Półpasiec – Epidemiologia

Półpasiec
Epidemiologia

Półpasiec (herpes zoster, HZ) jest wynikiem reaktywacji wirusa ospy wietrznej i półpaśca (VZV), z częstością występowania od 1,2 do 3,4 przypadków na 1000 osobolat u młodszych osób, a u pacjentów powyżej 65. roku życia wzrasta do 3,9-11,8 na 1000 osobolat. Ryzyko zachorowania w ciągu życia wynosi około 25-30%, zwiększając się do 50% u osób powyżej 80 lat. Głównym czynnikiem ryzyka jest wiek, a także immunosupresja, która zwiększa ryzyko zachorowania nawet 20-100-krotnie. Powikłania występują u 13-26% pacjentów, z neuralgią popółpaścową (PHN) jako najczęstszym powikłaniem, szczególnie u osób starszych (częstość PHN u osób 70-79 lat wynosi 235 na 100 000). Hospitalizacje dotyczą 1-4% chorych, a zgony są rzadkie, z częstością 0,017-0,465 na 100 000 osobolat, głównie u osób starszych i immunosupresyjnych. Epidemiologia półpaśca wykazuje regionalne różnice, z częstością 3-5 przypadków na 1000 osobolat w Ameryce Północnej, Europie i regionie Azji i Pacyfiku, a dane z Azji Południowo-Wschodniej, Ameryki Łacińskiej i Afryki są ograniczone.

Epidemiologia Półpaśca

Półpasiec (herpes zoster, HZ) jest chorobą zakaźną wywołaną przez reaktywację wirusa ospy wietrznej i półpaśca (varicella-zoster virus, VZV), który wcześniej wywołał ospę wietrzną i pozostał w stanie uśpienia w zwojach nerwowych. Choroba ta stanowi znaczący problem zdrowia publicznego na całym świecie, powodując około miliona przypadków rocznie tylko w Stanach Zjednoczonych.¹²

Częstotliwość występowania półpaśca

Dane epidemiologiczne wskazują, że około 1 na 3 osoby w Stanach Zjednoczonych zachoruje na półpaśca przynajmniej raz w życiu.¹² Podobne szacunki występują w innych krajach rozwiniętych. Częstość występowania półpaśca waha się od 1,2 do 3,4 przypadków na 1000 osobolat wśród młodszych, zdrowych osób, podczas gdy wśród pacjentów powyżej 65. roku życia wzrasta do 3,9-11,8 przypadków na 1000 osobolat.¹²

W Ameryce Północnej, Europie i regionie Azji i Pacyfiku częstość występowania półpaśca wynosi między 3 a 5 przypadków na 1000 osobolat.¹ Badania sugerują, że ryzyko zachorowania na półpaśca w ciągu życia wynosi między 25% a 30%, wzrastając do 50% u osób, które dożyły 80 lat.¹ W Australii odnotowuje się około 560 przypadków półpaśca na 100 000 mieszkańców rocznie we wszystkich grupach wiekowych.¹

Czynniki ryzyka wystąpienia półpaśca

Głównym czynnikiem ryzyka zachorowania na półpasiec jest wiek. Częstość występowania tej choroby znacząco wzrasta po 50. roku życia, niemal podwajając się w każdej kolejnej dekadzie życia.¹² Jest to związane z naturalnym obniżeniem odporności komórkowej specyficznej dla VZV, które postępuje wraz z wiekiem.¹

Innym istotnym czynnikiem ryzyka jest stan immunosupresji. Osoby z obniżoną odpornością z powodu chorób (np. zakażenie HIV, choroby nowotworowe, szczególnie układu krwiotwórczego) lub stosowania leków immunosupresyjnych są narażone na 20-100 razy większe ryzyko zachorowania w porównaniu z osobami w tym samym wieku o prawidłowej odporności.¹ Przykładowo:

25% pacjentów z HIV doświadcza epizodu półpaśca¹
7-9% osób po przeszczepie nerki lub serca rozwija półpaśca¹
Do 30% pacjentów może rozwinąć półpaśca w pierwszym roku po przeszczepie komórek macierzystych szpiku kostnego¹

Dodatkowo, dane epidemiologiczne wskazują na wyższą częstość występowania półpaśca wśród kobiet niż mężczyzn. Badania wykazały stałą nadwyżkę przypadków wśród kobiet we wszystkich grupach wiekowych (z wyjątkiem grupy 15-24 lat), ze średnią roczną nadwyżką wynoszącą 28%.¹ Skumulowana częstość występowania (3,22-11,2 vs 2,44-8,0 przypadków na 1000 populacji) i wskaźniki zachorowalności (6,05-12,8 vs 4,30-8,5 przypadków na 1000 osobolat) były wyższe u kobiet niż u mężczyzn.¹

Badania wskazują również, że rasa może wpływać na ryzyko zachorowania. Według badania przeprowadzonego w Karolinie Północnej, „osoby rasy czarnej były znacznie mniej narażone na rozwój półpaśca niż osoby rasy białej”.¹

Trendy epidemiologiczne półpaśca

W ciągu ostatnich kilkudziesięciu lat odnotowano stopniowy, ale stały wzrost częstości występowania półpaśca i neuralgii popółpaścowej (PHN) we wszystkich grupach wiekowych.¹ Ten trend obserwowano w siedmiu krajach, często jeszcze przed wprowadzeniem programów szczepień przeciwko ospie wietrznej.¹²

Przyczyny tego zjawiska nie są w pełni poznane. Wśród potencjalnych czynników wymienia się:¹

Starzenie się populacji
Zwiększone stosowanie leków immunosupresyjnych
Rozpowszechnione szczepienia dzieci przeciwko wirusowi ospy wietrznej

Wpływ szczepień przeciwko ospie wietrznej na epidemiologię półpaśca pozostaje przedmiotem badań i dyskusji. Hope-Simpson jako pierwszy postawił hipotezę, że ponowna ekspozycja na krążący VZV (tzw. egzogenne wzmocnienie odporności) może zapobiegać reaktywacji wirusa.¹ Według tej teorii, szczepienia dzieci przeciwko ospie wietrznej mogłyby krótkoterminowo zwiększyć częstość występowania półpaśca wśród dorosłych, ponieważ mieliby oni mniej kontaktów z dziećmi chorymi na ospę wietrzną, a tym samym mniej okazji do egzogennego wzmocnienia odporności.¹

Modele matematyczne przewidują, że zwiększona częstość występowania półpaśca mogłaby utrzymywać się przez ponad 30 lat po wprowadzeniu powszechnych szczepień przeciwko ospie wietrznej.¹ Jednakże dotychczasowe obserwacje nie wykazały jednoznacznego wpływu szczepień przeciwko ospie wietrznej na częstość występowania półpaśca.¹²

Powikłania i hospitalizacje związane z półpaścem

Ogółem, u 13-26% pacjentów z półpaścem rozwijają się powikłania, które występują częściej u osób starszych i z obniżoną odpornością.¹ Najczęstszym powikłaniem półpaśca jest neuralgia popółpaścowa (PHN), definiowana jako ból nerwowy utrzymujący się ponad 90 dni od wystąpienia wysypki.¹

Ryzyko rozwoju PHN zwiększa się z wiekiem. Badania wykazują, że populacyjna częstość występowania PHN jest 3 razy wyższa u osób w wieku 70-79 lat (235 na 100 000) niż u osób w wieku 50-59 lat (73 na 100 000).¹ Około 10-18% osób po półpaścu doświadcza PHN, przy czym odsetek ten jest wyższy u osób starszych.¹

Około 1-4% osób chorujących na półpaśca jest hospitalizowanych z powodu powikłań.¹² Starsi dorośli i osoby z osłabionym układem odpornościowym są bardziej narażeni na konieczność hospitalizacji.¹ Wskaźniki hospitalizacji wahają się od 2 do 25 na 100 000 osobolat, przy czym wyższe wskaźniki obserwuje się wśród populacji osób starszych.¹

Śmiertelność związana z półpaścem

Zgony związane z półpaścem są rzadkie. W Stanach Zjednoczonych odnotowuje się mniej niż 100 zgonów z powodu półpaśca rocznie.¹² Jedna z analiz szacuje, że półpasiec jest przyczyną około 96 zgonów rocznie (0,28-0,69 na 1 milion populacji).¹

Wskaźniki śmiertelności związane z półpaścem wahają się od 0,017 do 0,465 na 100 000 osobolat.¹ Szacuje się, że w Walii około jeden na 1000 przypadków półpaśca u osób powyżej 70. roku życia kończy się zgonem.¹

Niemal wszystkie zgony z powodu półpaśca występują u osób starszych lub z upośledzoną odpornością.¹²

Nawroty półpaśca

Ryzyko ponownego wystąpienia półpaśca u osób immunokompetentnych wynosi około 4% w ciągu życia.¹ Badania z długoterminową obserwacją wykazują wyższe ryzyko (5-6%).¹ Przez okres do 8 lat po początkowym epizodzie półpaśca, ryzyko ponownego epizodu u osób immunokompetentnych wynosi 6-8%.¹

Nawroty półpaśca występują niemal wyłącznie u osób z obniżoną odpornością.¹² Do czynników ryzyka nawrotu półpaśca w dowolnej lokalizacji należą osłabiona odporność, płeć żeńska, predysponujące schorzenia, takie jak cukrzyca, oraz długotrwała PHN po początkowym epizodzie półpaśca.¹

Nadzór epidemiologiczny nad półpaścem

Systemy nadzoru epidemiologicznego nad półpaścem różnią się w zależności od kraju. W niektórych regionach półpasiec podlega obowiązkowej zgłaszalności, podczas gdy w innych nie jest objęty takim wymogiem.

