Journal of General Internal Medicine

, Volume 20, Issue 8, pp 748–753 | Cite as

The incidence of herpes zoster in a United States administrative database

  • Ralph P. InsingaEmail author
  • Robbin F. Itzler
  • James M. Pellissier
  • Patricia Saddier
  • Alexander A. Nikas
Original Articles


BACKGROUND: Few recent studies have reported data on the incidence of herpes zoster (HZ) in U.S. general clinical practice.

OBJECTIVE: To estimate the age- and sex-specific incidence of HZ among U.S. health plan enrollees.

DESIGN: Data for the years 2000 to 2001 were obtained from the Medstat MarketScan database, containing health insurance enrollment and claims data from over 4 million U.S. individuals. Incident HZ cases were identified through HZ diagnosis codes on health care claims. The burden of HZ among high-risk individuals with recent care for cancer, HIV, or transplantation was examined in sub-analyses. Overall incidence rates were age- and sex-adjusted to the 2000 U.S. population.

PARTICIPANTS: MarketScan U.S. health plan enrollees of all ages.

MEASUREMENTS AND MAIN RESULTS: We identified 9,152 incident cases of HZ (3.2 per 1,000 person-years) (95% confidence interval [CI], 3.1 to 3.2 per 1,000]. Annual HZ rates per 1,000 person-years were higher among females (3.8) than males (2.6) (P<.0001). HZ rates rose sharply with age, and were highest among individuals over age 80 (10.9 per 1,000 person-years) (95% CI, 10.2 to 11.6). The incidence of HZ per 1,000 person-years among patients with evidence of recent care for transplantation, HIV infection, or cancer (10.3) was greater than for individuals without recent care for these conditions (3.0) (P<.0001).

CONCLUSIONS: The overall incidence of HZ reported in the present study was found to be similar to rates observed in U.S. analyses conducted 10 to 20 years earlier, after age- and sex-standardizing estimates from all studies to the 2000 U.S. population. The higher rate of HZ in females compared with males contrasts with prior U.S. studies.

