the first study to show that smoking is associated with a dramatically younger age of onset of HZO, at 11.5 years younger compared to nonsmokers (P < 0.0001). Immunosuppressed and nondiabetic patients were also associated with a younger onset age (P < 0.05).

The authors conclude that public policy recommendations for varicella and zoster vaccination should take into consideration the potential consequences of temporary alteration of epidemiology of varicella reactivation.