Systemy nadzoru w różnych krajach

W Stanach Zjednoczonych CDC prowadzi monitoring wpływu programów szczepień przeciwko ospie wietrznej i półpaścowi wśród dorosłych i dzieci.¹ Półpasiec nie jest jednak chorobą podlegającą obowiązkowej zgłaszalności na poziomie federalnym.

W Australii półpasiec podlega rutynowej zgłaszalności i musi być zgłaszany przez lekarzy i laboratoria diagnostyczne w ciągu 5 dni od diagnozy.¹ Z kolei w Anglii i Walii nadzór nad szczepieniami przeciwko półpaścowi pozwala monitorować trendy epidemiologiczne.¹

W stanie Minnesota w USA szkoły i placówki opieki nad dziećmi mają obowiązek zgłaszania wszystkich potwierdzonych i podejrzewanych przypadków półpaśca u dzieci poniżej 18 roku życia. Dodatkowo przeprowadzane jest badanie typowania szczepów wirusa, co pomaga śledzić zmieniającą się epidemiologię półpaśca w erze wysokiego odsetka szczepień przeciwko ospie wietrznej.¹

Na Hawajach półpasiec nie podlega obowiązkowej zgłaszalności do Departamentu Zdrowia, w związku z czym liczba przypadków występujących rocznie jest nieznana.¹ Podobnie w stanie New Jersey półpasiec nie jest obecnie chorobą podlegającą zgłoszeniu.¹

Wyzwania w nadzorze epidemiologicznym

Nadzór nad półpaścem napotyka różne wyzwania, które mogą wpływać na dokładność danych epidemiologicznych. Wiele badań wykorzystuje elektroniczne lub papierowe akty zgonu, co może prowadzić do niedoszacowania lub przeszacowania rzeczywistego wskaźnika śmiertelności z powodu infekcji innych niż półpasiec i chorób niezakaźnych, szczególnie u osób starszych.¹

Istnieje również wyraźna luka w literaturze dotyczącej częstości występowania półpaśca w Azji, Ameryce Łacińskiej i Afryce.¹ Podobnie, w krajach Zatoki Perskiej odnotowano brak badań dotyczących ogólnokrajowych trendów w częstości występowania półpaśca i wpływu szczepień przeciwko ospie wietrznej na zakażenia VZV i półpaścem.¹

W regionie Azji Południowo-Wschodniej istnieją znaczące luki w literaturze dotyczącej ogólnokrajowej częstości występowania, chorobowości i kosztów ekonomicznych półpaśca, zarówno w poszczególnych grupach wiekowych, jak i wśród populacji szczególnie narażonych.¹

Znaczenie długoterminowego nadzoru

Długoterminowy nadzór jest niezbędny do ustalenia wpływu powszechnych szczepień dzieci przeciwko ospie wietrznej na częstość występowania półpaśca.¹ Ponadto monitorowanie chęci do szczepień przeciwko półpaścowi jest konieczne do informowania decyzji w zakresie zdrowia publicznego.¹

Badania wskazują, że tylko połowa osób wyraża chęć zaszczepienia się przeciwko półpaścowi. Wskaźnik ten jest najwyższy w regionie wschodniego śródziemnomorza (ponad 70%) i wynosi około 55% w regionie zachodniego Pacyfiku.¹ Po otrzymaniu rekomendacji od pracowników służby zdrowia, 75,19% osób jest skłonnych zaszczepić się przeciwko półpaścowi; bez takich rekomendacji wskaźnik chęci szczepienia wynosi tylko 49,39%.¹

Wpływ szczepień na epidemiologię półpaśca

Szczepienia przeciwko ospie wietrznej i półpaścowi mają potencjał do znaczącej zmiany epidemiologii półpaśca w przyszłości.

Szczepienia przeciwko ospie wietrznej a epidemiologia półpaśca

Wpływ powszechnych szczepień dzieci przeciwko ospie wietrznej na epidemiologię półpaśca jest złożony. Z jednej strony, w dłuższej perspektywie, może to prowadzić do zmniejszenia liczby dorosłych z uśpionym dzikim typem VZV, a tym samym do zmniejszenia częstości występowania półpaśca.¹

Z drugiej strony, w krótszej perspektywie, dorośli z uśpionym VZV mogą mieć mniej kontaktów z dziećmi chorymi na ospę wietrzną, a tym samym mniej okazji do egzogennego wzmocnienia odporności, co teoretycznie mogłoby prowadzić do tymczasowego zwiększenia częstości występowania półpaśca i obniżenia wieku jego wystąpienia.¹

Od czasu wprowadzenia powszechnych szczepień dzieci przeciwko ospie wietrznej, nie zaobserwowano jednak jednoznacznego wpływu na częstość występowania lub rozkład wiekowy półpaśca.¹ Badania i dane z nadzoru, przynajmniej przy powierzchownym spojrzeniu, nie wykazują spójnych trendów w częstości występowania w USA od czasu rozpoczęcia programu szczepień przeciwko ospie wietrznej w 1995 roku.¹

Niemniej jednak, niektóre badania sugerują pewne zmiany. Według badania Patel i wsp., od czasu wprowadzenia szczepionki przeciwko ospie wietrznej, koszty hospitalizacji z powodu powikłań półpaśca wzrosły o ponad 700 milionów dolarów rocznie dla osób powyżej 60 roku życia.¹ Inne badanie przeprowadzone przez Yih i wsp. wykazało, że wraz ze wzrostem zasięgu szczepień przeciwko ospie wietrznej u dzieci, częstość występowania ospy wietrznej zmniejszyła się, a częstość występowania półpaśca wśród dorosłych wzrosła o 90%.¹

Szczepienia przeciwko półpaścowi

Obecnie dostępne są dwie główne szczepionki przeciwko półpaścowi: starsza szczepionka zawierająca żywy atenuowany wirus (Zostavax) oraz nowsza, rekombinowana szczepionka podjednostkowa (Shingrix).

Szczepionka Zostavax wykazała ponad 51% skuteczność u dorosłych powyżej 50 roku życia i ponad 70% skuteczność u osób w wieku 60 lat i starszych.¹ Jednak miała ona ograniczoną skuteczność, a jej efekt ochronny słabł z czasem.¹

Nowsza szczepionka Shingrix wykazuje znacznie wyższą skuteczność. Badania kliniczne wykazały 97% skuteczność w zapobieganiu półpaścowi u osób w wieku 50-69 lat i 91% skuteczność u dorosłych w wieku 70 lat i starszych.¹ Wśród osób, które zachorowały na półpasiec po szczepieniu, choroba była łagodniejsza, a PHN rozwinęła się tylko u 9% pacjentów w wieku 50-69 lat i 11% u osób w wieku 70 lat i starszych.¹

Wpływ szerokiego przyjęcia szczepień przeciwko półpaścowi może dramatycznie zmniejszyć wskaźnik zachorowalności.¹ Jednakże, pomimo dostępności szczepionki, wskaźniki szczepień pozostają niskie. W 2014 roku tylko 28% dorosłych w wieku 60 lat i starszych w USA zgłosiło otrzymanie szczepionki przeciwko półpaścowi.¹ Badanie przeprowadzone w 2016 roku wykazało, że tylko 33% kwalifikujących się pacjentów zostało zaszczepionych.¹

Według badania przeprowadzonego przez Amerykańskie Stowarzyszenie Osteopatyczne, mniej niż dwie trzecie Amerykanów (62%) jest świadomych, że istnieje szczepionka zapobiegająca półpaścowi.¹ Ta niska świadomość, w połączeniu z innymi barierami, takimi jak ograniczona skuteczność poprzedniej szczepionki i obawy dotyczące kosztów, przyczynia się do niskich wskaźników szczepień.¹

Zalecenia dotyczące szczepień

W Stanach Zjednoczonych CDC zaleca dwie dawki rekombinowanej szczepionki przeciwko półpaścowi (Shingrix), podawane w odstępie 2-6 miesięcy, w celu zapobiegania półpaścowi i związanym z nim powikłaniom u dorosłych w wieku 50 lat i starszych, a także u osób z obniżoną odpornością w wieku 19 lat i starszych.¹²

W Australii, od 1 listopada 2023 roku, szczepionka Shingrix zastąpiła Zostavax w Narodowym Programie Szczepień.¹ Jest ona zalecana wszystkim osobom w wieku 50 lat i starszych, a także osobom z obniżoną odpornością w wieku 18 lat i starszych.¹

W Wielkiej Brytanii, od 1 września 2023 roku, kwalifikacja do szczepienia Shingrix została rozszerzona, obejmując wszystkie osoby z obniżoną odpornością w wieku 50 lat i starsze, bez górnej granicy wieku.¹

Światowa Organizacja Zdrowia zaleca rozważenie zastosowania rekombinowanej szczepionki przeciwko półpaścowi w schemacie 2-dawkowym, z minimalnym odstępem 2 miesięcy między dawkami, w celu zapobiegania półpaścowi u starszych dorosłych i osób z chorobami przewlekłymi, w krajach, w których półpasiec stanowi istotny problem zdrowia publicznego.¹

Regionalne różnice w epidemiologii półpaśca

Epidemiologia półpaśca wykazuje pewne różnice w zależności od regionu geograficznego, choć dane z niektórych obszarów świata są ograniczone.

