From 1997 to 2006, a total of 48,388 patients with herpes zoster, ranging from a 3-month-old girl to a 102-year-old woman, were monitored at the 46 dermatology clinics in the Miyazaki Prefecture, which has a population of about 1.2 million. The mean herpes zoster incidence was 4.15/1,000 person-years, ranging from 1.96 to 7.84/1,000 person-years among different age groups, and the herpes zoster incidence was significantly higher in females (4.58) than in males (3.67). The incidence by age group was 1.96-2.86/1,000 person-years below the age of 50 years, and it increased to 5.23-7.84/1,000 person-years in persons 50-59 and older, with a trough in the ages 30-39, forming the small and large peaks. Females showed a significantly higher incidence than males, and the difference between the sexes was small below age 40 but greater at 40-49, 50-59, and 60-69. The incidence of herpes zoster was highest in August and lowest in winter, mirroring the prevalence of varicella. The number of herpes zoster cases at 60 years and older increased more than in the population from 1997 to 2006, and this increased incidence of herpes zoster in the 60-69 years and older, especially in females, might have raised the rate in contrast to the stable incidence below the age of 60 years. This large-scale survey clarifies the epidemiology of herpes zoster by age, gender, and season in relation to the prevalence of varicella in the Miyazaki Prefecture in Japan.

Background.The incidence of recurrent herpes zoster (HZ) and the relationship between initial and recurrent HZ are not clear.Methods.The Miyazaki Dermatologist Society has surveyed ~5000 patients with HZ annually since 1997. A questionnaire regarding HZ and its recurrence was completed by the dermatologists.Results.A total of 34 877 patients with HZ were registered at 43 clinics between June 2009 and November 2015. Among 16 784 patients seen at 10 of the 43 clinics, 1076 patients (6.41%) experienced recurrence. Herpes zoster was more frequent in female than in male patients (5.27 vs 4.25 in 1000 person-years, P < .001), as was HZ recurrence (7.63% vs 4.73%, P < .001). Two and three recurrences were observed in 49 and 3 patients, respectively. Recurrence in the same dermatome was observed in 16.3% of patients, and more frequently this occurred in the left side (P = .027). The number of HZ-experienced persons increased with age, and one third of the population had experienced HZ by the age of 80.Conclusions.Recurrent HZ was observed in 6.41% of patients, with a higher incidence in women. Moreover, HZ experience reduced the HZ incidence to 31.7% of the incidence in the HZ-naive population.

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Acyclovir, valacyclovir, and famciclovir are used for the treatment of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections. Helicase-primase inhibitors (HPIs) inhibit replication fork progression that separates double DNA strands into two single strands during DNA synthesis. The HPIs amenamevir and pritelivir have novel mechanisms of anti-herpetic action, and their once-daily administration has clinical efficacy for genital herpes. Among HPIs, amenamevir has anti-VZV activity. The concentrations of HSV-1 and VZV required for the 50% plaque reduction of amenamevir were 0.036 and 0.047 μM, respectively. We characterized the features of amenamevir regarding its mechanism, resistance, and synergism with acyclovir. Its antiviral activity was not influenced by the viral replication cycle, in contrast to acyclovir. A clinical trial of amenamevir for herpes zoster demonstrated its non-inferiority to valacyclovir. To date, amenamevir has been successfully used in over 1,240,000 patients with herpes zoster in Japan. Post-marketing surveillance of amenamevir in Japan reported side effects with significant potential risk identified by the Japanese Risk Management Plan, including thrombocytopenia, gingival bleeding, and palpitations, although none of these were serious. The clinical efficacy and safety profiles of amenamevir were established in patients with herpes zoster. Therefore, amenamevir as an HPI opens a new era of anti-herpes therapy.

Universal vaccination increased the HZ incidence in the child-rearing generation among the generations, possibly by reduced chance of boosting their immunity by exposure to varicella.