Key words

zoster shingles incidence cancer HIV 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gnann JW Jr., Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002;347:340–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Dworkin RH, Nagasako EM, Johnson RW, Griffin DR. Acute pain in herpes zoster: the famciclovir database project. Pain. 2001;94:113–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Chidiac C, Bruxelle J, Daures JP, et al. Characteristics of patients with herpes zoster on presentation to practitioners in France. Clin Infect Dis. 2001;33:62–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Haanpaa M, Laippala P, Nurmikko T. Allodynia and pinprick hypesthesia in acute herpes zoster, and the development of postherpetic neuralgia. J Pain Symptom Manage. 2000;20:50–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Jung BF, Johnson RW, Griffin DR, Dworkin RH. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology. 2004;62:1545–51.PubMedGoogle Scholar
  6. 6.
    Dworkin RH, Schmader KE. Treatment and prevention of postherpetic neuralgia. Clin Infect Dis. 2003;36:877–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Davies L, Cossins L, Bowsher D, Drummond M. The cost of treatment for post-herpetic neuralgia in the UK. Pharmacoeconomics. 1994;6:142–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. BMJ. 2000;321:794–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson RW. Consequences and management of pain in herpes zoster. J Infect Dis. 2002;186(suppl 1):S83–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch Intern Med. 1995;155:1605–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Fleming DM, Cross KW, Cobb WA, Chapman RS. Gender difference in the incidence of shingles. Epidemiol Infect. 2004;132:1–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Kost RG, Straus SE. Postherpetic neuralgia—pathogenesis, treatment, and prevention. N Engl J Med. 1996;335:32–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Opstelten W, Mauritz JW, de Wit NJ, van Wijck AJ, Stalman WA, van Essen GA. Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Fam Pract. 2002;19:471–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Severson EA, Baratz KH, Hodge DO, Burke JP. Herpes zoster ophthalmicus in Olmsted county, Minnesota: have systemic antivirals made a difference? Arch Ophthalmol. 2003;121:386–90.PubMedGoogle Scholar
  15. 15.
    Gnann JW Jr. Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis. 2002;186(suppl 1):S91–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Straus SE, Ostrove JM, Inchauspe G, et al. NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Ann Intern Med. 1988;108:221–37.PubMedGoogle Scholar
  17. 17.
    Hope-Simpson RE. The nature of herpes zoster: a long-term study and a new hypothesis. Proc R Soc Med. 1965;58:9–20.PubMedGoogle Scholar
  18. 18.
    McGregor RM. Herpes zoster, chicken-pox, and cancer in general practice. BMJ. 1957;32:84–7.Google Scholar
  19. 19.
    Brisson M, Edmunds WJ, Law B, et al. Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Epidemiol Infect. 2001;127:305–14.PubMedGoogle Scholar
  20. 20.
    Czernichow S, Dupuy A, Flahault A, Chosidow O. [Herpes zoster: incidence study among “sentinel” general practitioners]. Ann Dermatol Venereol. 2001;128:497–501.PubMedGoogle Scholar
  21. 21.
    di Luzio PU, Arpinelli F, Visona G. Herpes zoster and its complications in Italy: an observational survey. J Infect. 1999;38:116–20.CrossRefGoogle Scholar
  22. 22.
    Richards P. Shingles in one family practice. Arch Fam Med. 1996;5:42–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Levin MJ, Smith JG, Kaufhold RM, et al. Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-hose VZV vaccine. J Infect Dis. 2003;188:1336–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Buchbinder SP, Katz MH, Hessol NA, et al. Herpes zoster and human immunodeficiency virus infection. J Infect Dis. 1992;166:1153–6.PubMedGoogle Scholar
  25. 25.
    Barton T, Collis T, Stadtmauer E, Schuster M. Infectious complications the year after autologous bone marrow transplantation or peripheral stem cell transplantation for treatment of breast cancer. Clin Infect Dis. 2001;32:391–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Engels EA, Rosenberg PS, Biggar RJ. Zoster incidence in human immunodeficiency virus-infected hemophiliacs and homosexual men, 1984–1997. District of Columbia Gay Cohort Study. Multicenter Hemophilia Cohort Study. J Infect Dis. 1999;180:1784–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Mattiuzzi GN, Cortes JE, Talpaz M, et al. Development of varicellazoster virus infection in patients with chronic myelogenous leukemia treated with imatinib mesylate. Clin Cancer Res. 2003;9:976–80.PubMedGoogle Scholar
  28. 28.
    Gourishankar S, McDermid JC, Jhangri GS, Preiksaitis JK. Herpes zoster infection following solid organ transplantation: incidence, risk factors and outcomes in the current immunosuppressive era. Am J Transplant. 2004;4:108–15.PubMedCrossRefGoogle Scholar
  29. 29.
    Long JS. Regression Models for Categorical and Limited Dependent Variables. Thousand Oaks, Calif: Sage Publications, Inc.; 1997.Google Scholar
  30. 30.
    U.S. Census Bureau. 2000 resident population estimates of the United States by age and sex. Scholar
  31. 31.
    U.S. Census Bureau. USA Statistics In Brief—Population By Sex, Age, and Region. Worldwide Web. July 2, 2004.Google Scholar
  32. 32.
    Ragozzino MW, Melton LJ III, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine. 1982;61:310–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Thomas SL, Wheeler JG, Hall AJ. Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. Lancet. 2002;360:678–82.PubMedCrossRefGoogle Scholar
  34. 34.
    Law B, Fitzsimon C, Ford-Jones L, et al. Cost of chickenpox in Canada: part I. Cost of uncomplicated cases. Pediatrics. 1999;104:1–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O. The burden of uncomplicated cases of chickenpox in Israel. J Infect. 2002;45:233–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Helgason S, Sigurdsson JA, Gudmundsson S. The clinical course of herpes zoster: a prospective study in primary care. Eur J Gen Pract. 1996;2:12–6.CrossRefGoogle Scholar
  37. 37.
    Rubben A, Baron JM, Grussendorf-Conen EI. Routine detection of herpes simplex virus and varicella zoster virus by polymerase chain reaction reveals that initial herpes zoster is frequently misdiagnosed as herpes simplex. Br J Dermatol. 1997;137:259–61.PubMedCrossRefGoogle Scholar
  38. 38.
    Kalman CM, Laskin OL. Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults. Am J Med. 1986;81:775–8.PubMedCrossRefGoogle Scholar
  39. 39.
    McKendrick MW, Care CC, Kudesia G, Bates CJ, Oxley MK, Eley A. Is VZV reactivation a common cause of unexplained unilateral pain? Results of a prospective study of 57 patients. J Infect. 1999;39:209–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Fueyo MA, Lookingbill DP. Herpes zoster and occult malignancy. J Am Acad Dermatol. 1984;11:480–2.PubMedCrossRefGoogle Scholar
  41. 41.
    Ragozzino MW, Melton LJ III, Kurland LT, Chu CP, Perry HO. Risk of cancer after herpes zoster: a population-based study. N Engl J Med. 1982;307:393–7.PubMedGoogle Scholar
  42. 42.
    Wurzel CL, Kahan J, Heitler M, Rubin LG. Prognosis of herpes zoster in healthy children. Am J Dis Child. 1986;140:477–8.PubMedGoogle Scholar
  43. 43.
    Feder HM Jr. Herpes zoster [letter]. N Engl J Med. 2003;348:2044–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Feder HM Jr., Hoss DM. Herpes zoster in otherwise healthy children. Pediatr Infect Dis J. 2004;23:451–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Brooks JM, Chrischilles E, Scott S, Ritho J, Chen-Hardee S. Information gained from linking SEER Cancer Registry Data to state-level hospital discharge abstracts. Surveillance, Epidemiology, and End Results. Med Care. 2000;38:1131–40.PubMedCrossRefGoogle Scholar
  46. 46.
    Whittle J, Steinberg EP, Anderson GF, Herbert R. Accuracy of Medicare claims data for estimation of cancer incidence and resection rates among elderly Americans. Med Care. 1991;29:1226–34.PubMedCrossRefGoogle Scholar
  47. 47.
    National Center for Health Statistics. Health, United States, 2004 with Chart Book on Trends in the Health of Americans. Hyattsville, Md: National Center for Health Statistics; 2004.Google Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Ralph P. Insinga
    • 1
    Email author
  • Robbin F. Itzler
    • 1
  • James M. Pellissier
    • 1
  • Patricia Saddier
    • 2
  • Alexander A. Nikas
    • 2
  1. 1.Department of Health Economic StatisticsMerck Research LaboratoriesBlue BellUSA
  2. 2.Department of EpidemiologyMerck Research LaboratoriesBlue BellUSA

Personalised recommendations