Ameryka Północna i Europa

W Ameryce Północnej i Europie częstość występowania półpaśca wynosi między 3 a 5 przypadków na 1000 osobolat.¹ W Stanach Zjednoczonych roczna częstość występowania półpaśca we wszystkich grupach wiekowych wynosi 4,47 na 1000 osobolat (95% przedział ufności [CI]: 4,44-4,50), przy czym wskaźnik ten monotonnicznie wzrasta z wiekiem od 0,86 (95% CI: 0,84-0,88) dla osób w wieku 19 lat do 12,78 (95% CI: 12,49-13,07) dla pacjentów w wieku 80 lat.¹

W Kanadzie szacuje się, że każdego roku występuje 130 000 nowych przypadków półpaśca, 17 000 przypadków PHN i 20 zgonów.¹

W Anglii i Walii roczna częstość występowania półpaśca dla osób w wieku 70-79 lat szacowana jest na około 790-880 przypadków na 100 000 osób.¹ W Walii każdego roku rozpoznaje się około 750 przypadków półpaśca przez lekarzy pierwszego kontaktu na 100 000 osób w wieku 65 lat i starszych.¹

Azja i region Pacyfiku

W regionie Azji i Pacyfiku częstość występowania półpaśca jest podobna do tej w Ameryce Północnej i Europie, wynosząc między 3 a 5 przypadków na 1000 osobolat.¹

W Singapurze szacuje się, że rocznie występuje około 30 000 nowych przypadków półpaśca.¹ W Korei badanie populacyjne wykazało częstość występowania wynoszącą od 2,0 na 1000 osobolat w grupie dzieci do 21,8 na 1000 osobolat u osób w wieku 70-79 lat.¹

Jednakże istnieje wyraźny brak badań dotyczących częstości występowania półpaśca w wielu krajach Azji, Ameryce Łacińskiej i Afryce.¹ W krajach Zatoki Perskiej odnotowano brak informacji na temat częstości występowania półpaśca w skali kraju, a trzy zidentyfikowane badania wykazały częstość występowania półpaśca obserwowaną w pojedynczych klinikach, wahającą się od 0,62% do 2,3%.¹

Podobnie, w regionie Azji Południowo-Wschodniej istnieją znaczące luki w literaturze dotyczącej ogólnokrajowej częstości występowania, chorobowości i kosztów ekonomicznych półpaśca.¹

Australazja

W Australii odnotowuje się około 560 przypadków półpaśca na 100 000 mieszkańców rocznie we wszystkich grupach wiekowych.¹ Wskaźniki półpaśca u dorosłych immunokompetentnych wzrastają od wieku 50 lat, z 1174 przypadkami na 100 000 mieszkańców u osób w wieku ≥50 lat.¹

Częstość występowania półpaśca nadal rośnie z wiekiem, od szacowanego wskaźnika 630 na 100 000 mieszkańców u osób w wieku 50-59 lat do 1366 na 100 000 mieszkańców u osób w wieku 60-69 lat i 1531 na 100 000 mieszkańców u osób w wieku 70-79 lat.¹

Rdzenni mieszkańcy Australii i wysp Cieśniny Torresa mają zwiększone ryzyko hospitalizacji z powodu półpaśca od wcześniejszego wieku w porównaniu z osobami niebędącymi rdzennymi mieszkańcami. Szacowany wskaźnik dla rdzennych Australijczyków w wieku 60-69 lat wynosi 34 na 100 000.¹

Przyszłe trendy i wyzwania

Przewiduje się, że częstość występowania półpaśca będzie zmieniać się w przyszłości ze względu na kilka czynników, w tym starzenie się populacji, zmiany w terapii chorób nowotworowych i autoimmunologicznych oraz zmiany we wskaźnikach szczepień przeciwko ospie wietrznej i półpaścowi.¹

Starzenie się populacji

Ponieważ częstość występowania półpaśca znacząco wzrasta z wiekiem, starzenie się populacji na całym świecie prawdopodobnie doprowadzi do wzrostu liczby przypadków półpaśca w nadchodzących dekadach.¹ Szacuje się, że odsetek osób w wieku 60 lat i starszych podwoi się w ciągu najbliższych kilku dekad, co może prowadzić do znacznego wzrostu liczby przypadków półpaśca.¹

Półpasiec może być uważany za niski priorytet zdrowotny w wielu krajach, jednak rosnący odsetek osób starszych w populacji będzie generował zwiększone obciążenie społeczne i ekonomiczne związane z tą chorobą.¹

Wpływ szczepień

Szczepienia przeciwko ospie wietrznej i półpaścowi mają potencjał do znaczącego wpływu na przyszłą epidemiologię półpaśca. Szersze przyjęcie szczepień przeciwko półpaścowi może dramatycznie zmniejszyć wskaźnik zachorowalności.¹

Jednakże, skuteczność programów szczepień zależy od poziomu ich akceptacji przez populację. Obecnie wskaźniki szczepień przeciwko półpaścowi pozostają niskie, co ogranicza ich potencjalny wpływ na epidemiologię choroby.¹

Ponadto, potrzebne są dalsze badania nad długoterminowym wpływem powszechnych szczepień dzieci przeciwko ospie wietrznej na epidemiologię półpaśca.¹

Potrzeby badawcze

Istnieje wyraźna potrzeba dalszych badań w kilku obszarach związanych z epidemiologią półpaśca:

Częstość występowania półpaśca w regionach świata, dla których dane są ograniczone, takich jak Azja, Ameryka Łacińska i Afryka¹
Długoterminowy wpływ szczepień przeciwko ospie wietrznej na epidemiologię półpaśca¹
Świadomość choroby w populacji ogólnej i wśród pracowników służby zdrowia¹
Wpływ szczepień przeciwko półpaścowi na częstość występowania choroby i jej powikłań¹
Potencjalne dodatkowe korzyści szczepień przeciwko półpaścowi, takie jak zmniejszone ryzyko demencji i udaru¹

Niedawno rozpoczęto badanie o wartości 1,7 miliona dolarów na Uniwersytecie Delaware, które ma na celu zbadanie związku między szczepionką przeciwko półpaścowi a zmniejszonym ryzykiem udaru i demencji.¹ Takie badania mogą dostarczyć cennych informacji na temat dodatkowych korzyści szczepień przeciwko półpaścowi, wykraczających poza zapobieganie samej chorobie.¹

Podsumowanie nadzoru epidemiologicznego

Półpasiec stanowi znaczące globalne obciążenie zdrowotne, które prawdopodobnie wzrośnie wraz ze starzeniem się populacji.¹ Częstość występowania półpaśca waha się od 3 do 5 przypadków na 1000 osobolat w Ameryce Północnej, Europie i regionie Azji i Pacyfiku, i znacząco wzrasta z wiekiem.¹

Ryzyko zachorowania na półpaśca w ciągu życia wynosi około 30%, wzrastając do 50% u osób, które dożyły 80 lat.¹¹ Powikłania półpaśca, szczególnie neuralgia popółpaścowa, stanowią istotne obciążenie dla pacjentów i systemów opieki zdrowotnej.¹

Szczepienia przeciwko półpaścowi, szczególnie nowsza szczepionka rekombinowana, wykazują wysoką skuteczność w zapobieganiu chorobie i jej powikłaniom.¹ Szersze przyjęcie szczepień mogłoby znacząco zmniejszyć wskaźniki zachorowalności i obciążenie zdrowotne związane z półpaścem.¹

Jednak potrzebne są dalsze badania i działania w zakresie zdrowia publicznego, aby zwiększyć świadomość choroby, poprawić wskaźniki szczepień i lepiej zrozumieć długoterminowy wpływ szczepień na epidemiologię półpaśca.¹²

