Who is at risk for Herpes Zoster (shingles) rash?

From the Guidelines

Anyone who has had chickenpox is at risk for developing shingles, as the varicella-zoster virus remains dormant in nerve tissue after the initial infection. The risk increases significantly with age, particularly after 50, with about one in three people developing shingles in their lifetime 1. Those with weakened immune systems face higher risk, including individuals with HIV/AIDS, cancer patients undergoing treatment, organ transplant recipients on immunosuppressive drugs, and those taking medications like steroids that suppress immune function. People under chronic stress or with certain diseases like diabetes may also be more vulnerable.

Key Factors

• Age: significantly increases risk after 50 years old
• Weakened immune system: due to conditions like HIV/AIDS, cancer, or immunosuppressive medications
• Chronic stress and certain diseases: such as diabetes

Vaccination Recommendations

The shingles vaccine (Shingrix) is recommended for adults 50 and older, even if they've had shingles before or received the older Zostavax vaccine 1. For those with compromised immunity, vaccination may be recommended starting at age 19. The vaccine significantly reduces the risk of developing shingles and its complications, particularly postherpetic neuralgia, a painful condition that can persist long after the rash heals. According to the most recent study, the recombinant zoster vaccine (RZV) is preferred over the live zoster vaccine (ZVL) due to its higher efficacy and safety profile 1.

From the FDA Drug Label

1. 3 Herpes Zoster Two randomized, double‑blind clinical trials in immunocompetent adults with localized herpes zoster were conducted.

The individuals at risk for Herpes Zoster (shingles) rash are not explicitly stated in the provided text, but based on the information given, it can be inferred that:

• Immunocompetent adults are the population in which the trials were conducted.
• The trials included subjects aged less than 50 years and greater than 50 years. No specific risk factors are mentioned, but it can be conservatively inferred that adults with localized herpes zoster may be at risk for the rash. 2

From the Research

Risk Factors for Herpes Zoster

The following individuals are at risk for Herpes Zoster (shingles) rash:

• Patients with conditions that decrease cell-mediated immunity, who are 20 to 100 times more likely to develop herpes zoster 3
• Older adults, as increasing age is the primary risk factor 4
• Individuals with chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disorder (COPD), who have a 24% and 41% increased risk of HZ, respectively, compared with healthy controls 5
• Immunocompromised adults, including those with immunosuppressive disorders and therapies, who are at increased risk of developing HZ 6

High-Risk Groups

Certain groups are at higher risk for Herpes Zoster, including:

• Adults 50 years and older, who have a higher risk of developing HZ and its complications 3, 4, 5
• Adults with asthma or COPD, who may be at increased risk of HZ and its complications, and may benefit from vaccination 5
• Immunocompromised adults, including those with immunosuppressive disorders and therapies, who are at increased risk of developing HZ and may benefit from vaccination with the recombinant zoster vaccine (RZV) 6