From the Guidelines
Having Herpes Zoster (shingles) is a significant risk factor for recurrent Herpes Zoster (shingles), with a cumulative incidence of recurrence of 2.5% at 2 years and increasing to 10.3% at 10 years. According to a recent study in the US, with an average 5.6 years of follow-up, the risk of recurrence is substantial, highlighting the importance of preventive measures 1. The study found that the cumulative incidence of recurrence at 2,4,6,8, and 10 years was 2.5%, 4.8%, 6.6%, 8.0%, and 10.3%, respectively.
Key factors to consider in managing the risk of recurrence include:
- The time frame for vaccination following an episode of HZ, which varies between countries, but a minimal 2-month interval is recommended 1
- The use of zoster vaccine, either ZVL or RZV, which is recommended after a prior episode of HZ to reduce the risk of recurrence 1
- The importance of early antiviral treatment, such as acyclovir, valacyclovir, or famciclovir, within 72 hours of symptom onset to reduce the severity and duration of the outbreak
Vaccination with zoster vaccine, either ZVL or RZV, after a prior episode of HZ is recommended to reduce the risk of recurrence, with a minimal 2-month interval between the episode and vaccination 1. This recommendation is based on the high rates of HZ recurrence after a prior episode, and the documented minimal interval between an episode of HZ and recurrence of 2 months.
From the Research
Herpes Zoster Recurrence
Having Herpes Zoster (shingles) can be a risk factor for recurrent Herpes Zoster (shingles). The following points highlight the relationship between the initial episode and the recurrence:
- The incidence rate of Herpes Zoster recurrence is estimated to be around 1.7-16.6 cases per 1000 person-years in general populations 2.
- Studies have reported that approximately 1.2-9.6% of individuals may experience Herpes Zoster recurrence after an initial episode 2.
- Recognized risk factors for Herpes Zoster recurrence include immunocompromised status, female sex, family history, and comorbidities such as diabetes 2.
- Other factors that may predispose individuals to recurrence include long-lasting pain after the initial Herpes Zoster episode and the presence of herpes zoster ophthalmicus 2.
- A population-based cohort study found that the recurrence rate of Herpes Zoster is 12.0 per 1,000 person-years, with significant risk factors including old age, women, zoster-related pain longer than 30 days, concurrent hematologic malignancies, autoimmune diseases, dyslipidemia, and hypertension 3.
Risk Factors for Recurrence
The risk factors for Herpes Zoster recurrence can be categorized into several groups:
- Demographic factors: old age, female sex 3, 2, 4.
- Clinical factors: zoster-related pain longer than 30 days, concurrent hematologic malignancies, autoimmune diseases, dyslipidemia, and hypertension 3.
- Comorbidities: diabetes, digestive disorders 2, 4.
- Immunocompromised status: individuals with weakened immune systems are more likely to experience Herpes Zoster recurrence 5, 2.