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Clinical Overview of Shingles (Herpes Zoster) | Shingles (Herpes Zoster) | CDC
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html
An estimated one million cases of herpes zoster occur annually in the United States. The incidence of herpes zoster varies by age and is approximately two to nine cases per 1,000 US population annually. The precise incidence of recurrence is not known. […] One study estimated 96 deaths occur each year where herpes zoster was the underlying cause (0.280.69 per 1 million population). Almost all of the deaths were in older adults or those with weakened immune systems. […] The CDC continues to monitor the impacts of the U.S. varicella and herpes zoster vaccination programs among adults and children.
#1 Shingles Facts and Stats | Shingles (Herpes Zoster) | CDC
https://www.cdc.gov/shingles/data-research/index.html
1 in 3 people in the United States develop shingles at least once. […] Risk increases with age and in people who have weakened immune systems. […] Approximately 1 to 4% of people with shingles go to the hospital for complications. Older adults and people with weakened or suppressed immune systems are more likely to need to go to the hospital. […] Fewer than 100 people die from shingles each year. Almost all shingles deaths are in older adults or people with compromised immune systems. […] Herpes zoster rates among adults in the United States gradually increased over a long period. We do not know the reason for this increase. However, the rates across age groups have recently plateaued or declined.
#1 Herpes Zoster – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK441824/
The incidence of herpes zoster ranges from 1.2 to 3.4 per 1000 persons per year among younger healthy individuals while incidence is 3.9 to 11.8 per 1000 persons per year among patients older than 65 years. There is no seasonal variation seen with herpes zoster. […] Recurrences are most common in patients who are immunosuppressed.
#1 Systematic review of incidence and complications of herpes zoster: towards a global perspective | BMJ Open
https://bmjopen.bmj.com/content/4/6/e004833
Objective The objective of this study was to characterise the incidence rates of herpes zoster (HZ), also known as shingles, and risk of complications across the world. […] We systematically reviewed studies examining the incidence rates of HZ, temporal trends of HZ, the risk of complications including postherpetic neuralgia (PHN) and HZ-associated hospitalisation and mortality rates in the general population. […] The incidence rate of HZ ranged between 3 and 5/1000 person-years in North America, Europe and Asia-Pacific, based on studies using prospective surveillance, electronic medical record data or administrative data with medical record review. […] A temporal increase in the incidence of HZ was reported in the past several decades across seven countries, often occurring before the introduction of varicella vaccination programmes.
#1 Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective
https://pmc.ncbi.nlm.nih.gov/articles/PMC4591524/
Epidemiology of herpes zoster and its complications […] Varicella zoster virus (VZV) causes a primary infection known as varicella (chicken pox). The virus then migrates from the skin lesions via nerve axons and, probably also by viremic spread, to spinal and cranial sensory ganglia where it becomes dormant. Later in life, in some individuals the virus is reactivated (usually within a single ganglion) to cause a secondary infection known as herpes zoster (HZ; shingles). Individuals with HZ can transmit VZV to their seronegative contacts, who may develop varicella, but not HZ. The household transmission rate of HZ (to cause varicella) is 15%, making it significantly less contagious than varicella but nevertheless of relevance to at-risk contacts. […] Over 95% of immunocompetent individuals aged at least 50 years are seropositive for VZV and are, therefore, at risk of developing HZ. VZV-specific cell-mediated immunity declines with age concomitantly with the rise in the incidence of HZ and its complications that occurs at about 50 years of age. The lifetime risk of developing HZ is between 25% and 30%, rising to 50% in those aged at least 80 years. The estimated average overall incidence of HZ is about 3.44.82 per 1000 person years which increases to more than 11 per 1000 person years in those aged at least 80 years. In Canada, the overall incidences of medically attended HZ and HZ-related outpatient visits and hospitalizations were reported to increase with age. Data from a general practitioner (GP) network in France showed that 1% of patients with HZ were hospitalized and the death rate was 0.2/100,000. HZ-associated mortality is rare, with reported incidence ranging from 0 to 0.47 per 100,000 person year, and the majority of deaths occur in those aged at least 60 years. However, many studies use electronic or paper death certificates which can lead to underestimations or overestimates of the true mortality rate due to infections other than HZ and noninfectious diseases, particularly in older people.
#1 Zoster (herpes zoster) | The Australian Immunisation Handbook
https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/zoster-herpes-zoster
Herpes zoster occurs most commonly in people who: […] The lifetime risk of herpes zoster for people who live to 80 years of age is around 50%. […] For up to 8 years after an initial episode of zoster, the risk of a repeat episode in immunocompetent people is 6â8%. […] Repeat episodes of herpes zoster are more common in people who are immunocompromised. […] In a large clinical trial of Zostavax in the United States (the Shingles Prevention Study), active surveillance in the unimmunised (placebo) participants estimated the herpes zoster incidence at 1112 cases per 100,000 person-years in people â¥60 years of age. […] In Australia, there are about 560 cases of herpes zoster per 100,000 population per year in all age groups. […] Rates of herpes zoster in immunocompetent adults increase from age 50 with 1174 cases per 100,000 population in people aged â¥50 years.
#1
https://medical.gsk.com/en-gb/infectious-diseases/herpes-zoster/epidemiology/incidence/
Anyone who has had varicella (chickenpox) can develop herpes zoster (shingles). […] The incidence of shingles is expected to increase given our ageing population. […] Shingles can occur at any time after infection with VZV, but the incidence of shingles and the severity of symptoms increase with age. […] The risk of complications also increases with age. In the UK as a whole, approximately 14,000 people develop post-herpetic neuralgia, the most common complication of shingles, every year. […] Overall, up to one in four people experience shingles in their lifetime. […] Lifetime prevalence of shingles episodes in unvaccinated 85-year-olds is estimated to be around 50%. […] Most people are infected with VZV before adolescence, remaining at risk of shingles for the rest of their lives and the lifetime risk of shingles is up to 1 in 4. […] The risk of VZV reactivation increases considerably with age, roughly doubling each decade after 50 years of age. […] In adults aged 70 years and older, over 50,000 cases of shingles occur each year in England and Wales.
#1 Shingles – Wikipedia
https://en.wikipedia.org/wiki/Shingles
Shingles is a re-activation of latent VZV infection: zoster can only occur in someone who has previously had chickenpox (varicella). […] The incidence rate of shingles ranges from 1.2 to 3.4 per 1,000 person-years among younger healthy individuals, increasing to 3.9 to 11.8 per 1,000 person-years among those older than 65 years, and incidence rates worldwide are similar. […] This relationship with age has been demonstrated in many countries, and is attributed to the fact that cellular immunity declines as people grow older. […] Another important risk factor is immunosuppression. […] According to a study in North Carolina, „black subjects were significantly less likely to develop zoster than were white subjects.” […] Adults with latent VZV infection who are exposed intermittently to children with chickenpox receive an immune boost.
#1 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html
An estimated 1 million cases of herpes zoster occur in the Unites States annually, with an individual lifetime risk of 30%. About 2% to 3% of patients with this condition are hospitalized each year, with costs ranging from $1 billion to $2 billion annually. In a typical family practice with 1,500 patients, three to five cases of herpes zoster can be expected each year. […] Almost all adults in the United States have been exposed to VZV. The incidence of herpes zoster ranges from one to three cases per 1,000 person-years in those younger than 50 years. Age is a major risk factor; T lymphocyte-specific immunity to the virus wanes over time, and more than one-half of unvaccinated patients 85 years and older will be affected. Women are at increased risk, whereas blacks are at decreased risk. Patients with conditions that decrease cell-mediated immunity (e.g., lymphoproliferative disorders, immunosuppressive drug use, human immunodeficiency virus sero-positivity) are at 20 to 100 times greater risk compared with age-matched controls.
#1 Herpes Zoster: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/1132465-overview
In the United States, approximately 95% of adults and 99.5% of adults aged 40 years or older have antibodies to VZV and thus are vulnerable to reactivation of infection. A person of any age with a previous varicella infection may develop zoster, but the incidence increases with advancing age as a consequence of declining immunity. […] Approximately 4% of patients develop a recurrent episode later in life. Recurrent zoster occurs almost exclusively in people who are immunosuppressed. Approximately 25% of patients with HIV and 7%-9% of those receiving renal transplantation or cardiac transplantation experience a bout of zoster. […] HZO represents 10%-15% of all cases of HZ. Approximately half of these patients develop complications of HZO. The risk of ophthalmic complications in patients with herpes zoster does not seem to correlate with age, sex, or severity of the rash.
#1 Zoster (herpes zoster) | The Australian Immunisation Handbook
https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/zoster-herpes-zoster
Herpes zoster incidence continues to rise with age, from an estimated rate of 630 per 100,000 population in people aged 50â59 years to 1366 per 100,000 population in people aged 60 to 69 to 1531 per 100,000 population in people aged 70â79 years. […] Aboriginal and Torres Strait Islander people have an increased risk of hospitalisation from herpes zoster from an earlier age when compared to non-Indigenous people. […] The estimated rate for Aboriginal and Torres Strait Islander people aged 60-69 years is 34 per 100,000. […] People who are immunocompromised have an increased risk of herpes zoster compared with non-immunocompromised people. […] Rates of herpes zoster are up to 15 times higher in people who are immunocompromised due to HIV infection. […] In the 1st year after haematopoietic stem cell transplantation, up to 30% of patients may develop herpes zoster.
