The lifetime occurrence of Herpes zoster and prevalence of post‐herpetic neuralgia: A retrospective survey in an elderly population

Abstract

One-thousand-and-seventy-one randomly chosen elderly persons (537 women, 534 men; median age 80) were recruited from the Institute of Human Aging (Dept of Psychiatry, University of Liverpool). Almost a quarter (23.8%; equal numbers of both sexes) had had shingles (HZ), at a median age of 60 (for both sexes); 39 subjects (3.6% of all respondents, 15% of those who had had shingles), two thirds of whom were female, developed post-herpetic neuralgia (PHN), defined as pain persisting for more than 3 months; they acquired HZ at a median age of 70. In 22 of them, pain had resolved by the time they were questioned, but in 17 it was ongoing (from less than 12 to 504 months). Two new independent risk factors for PHN were identified: (1) female gender; and (2) living alone at the time of HZ acquisition (p = 0.009). In addition to confirming the well-known factor of: (3) age at shingles acquisition (up to the early 90s); and (4) scarring, presumed to be a consequence of rash severity, was significantly commoner in subjects whose HZ was followed by PHN.Extrapolating the prevalence figures to the whole UK population, of whom 9.28 million were over 64 in 1992, it can be conservatively estimated that at any one time, some 200 000 people in the UK have PHN. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

Herpes Zoster Recurrences More Frequent Than Previously Reported

“…In a retrospective survey of 1071 persons of advanced age, 235 (21.9%) self-reported having had HZ, including 32 (13.6%) of 235 with at least 1 self-reported recurrence. 14 The Shingles Prevention Study, a large clinical trial of the efficacy and safety of a zoster vaccine, was not designed to study recurrence but did report 3 laboratory-confirmed HZ recurrences in 3 years of follow-up among 1308 cases of HZ in immunocompetent people. 16 Overall, published data on HZ recurrences are scarce and often based on anecdotal reports of small numbers of cases collected using different methods over varying durations of follow-up.…”

“…[1][2][3][4][5] Studies of HZ recurrence often focus on special populations with hematologic malignancies or exposure to chemotherapeutic or immunotoxic agents like arsenic, [6][7][8][9] or they are population studies with small numbers of cases or short follow-up periods. [10][11][12][13][14][15][16] This study assessed the rate of HZ recurrence with up to 12 years of follow-up in a population-based cohort of 1669 persons with a confirmed previous episode of HZ between January 1, 1996, and December 31, 2001. Like the index episodes, HZ recurrences were required to meet predefined diagnostic criteria of dermatomal rash and pain.…”

Further characterization of a rat model of varicella zoster virus–associated pain: Relationship between mechanical hypersensitivity and anxiety-related behavior, and the influence of analgesic drugs

“…However, recovery from AHZ may frequently become complicated by the development of postherpetic neuralgia (PHN), a neuropathic pain syndrome characterised by persisting pain arising in areas affected by herpes zoster at least three months after healing of skin lesions (Dworkin and Portenoy, 1994). Without treatment, the reported incidence of pain persisting three months after the development of herpetic rash is 8% to 15% and increases rapidly in the elderly population (Bowsher, 1999;Johnson and Patrick, 2003). PHN may be accompanied by varying degrees of sensory deficits including abnormal hyper-sensory phenomena, such as allodynia (an abnormal pain response to innocuous stimuli) and hyperalgesia (an increased response to noxious stimuli), and/or hyposensory phenomena, such as partial or complete sensory loss (Nurmikko, 1995;Fields et al, 1998;Pappagallo et al, 2000).…”

Effect of Viral Load on the Outcome of Herpes Zoster

“…This leads to altered sensory perception and pain in the area supplied by the affected nerves (1). The onset and severity of PHN are associated with older age, female gender, the presence of prodromal pain, the extent and location of the rash, and the severity of pain at zoster onset (3,5,13,21). Antiviral agents prescribed within 72 h of rash onset have been shown to reduce the duration of PHN in patients over age 50 years, and treatment with antiviral agents is currently recommended for the management of these patients (12).…”