Epidemiology Shingles

Most current estimates of the epidemiology and burden of herpes zoster and PHN come from studies in Europe and the USA. The reported incidence of herpes zoster in these regions varies from 1.3 to 4.8/1000 patients/year, and this rate increases sharply with age, with a 2- to 4-fold increase in those aged >60 years.

The incidence rate of herpes zoster ranges from 1.2 to 3.4 per 1,000 person-years among healthy individuals, increasing to 3.9–11.8 per 1,000 person‐years among those older than 65 years.Similar incidence rates have been observed worldwide. Herpes zoster develops in an estimated 500,000 Americans each year.

United States

A study of patients in a large health maintenance organization (HMO) in the United States revealed 1075 cases from 1990-1992.¹ The following characteristics were noted:

• Incidence was 215 cases per 100,000 people per year.
• Older patients were more at risk (1424 cases per 100,000 people per year for age >75 y).
• Fewer than 5% of cases were in children and younger adolescents.
• Three of 4 patients with recurrent zoster were HIV positive.

Over 90 percent of adults in the United States have serologic evidence of varicella–zoster virus infection and are at risk for herpes zoster.² The annualized incidence of herpes zoster is about 1.5 to 3.0 cases per 1000 persons.^3,4 An incidence of 2.0 cases per 1000 persons would translate into more than 500,000 cases annually in the United States. Increasing age is a key risk factor for the development of herpes zoster; the incidence of shingles among persons older than 75 years of age exceeds 10 cases per 1000 person-years.³ The lifetime risk of herpes zoster is estimated to be 10 to 20 percent.⁴