#1 Gender difference in the incidence of shingles | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/gender-difference-in-the-incidence-of-shingles/EA2A30569481F5EFAC7EBCD25908351B
We investigated age- and gender-specific incidence of shingles reported in a large sentinel practice network monitoring a defined population over the years 19942001. […] Shingles incidence was greater in females in each age group (except for 1524 years). […] Gender-specific age-standardized incidence rates of shingles were calculated for each year and showed a consistent female excess in each of the 8 years (average annual excess 28%).
#1 Varicella-Zoster Virus (VZV): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/231927-overview
The cumulative incidence (3.2211.2 vs 2.448.0 cases per 1000 population) and incidence rates (6.0512.8 vs 4.308.5 cases per 1000 person-years) were higher in females than males. Studies revealed a trend of increasing incidence of HZ with increasing age and over time. […] Zoster mortality is presumably elevated in countries severely affected by the HIV/AIDS pandemic. […] The lifetime risk of developing HZ is between 25% and 30%, rising to 50% in those aged at least 80 years. The estimated average overall incidence of HZ is about 3.44.82 per 1000 person years, which increases to more than 11 per 1000 person years in those aged at least 80 years.
#1 Shingles | Surveillance, Trends, Deaths | Herpes Zoster | CDC
http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/shingles/surveillance.html
There has been a gradual but steady increase in incidence of shingles and Postherpatic Neuralgia among each age group. […] Almost 1 out of 3 people in the United States will develop shingles during their lifetime. […] Your risk of getting shingles increases as you age, especially after age 50. […] The most common complication of shingles is postherpatic neuralgia (PHN), which is severe pain in the areas where the shingles rash occurred. […] Approximately 1 to 4% of people who get shingles are hospitalized for complications. […] Each year, about 96 shingles-related deaths occur in the United States. […] Shingles is increasing among adults in the United States. […] The increase has been gradual over a long period of time. […] Other countries without routine chickenpox vaccination programs have observed similar increases in shingles rates. […] In 2014, 28% of adults aged 60 years and older reported receiving the shingles vaccine.
#1 Herpes zoster: epidemiology, clinical features, treatment and prevention – Australian Prescriber
https://australianprescriber.tg.org.au/articles/herpes-zoster-epidemiology-clinical-features-treatment-and-prevention.html
Herpes zoster (also called shingles) is becoming more common as the population ages. […] Studies have shown that about a third of the population will experience herpes zoster during the course of their lifetime with the incidence increasing particularly after the age of 60 years. […] The varicella vaccine for children has been government funded since late 2005 in Australia. […] These data support the need for more widespread uptake of the licensed herpes zoster vaccine in adults. […] Globally there is also evidence that the rate of herpes zoster is increasing. […] The underlying reasons for this are probably multifactorial and include: the ageing of the population, increased use of immunosuppressant drugs, widespread childhood vaccination against varicella zoster virus. […] A live attenuated herpes zoster vaccine was effective in decreasing the incidence of herpes zoster by about half and the overall burden of illness by about 60% in people aged 60 years and over.
#1 Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective
https://pmc.ncbi.nlm.nih.gov/articles/PMC4591524/
Impact of varicella vaccination on HZ epidemiology […] Hope-Simpson was the first to postulate that re-exposure to circulating VZV, a phenomenon known as exogenous boosting, could prevent reactivation of VZV. Vaccination of children against varicella, which is established in some countries, could have two effects on the epidemiology of HZ. The first is that there will be fewer adults carrying dormant wild type VZV as vaccinated children grow older, thus reducing the incidence of HZ. The second is that, in the shorter term, adults with dormant VZV will have less contact with children with varicella and therefore less opportunity for exogenous boosting. Since exogenous boosting is thought to inhibit VZV reactivation, this could result in a temporary increased incidence of HZ and could reduce the age of HZ onset. Mathematical models predict that this increased incidence could last for more than 30 years.
#1 Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective
https://pmc.ncbi.nlm.nih.gov/articles/PMC4591524/
Since the introduction of widespread childhood varicella vaccination, no impact has been observed on the incidence or age distribution of HZ. Other studies have reported an increasing trend in the general population as well as in immunocompromised populations, but this trend preceded the implementation of childhood varicella vaccination. Long-term surveillance will be necessary to establish if there will be an increased incidence of HZ.
#1 Zoster (herpes zoster) | The Australian Immunisation Handbook
https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/zoster-herpes-zoster
The risk of herpes zoster in people receiving therapy for conditions such as cancer, transplants or autoimmune conditions varies depending on their age, condition, the therapy they are receiving, and whether there is concomitant therapies. […] Overall, 13â26% of patients with herpes zoster develop complications. […] Complications occur more often in older people and people who are immunocompromised. […] Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster, but it occurs very infrequently in children and young adults. […] The population-based incidence of PHN is 3 times higher in people aged 70â79 years (235 per 100,000) than in people aged 50â59 years (73 per 100,000).
#1 Herpes zoster (shingles) vaccine: Canadian Immunization Guide – Canada.ca
https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-8-herpes-zoster-(shingles)-vaccine.html
Herpes zoster (shingles) is a manifestation of reactivation of the varicella-zoster virus (VZV), a DNA virus of the Herpesvirus family, which, as a primary infection, causes varicella (chickenpox). […] HZ occurs most frequently among older adults and immunocompromised persons. […] The most frequent complication of acute HZ is PHN which is characterized by prolonged and often debilitating neurogenic pain that lasts for more than 90 days from the onset of rash. […] In recent studies, the lifetime risk of HZ has been estimated to be as high as 30% in the general population. In Canada, it is estimated that each year there are 130,000 new cases of HZ, 17,000 cases of PHN and 20 deaths. […] RZV is recommended for individuals 50 years of age without contraindications. […] RZV should be considered for immunocompromised adults 50 years of age based on a case-by-case assessment of the benefits vs risks.
#1 Shingles: How Painful Is It? And Is there a Vaccine?
https://www.ncoa.org/article/what-is-shingles-and-how-long-can-it-last/
Researchers don’t know all the reasons why the chickenpox virus reactivates in some people and not others. But they do know that age and the immune system are key factors. […] Older adults have a higher risk of developing PHN, which about 10% to 18% of people get after having the shingles rash. […] Getting the shingles vaccine is a safe, effective way to protect yourself from these potential and serious complications. […] A 2024 study found that older adults who received the Shingrix vaccine had a 17% lower risk of dementia compared to those who took the since-discontinued Zostavax shingles vaccine.
#1 Systematic review of incidence and complications of herpes zoster: towards a global perspective | BMJ Open
https://bmjopen.bmj.com/content/4/6/e004833
HZ may be regarded as a low health priority in many of these countries; however, the proportion of people 60 years of age is projected to double in the next several decades, and the numbers of HZ cases are expected to increase substantially. […] The temporal increase was independent of age. […] The risk of developing PHN varied from 5% to more than 30%. […] The risk of recurrence of HZ ranged from 1% to 6%, with long-term follow-up studies showing higher risk (56%). […] Hospitalisation rates ranged from 2 to 25/100000 person-years, with higher rates among elderly populations. […] Mortality rates associated with HZ ranged from 0.017 to 0.465/100000 person-years in studies.
#1 Shingles – Information for health professionals – Public Health Wales
https://phw.nhs.wales/topics/immunisation-and-vaccines/vaccines-professionals/shingles-information-for-health-professionals/
Shingles can happen at any age, but it is more common as people get older. The chances of getting shingles in your lifetime are about 1 in 4. […] Each year, approximately 750 cases of shingles are diagnosed by GPs per 100,000 people aged 65 and over in Wales (data taken from Audit+, 2023). […] In Wales approximately 60 cases of PHN are diagnosed by GPs per 100,000 people aged 65 and over each year (data taken from Audit+, 2023). […] From April 2021 to March 2022, there were 90 people aged 65 and over admitted to hospital with shingles (data taken from Patient Episode Database Wales (PEDW)). […] It’s estimated that around one in every 1,000 cases of shingles in adults over 70 results in death. […] In February 2019, based on impact and cost effectiveness modelling, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the national shingles immunisation programme should be changed to offer Shingrix.
#1 Colgate Oral Health Network
https://www.colgateoralhealthnetwork.com/article/orofacial-shingles-complications-and-prevention/
Shingles (herpes zoster; HZ) is an acute viral infection occurring in individuals that previously experienced chickenpox as a result of infection with the varicella zoster virus. […] An estimated 1 in 3 people will experience HZ during their lifetime, with an increased risk for older and immunosuppressed individuals. […] In the US, an overall average rate of approximately 2 to 3 per 1,000 people per year has been reported. […] This was data reported several years after the introduction of a live attenuated vaccine against HZ (recommended for individuals age 60 and over), and prior to the introduction of a new vaccine and recommendations in 2018. […] Risk factors for recurrence of HZ in any location include weakened immunity, being female, predisposing conditions such as diabetes, and long-duration PHN after the initial episode of HZ.
