Family History as a Risk Factor for Herpes Zoster

Abstract

To assess risk factors for herpes zoster beyond age and immunosuppression, especially the association with a family history of herpes zoster, since a preventative herpes zoster and postherpetic neuralgia vaccine is now available. Design:We undertook a case-control study of herpes zoster, which represents reactivation of latent varicella zoster virus residing in dorsal root ganglia following primary infection, involving 504 patients and 523 controls. Interviews were conducted by trained medical investigators using a structured questionnaire. Setting:The Center for Clinical Studies, an outpatient clinic and research center in Houston, Texas.Participants: Nonimmunocompromised patients with confirmed cases of herpes zoster were included in the study. Controls were nonimmunocompromised clinic patients with new diagnoses of skin diseases other than herpes zoster.Results: Cases were more likely to report blood relatives with a history of zoster (39%) compared with controls (11%; PϽ .001). Risk was increased with multiple blood relatives (odds ratio, 13.77; 95% confidence interval, 5.85-32.39) compared with single blood relatives (odds ratio, 4.50; 95% confidence interval, 3.15-6.41). Conclusions:The results suggest an association between herpes zoster and family history of zoster. Future studies will be needed to investigate this association.

No evidence of family history as a risk factor for herpes zoster in patients with post‐herpetic neuralgia

“…It should be noted that the population sample examined by Hicks et al [2008] was significantly younger (36.3% of the patients and 31.8% of the controls were over 65 years of age) than that examined in the present study, where more than 80% of the patients and the controls were over 65 years of age. It is known that the lifetime risk of developing herpes zoster is about 20-30%.…”

“…It is noted that whereas the percentages of the patients who reported a family history of zoster were relatively similar in the two studies (i.e., 28.4% in the present study vs. 39.3% reported by Hicks et al [2008]), a percentage of controls with a positive family history of zoster much higher than that found by Hicks et al [2008] was found in the present study (i.e., 29.6% vs. 10.5%, respectively). It is difficult to speculate on the possible reasons for the discrepancy of the two studies, but some possible conclusions may be drawn.…”

“…Several other studies also indicate an older age to be an independent predictor of post-herpetic neuralgia [Johnson and Dworkin, 2003]. In the present study the patients were affected by postherpetic neuralgia, which usually follows severe acute herpes zoster, and this represents the second major difference between the present study and that of Hicks et al [2008], who analyzed data from individuals generically defined as zoster patients. It can be expected that patients affected by post-herpetic neuralgia, i.e., a complicated form of herpes zoster, are more likely to remember possible cases of herpes zoster in their relatives.…”

“…Hicks et al [2008] have published recently data on the distribution of patients with herpes zoster and controls according to family history of herpes zoster. In that study, 39.3% of the patients reported a family history of herpes zoster versus 10.5% of the controls, and a dosedependent effect between having a single blood relative or multiple blood relatives with a history of herpes zoster was documented.…”

“…The risk factors identified in analytical studies include age, sex, ethnicity, genetic susceptibility, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure [Schmader et al, 1990;Thomas and Hall, 2004]. An association between herpes zoster and family history of zoster has been proposed [Ozawa et al, 1999;Haanpaa et al, 2002;Hicks et al, 2008]. A genetic susceptibility to a number of infections including herpes encephalitis, which is caused by a virus sharing many similarities with varicella zoster virus, has been reported recently [Casrouge et al, 2006].…”