#1 Chickenpox and shingles (varicella / herpes zoster)
https://www.health.vic.gov.au/infectious-diseases/chickenpox-and-shingles-varicella-herpes-zoster
Chickenpox and shingles must be notified by medical practitioners and pathology services in writing within 5 days of diagnosis. […] Varicella is a routine notifiable condition and must be notified by medical practitioners and pathology services in writing within 5 days of diagnosis. […] Chickenpox is highly infectious, shingles much less so. More than 80 per cent of non-immune household contacts of a case of chickenpox will become infected. […] Herpes zoster (shingles) occurs due to the reactivation of latent virus from the dorsal root ganglia. About 1 in 3 people will get shingles in their lifetime. […] Timely vaccination of susceptible contacts is indicated to contain an outbreak. […] Immunosuppressed people, particularly those with primary or acquired diseases associated with cellular immune deficiency, and people receiving immunosuppressive therapy, are at high risk of more severe infection.
#1 Shingles – Information for health professionals – Public Health Wales
https://phw.nhs.wales/topics/immunisation-and-vaccines/vaccines-professionals/shingles-information-for-health-professionals/
From 1 September 2023, the eligibility for Shingrix vaccination expanded to include all immunocompromised individuals aged 50 and over, with no upper age limit. […] Phase 2 (01 September 2028 to 31 August 2033): During Phase 2, Shingrix should be offered to those turning 60 and 65. […] From 1 September 2033, Shingrix will be offered routinely to all immunocompetent individuals at 60 years of age, and eligible immunocompromised (severely immunosuppressed) individuals aged 50 years or over. […] Further information about eligibility for the shingles vaccine from 1 September 2023 is available in the Guidance section. […] Shingles vaccination surveillance.
#1 Shingles for Schools and Child Care – MN Dept. of Health
https://www.health.state.mn.us/diseases/shingles/school.html
Schools and child cares are to report all confirmed and suspected cases of zoster (shingles) in children under 18 at their facility. […] MDH will also perform strain-type testing on all pediatric shingles cases submitted to the MDH Public Health Lab. Strain-typing can help us identify whether the disease is due to vaccine strain or wild-type varicella zoster virus and helps track the changing epidemiology of shingles in an era of high varicella vaccination rates. […] If the rash cannot be fully covered, exclude children or staff with shingles from schools or child care until all blisters have crusted and no new lesions have appeared for at least 24 hours. This is usually seven to 10 days after the rash began. […] Disseminated zoster, a more widespread form of the disease, is more infectious than localized zoster. If a person has been diagnosed with disseminated zoster, they must be excluded from school or child care settings regardless of whether their lesions can be completely covered.
#1 Herpes Zoster (Shingles) | Disease Outbreak Control Division
https://health.hawaii.gov/docd/disease_listing/shingles-herpes-zoster/
Herpes zoster, also known as zoster or shingles, is a painful skin rash caused by the varicella zoster virus (VZV) the same virus that causes chickenpox. […] In the U.S., currently an estimated 1 million people get shingles every year. […] About half of all cases occur in adults aged 60 years and older. […] Because health care providers are not required to report shingles to the Department of Health, the number of cases occurring annually in Hawaii is unknown.
#1 Department of Health | Communicable Disease Service | Varicella
https://www.nj.gov/health/cd/topics/varicella.shtml
Shingles is common in people 50 years of age and older. […] *Not currently reportable in NJ* […] CDC – Shingles (Herpes Zoster) […] NJDOH Shingles Disease Chapter.
#1 Systematic review of incidence and complications of herpes zoster: towards a global perspective | BMJ Open
https://bmjopen.bmj.com/content/4/6/e004833
HZ is a significant global health burden that is expected to increase as the population ages. […] It is essential for healthcare practitioners and health policymakers to be informed by the best available and up-to-date evidence on the HZ burden of disease. […] Our review included 63 studies on incidence, substantially more than the prior review by Thomas and Hall, which included 17 studies with overall incidence ranging from 1.2 to 4.8/1000 person-years. […] Relatively similar estimates of the HZ incidence rate (between 3 and 5/1000 person-years) were reported in North America, Europe and Asia-Pacific. […] However, we observed some variations in estimates most likely due to the various study designs, case ascertainments, age distributions of the population and year of the study. […] There is a scarcity of research examining the incidence of HZ in Asia, Latin America and Africa.
#1
https://link.springer.com/article/10.1007/s40121-022-00715-8
There were notable gaps in the literature regarding country-wide trends in HZ incidence and the impact of VZV vaccination on VZV and HZ infection. […] The lack of studies identified in this review relating to HZ incidence and prevalence reflects the lack of evidence found in the Middle East by a recent meta-regression study examining trends in global HZ infection. […] While most GCC countries have introduced VZV vaccinations into their national immunization programs, there is limited evidence relating to the impact of vaccination on incidence rates of VZV, and an absence of research evaluating the impact of VZV vaccination on the incidence of HZ. […] There were no studies found for the GCC countries on the impact of VZV vaccination on the incidence of HZ, and thus this remains a significant gap in the current literature.
#1
https://link.springer.com/article/10.1007/s40121-023-00822-0
Global incidence of herpes zoster (HZ) is increasing; however, there is a lack of literature reviews evaluating the burden of disease of HZ in Southeast Asia. […] There were substantial gaps in the literature reporting the nationwide incidence, prevalence, and economic toll of HZ in Southeast Asia, both in individual age groups and among vulnerable populations. […] However, the abundance of clinical case reports highlighting numerous symptoms and the severity of complications across health centers suggests HZ healthcare resource utilization is substantial in the region. […] Further research is needed to determine the disease awareness in the general population and healthcare professionals, as well as its impact in Southeast Asian societies to inform future strategies for HZ prevention.
#1 JMIR Public Health and Surveillance – Willingness to Vaccinate Against Herpes Zoster and Its Associated Factors Across WHO Regions: Global Systematic Review and Meta-Analysis
https://publichealth.jmir.org/2023/1/e43893/
Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged 50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccines availability. Monitoring HZ vaccination willingness is necessary to inform public health decision-making.
#1 Shingles – Wikipedia
https://en.wikipedia.org/wiki/Shingles
When routine chickenpox vaccination was introduced in the United States, there was concern that, because older adults would no longer receive this natural periodic boost, there would be an increase in the incidence of shingles. […] Multiple studies and surveillance data, at least when viewed superficially, demonstrate no consistent trends in incidence in the U.S. since the chickenpox vaccination program began in 1995. […] A later study by Patel et al. concluded that since the introduction of the chickenpox vaccine, hospitalization costs for complications of shingles increased by more than $700 million annually for those over age 60. […] Another study by Yih et al. reported that as varicella vaccine coverage in children increased, the incidence of varicella decreased, and the occurrence of shingles among adults increased by 90%. […] It is likely that incidence rate will change in the future, due to the aging of the population, changes in therapy for malignant and autoimmune diseases, and changes in chickenpox vaccination rates; a wide adoption of zoster vaccination could dramatically reduce the incidence rate.
#1 Survey Finds Less than Two-Thirds of Americans (62%) Know a Preventive Vaccine is Available for Shingles – American Osteopathic AssociationSearchSearch
https://osteopathic.org/2018/06/12/survey-finds-less-than-two-thirds-of-americans-62-know-a-preventive-vaccine-is-available-for-shingles/
Survey Finds Less than Two-Thirds of Americans (62%) Know a Preventive Vaccine is Available for Shingles. […] A new survey commissioned by the American Osteopathic Association finds less than two-thirds of Americans (62%) are aware that there is a shingles vaccine. […] In 2016, researchers found only 33 percent of eligible patients were vaccinated, pointing to the limited efficacy of the previous vaccine, a lack of awareness that the illness can be prevented, and cost concerns. […] Shingles vaccination is now nearly twice as effective as the previous protocol and available to patients 10 years younger than before, enabling largescale prevention of a painful, common condition. […] Almost one in three Americans will be afflicted with shingles in their lifetime. […] The new vaccine, marketed as Shingrix, is shown to be 97 percent effective in adults ages 50-69, and more than 90 percent effective in those 70 to well past 80.
#1 Survey Finds Less than Two-Thirds of Americans (62%) Know a Preventive Vaccine is Available for Shingles – American Osteopathic AssociationSearchSearch
https://osteopathic.org/2018/06/12/survey-finds-less-than-two-thirds-of-americans-62-know-a-preventive-vaccine-is-available-for-shingles/
The earlier vaccine, Zostavax, prevented just over half (51%) of recipients from developing the painful disease and was recommended for patients 60 and older, due to waning immunity over time. […] Shingles occurs when the herpes zoster virusâthe same virus that causes chickenpoxâreactivates years or decades later. […] The pain associated with herpes-zoster can be intense and debilitating. […] More than half the cases of PHN affect people over 60. […] Other possible complications of shingles include pneumonia, hearing problems, blindness, encephalitis and very rarely death.
#1 Proactive Prevention and Treatment of Shingles Pain and PHN
https://www.uspharmacist.com/article/proactive-prevention-and-treatment-of-shingles-pain-and-phn
In the fight against acute HZ pain and PHN, immunization is the most effective option for their mitigation. Currently, the CDC recommends a two-dose series with Shingrix for adults aged 50 years and older or adults aged 19 years and older who are immunocompromised due to disease or drug therapy.24 Shingrix is a recombinant, adjuvanted zoster vaccine that boosts the immune response against VZV to prevent reactivation of the virus.25 Studies have shown a 97% efficacy rate in the prevention of HZ in patients aged 50 to 69 years and 91% efficacy in adults aged 70 years or older. Of those who developed HZ after vaccination, the disease was milder, and PHN developed in only 9% of patients aged 50 to 69 years and 11% in those aged 70 years and older.24
#1 Colgate Oral Health Network
https://www.colgateoralhealthnetwork.com/article/orofacial-shingles-complications-and-prevention/
The CDC recommends two doses of recombinant zoster vaccine (RZV, Shingrix), given two to six months apart, for the prevention of HZ and related complications in adults 50 years and older as well as immunocompromised adults 19 years-of-age and over. […] This FDA-approved vaccine was recommended in 2018, has been shown in clinical trials to be 97.2% effective in adults at least 50 years-of-age, and also protects against PHN. […] Hospitalization and death from HZ is rare in the US, with up to 4% of affected individuals hospitalized and less than 100 deaths annually among old and/or immunocompromised individuals.
#1 Zoster (shingles) | NCIRS
https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/zoster-shingles
Shingrix replaced Zostavax on the National Immunisation Program from 1 November 2023. […] Zoster (shingles) vaccination data NCIRS […] Shield yourself from shingles Australian Government Department of Health and Aged Care.
#1 Zoster (shingles) vaccine: frequently asked questions (FAQs) | NCIRS
https://ncirs.org.au/zoster-shingles/zoster-shingles-vaccine-frequently-asked-questions-faqs
Herpes zoster commonly known as shingles presents as a painful rash of fluid-filled blisters on one side of the face or body, often in a strip or band-like pattern. It is caused when the virus that causes chickenpox (varicella) reactivates. […] Shingrix is registered and recommended for use in people aged 50 years and over and immunocompromised people aged 18 years and over. Under the National Immunisation Program, it is available free for people aged 65 years and over, Aboriginal and Torres Strait Islander people aged 50 years and over, and immunocompromised people aged 18 years and over with certain medical conditions. […] In December 2024, Zostavax was deregistered in Australia and the vaccine was removed from the Australian Immunisation Handbook. […] People are at risk of developing shingles if they have previously had chickenpox (i.e. VZV infection). In Australia, most adults will be at risk even if they dont remember having had chickenpox in the past.
#1
https://www.who.int/news-room/fact-sheets/detail/shingles-(herpes-zoster)
WHO recommends that the use of the recombinant herpes zoster vaccine in a 2-dose schedule with a minimum 2-month interval between doses, for the prevention of herpes zoster in older adults and those with chronic conditions, be considered in countries where herpes zoster is an important public health problem. […] The vaccine is highly effective and licensed for adults age 50 years and older, even if they’ve had shingles before. […] Being vaccinated significantly reduces the risk of developing shingles and PHN. […] The chickenpox vaccine (varicella vaccine) can reduce the risk of developing shingles later in life. […] Studies have shown that children who received the chickenpox vaccine are significantly less likely to develop shingles compared to those who contracted chickenpox naturally.
#1 Annual incidence rates of herpes zoster among an immunocompetent population in the United States | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1262-8
Herpes zoster (HZ), also known as shingles, is a painful and commonly occurring condition in the United States. […] The objective of the current study is to estimate the overall and age- and gender-specific incidence rates (IRs) of HZ among an immunocompetent US population in 2011 following availability of a vaccine. […] The overall annual IR of HZ across all ages was 4.47 per 1000 person-years (95 % confidence interval [CI]: 4.444.50) which monotonically increased with age from 0.86 (95 % CI: 0.840.88) for those aged 19 to 12.78 (95 % CI: 12.4913.07) for patients 80 years. […] Despite the availability of a vaccine, HZ remains common among immunocompetent adults in the US with incidence rates of HZ observed to increase with age and be higher in women than men. […] In spite of vaccine availability, HZ continues to pose a significant burden in the US.
#1 Shingles | Doctor
https://patient.info/doctor/shingles-and-shingles-vaccination
How common is shingles? (Epidemiology) Chickenpox is a very common childhood illness. At least 90% of adults raised in the UK are immune, having been exposed in childhood. All these people are at risk of developing shingles. […] Shingles is thought to primarily affect older people but it can arise at any age, including in children. The incidence and severity of shingles increases with age. The annual incidence of shingles for those aged 70 to 79 years is estimated to be around 790 to 880 cases per 100,000 people in England and Wales. The lifetime risk is estimated at one in four. […] Increasing age significantly increases the incidence, morbidity and mortality of shingles. […] Incidence and risk are increased in the immunocompromised patient. Consider underlying immunodeficiency in those presenting with shingles affecting more than one dermatome. […] HIV, Hodgkin’s lymphoma and bone marrow transplantation all present a high risk.
#1
https://www.ncid.sg/News-Events/News/Pages/What-is-shingles-and-how-is-it-prevented.aspx
Shingles occurs only in people who have had a prior chicken pox infection. […] The US CDC says that one in three adults will get shingles in their lifetime. […] Dr Asok Kurup, an infectious diseases expert in private practice, said Singapore is estimated to have about 30,000 new shingles cases a year. […] With increasing age, the risk of getting shingles increases due to declining immunity, with increasing rates seen in individuals over the age of 50. […] Singapore included the varicella (or chicken pox) vaccine in the National Childhood Immunisation Programme in 2020. […] Dr Kurup said vaccination is the only way to protect against shingles. […] Two vaccines are licensed for use here, but most clinics offer only the newer and better vaccine, Shingrix, which is more effective at preventing shingles than the older Zostavax. […] The US stopped the sale of Zostavax in 2020, and recommends those who had taken it to get vaccinated with Shingrix.
#1 Epidemiology, treatment and prevention of herpes zoster: A comprehensive review – Indian Journal of Dermatology, Venereology and Leprology
https://ijdvl.com/epidemiology-treatment-and-prevention-of-herpes-zoster-a-comprehensive-review/
Herpes zoster is a major health burden that can affect individuals of any age. It is seen more commonly among individuals aged 50 years, those with immunocompromised status, and those on immunosuppressant drugs. […] Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. […] A systematic review published in 2014 reported an incidence of 35/1000-person years (PY) for herpes zoster in North America, Europe, and Asia- Pacific, with an increased incidence of 6-8/1000-person year at 60 years of age and 8-12/1000-person year at 80 years of age. […] The incidence of herpes zoster increases with age which was proven by a population-based study conducted in Korea that reported an incidence of 2.0/1000-person year among the childhood group to 21.8/1000-person year in those aged 70-79 years.
#1
https://link.springer.com/article/10.1007/s40121-022-00715-8
The reactivation of varicella zoster virus (VZV) in previously infected individuals can cause herpes zoster (HZ), which is characterized by a localized, painful dermatomal rash. […] While there is a global trend of increasing HZ cases, there is a lack of research examining the epidemiology of HZ within the Gulf Cooperation Council (GCC) countries. […] There was very limited country-wide information on the incidence of HZ in GCC countries, and three identified studies reported HZ prevalence as seen in a single clinic, ranging from 0.62% to 2.3%. […] There is a clear gap in the literature regarding the incidence of HZ infection, and the impacts of HZ and VZV vaccinations in the GCC countries. […] Further research into the epidemiology of HZ is necessary to inform the implementation of vaccination programs in the GCC countries.
#1 New research sheds light on shingles – Kaiser Permanente Department of Research & Evaluation
https://www.kp-scalresearch.org/new-research-sheds-light-on-shingles/
The study findings allow physicians to better understand the risk of shingles and to reassure otherwise healthy patients about their chance of severe illness or death. […] The findings underscore the importance of being immunized against shingles, even for people who already developed it once, said Bradley Ackerson, MD, a physician at the Kaiser Permanente South Bay Medical Center in Harbor City. […] Shingles is not a rare disease. The incidence generally goes up with age, and the risk of long-term complications is substantial, Dr. Ackerson said. […] The study gives physicians and researchers a good baseline to determine the effectiveness of the newest shingles vaccine available to patients.
#1 Beyond preventing shingles | UDaily
https://www.udel.edu/udaily/2024/october/epidemiology-shingles-vaccine-shingrix-dementia-research/
If a precursor to incident dementia is neuroinflammation and stroke, if you have a stroke, its a strong predictor for vascular dementia, explained Harris. […] Preventing shingles through vaccination may, therefore, be one strategy to slow dementia progression in those exhibiting underlying neuropathology of dementia. […] Harris hopes this study and its findings increase awareness of the benefits of shingles vaccination in older adults, especially those living in nursing homes, who are at greater risk of stroke and other adverse effects of shingles. The study also has broader research and public health implications. […] Vaccines have the potential to do more than just prevent the infection theyre designed to prevent, he said. If we prevent the infection, then we can also avoid the devastating downstream effects of that infection.
#1 Local epidemiology researcher leads $1.7 million study on shingles vaccine impact on dementia, stroke | Delaware First Media
https://www.delawarepublic.org/show/the-green/2024-11-08/local-epidemiology-researcher-leads-1-7-million-study-on-shingles-vaccine-impact-on-dementia-stroke
A major study at the University of Delaware is underway exploring the wide-ranging effectiveness of the shingles vaccine. […] At the University of Delaware, a $1.7 million study is underway allowing assistant professor of epidemiology Daniel Harris access to health records for roughly three million nursing home residents for a closer look at the effectiveness of the shingles vaccine in preventing the disease, dementia, and stroke. […] A University of Delaware researcher is exploring the links between a popular shingles vaccine and a reduced risk of stroke and dementia. […] Around 1 million people get shingles each year. Beyond being painful, the disease can also lead to a greater risk of having a stroke or dementia. […] Harris is combing through more than 3 million records from nursing homes nationwide to see if by helping prevent shingles, the Shingrix vaccine can also reduce the risk of stroke and dementia.
#1 Zoster (shingles) vaccine: frequently asked questions (FAQs) | NCIRS
https://ncirs.org.au/zoster-shingles/zoster-shingles-vaccine-frequently-asked-questions-faqs
Around 2030% of people will have shingles in their lifetime most after the age of 50 years and around half of all people who live to 85 years of age will develop shingles. […] The most common complication of shingles is post-herpetic neuralgia (PHN). PHN can be diagnosed when the nerve pain at the site of the rash continues for more than three months. It can have a severe effect on quality of life and be difficult to treat. […] All people aged 50 years and over, and those aged 18 years and over who are immunocompromised, are recommended to receive the Shingrix vaccine to prevent shingles and its complications. […] A 2-dose course of Shingrix is available free of charge under the NIP for: people aged 65 years and over, Aboriginal and Torres Strait Islander people aged 50 years and over, certain immunocompromised people aged 18 years and over.
#2 Herpes Zoster: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/1132465-overview
Before the advent of widespread vaccination, an estimated 4 million cases of primary VZV infection occurred annually in the United States alone. Infection was nearly universal by the end of the teenage years, with studies showing only 10% of persons older than age 15 years as remaining susceptible to infection. […] Over the period of a lifetime, 10%-20% of those with primary infections went on to experience episodes of herpes zoster. High-risk groups, such as elderly populations and immunocompromised people, might experience cumulative incidences as high as 50%. […] The estimated annual number of cases in the United States is approximately 1 million. Since the introduction of widespread vaccination for varicella in 1995, the incidence of primary VZV infection in the United States has been reduced by up to 90%. However, the effect of this vaccination, as well as that of the subsequently approved vaccination for herpes zoster, on the current and future incidence of herpes zoster remains to be determined.
#2 Shingles | Utah Epidemiology
https://epi.utah.gov/shingles/
Shingles, or herpes zoster, is an infection caused by the varicella zoster virus, the same virus that causes chickenpox. […] Almost 1 out of every 3 people in the US will develop shingles. […] Adults are best protected by getting the shingles vaccine. […] This will help them avoid ever getting this virus.
#2 Shingles – Wikipedia
https://en.wikipedia.org/wiki/Shingles
Shingles is a re-activation of latent VZV infection: zoster can only occur in someone who has previously had chickenpox (varicella). […] The incidence rate of shingles ranges from 1.2 to 3.4 per 1,000 person-years among younger healthy individuals, increasing to 3.9 to 11.8 per 1,000 person-years among those older than 65 years, and incidence rates worldwide are similar. […] This relationship with age has been demonstrated in many countries, and is attributed to the fact that cellular immunity declines as people grow older. […] Another important risk factor is immunosuppression. […] According to a study in North Carolina, „black subjects were significantly less likely to develop zoster than were white subjects.” […] Adults with latent VZV infection who are exposed intermittently to children with chickenpox receive an immune boost.
#2 Epidemiology of Herpes Zoster
https://www.gavinpublishers.com/article/view/epidemiology-of-herpes-zoster
Age is also an important risk factor for development of zoster. […] The incidence of zoster is increased in persons with hematologic malignancies and solid tumors. […] Herpes zoster vaccination for individuals aged 60 years reduces the incidence, burden of illness, and morbidity associated with herpes zoster and post herpetic neuralgia.
#2 Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective
https://pmc.ncbi.nlm.nih.gov/articles/PMC4591524/
Impact of varicella vaccination on HZ epidemiology […] Hope-Simpson was the first to postulate that re-exposure to circulating VZV, a phenomenon known as exogenous boosting, could prevent reactivation of VZV. Vaccination of children against varicella, which is established in some countries, could have two effects on the epidemiology of HZ. The first is that there will be fewer adults carrying dormant wild type VZV as vaccinated children grow older, thus reducing the incidence of HZ. The second is that, in the shorter term, adults with dormant VZV will have less contact with children with varicella and therefore less opportunity for exogenous boosting. Since exogenous boosting is thought to inhibit VZV reactivation, this could result in a temporary increased incidence of HZ and could reduce the age of HZ onset. Mathematical models predict that this increased incidence could last for more than 30 years.
#2 Shingles – Wikipedia
https://en.wikipedia.org/wiki/Shingles
When routine chickenpox vaccination was introduced in the United States, there was concern that, because older adults would no longer receive this natural periodic boost, there would be an increase in the incidence of shingles. […] Multiple studies and surveillance data, at least when viewed superficially, demonstrate no consistent trends in incidence in the U.S. since the chickenpox vaccination program began in 1995. […] A later study by Patel et al. concluded that since the introduction of the chickenpox vaccine, hospitalization costs for complications of shingles increased by more than $700 million annually for those over age 60. […] Another study by Yih et al. reported that as varicella vaccine coverage in children increased, the incidence of varicella decreased, and the occurrence of shingles among adults increased by 90%. […] It is likely that incidence rate will change in the future, due to the aging of the population, changes in therapy for malignant and autoimmune diseases, and changes in chickenpox vaccination rates; a wide adoption of zoster vaccination could dramatically reduce the incidence rate.
#2 Shingles | Surveillance, Trends, Deaths | Herpes Zoster | CDC
http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/shingles/surveillance.html
There has been a gradual but steady increase in incidence of shingles and Postherpatic Neuralgia among each age group. […] Almost 1 out of 3 people in the United States will develop shingles during their lifetime. […] Your risk of getting shingles increases as you age, especially after age 50. […] The most common complication of shingles is postherpatic neuralgia (PHN), which is severe pain in the areas where the shingles rash occurred. […] Approximately 1 to 4% of people who get shingles are hospitalized for complications. […] Each year, about 96 shingles-related deaths occur in the United States. […] Shingles is increasing among adults in the United States. […] The increase has been gradual over a long period of time. […] Other countries without routine chickenpox vaccination programs have observed similar increases in shingles rates. […] In 2014, 28% of adults aged 60 years and older reported receiving the shingles vaccine.
#2 Clinical Overview of Shingles (Herpes Zoster) | Shingles (Herpes Zoster) | CDC
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html
An estimated one million cases of herpes zoster occur annually in the United States. The incidence of herpes zoster varies by age and is approximately two to nine cases per 1,000 US population annually. The precise incidence of recurrence is not known. […] One study estimated 96 deaths occur each year where herpes zoster was the underlying cause (0.280.69 per 1 million population). Almost all of the deaths were in older adults or those with weakened immune systems. […] The CDC continues to monitor the impacts of the U.S. varicella and herpes zoster vaccination programs among adults and children.
#2 Herpes Zoster – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK441824/
The incidence of herpes zoster ranges from 1.2 to 3.4 per 1000 persons per year among younger healthy individuals while incidence is 3.9 to 11.8 per 1000 persons per year among patients older than 65 years. There is no seasonal variation seen with herpes zoster. […] Recurrences are most common in patients who are immunosuppressed.
#2 Proactive Prevention and Treatment of Shingles Pain and PHN
https://www.uspharmacist.com/article/proactive-prevention-and-treatment-of-shingles-pain-and-phn
In the fight against acute HZ pain and PHN, immunization is the most effective option for their mitigation. Currently, the CDC recommends a two-dose series with Shingrix for adults aged 50 years and older or adults aged 19 years and older who are immunocompromised due to disease or drug therapy.24 Shingrix is a recombinant, adjuvanted zoster vaccine that boosts the immune response against VZV to prevent reactivation of the virus.25 Studies have shown a 97% efficacy rate in the prevention of HZ in patients aged 50 to 69 years and 91% efficacy in adults aged 70 years or older. Of those who developed HZ after vaccination, the disease was milder, and PHN developed in only 9% of patients aged 50 to 69 years and 11% in those aged 70 years and older.24
#2
https://link.springer.com/article/10.1007/s40121-023-00822-0
Global incidence of herpes zoster (HZ) is increasing; however, there is a lack of literature reviews evaluating the burden of disease of HZ in Southeast Asia. […] There were substantial gaps in the literature reporting the nationwide incidence, prevalence, and economic toll of HZ in Southeast Asia, both in individual age groups and among vulnerable populations. […] However, the abundance of clinical case reports highlighting numerous symptoms and the severity of complications across health centers suggests HZ healthcare resource utilization is substantial in the region. […] Further research is needed to determine the disease awareness in the general population and healthcare professionals, as well as its impact in Southeast Asian societies to inform future strategies for HZ prevention.