Epidemiology

The annual incidence of HZ in the UK is estimated between 1.85 and 3.9 cases per 1000 population.[4] It increases with age from fewer than two cases per 1000 among people under 50 years to 11 cases per 1000 among people aged 80 years or over.

Similar incidence rates have been reported in the US, where over 90% of adults have serological evidence of varicella-zoster virus (VZV) infection and are therefore at risk of HZ.[5] In the Netherlands, the incidence of HZ is 3.4 per 1000.[6] In Italy, the incidence in people >14 years of age has been estimated at 1.4 per 1000.[7] In Spain the incidence is 4.2 per 1000.[8] HZ has no seasonal variation, and there appears to be no difference in incidence worldwide.

Incidence is higher among women.[9] The incidence is also higher in people with immunosuppression (e.g., those with HIV or malignancies, and those on chemotherapy or corticosteroid treatment).[10][11][12] The risk of shingles remains increased among people living with HIV, even if they are taking antiretroviral therapy.[9][13][14] Black people appear less likely to experience HZ than other ethnicities.[15] It is unknown if exposure to unvaccinated children offers protection.[16]

Incidence of HZ has increased over time in the US, both before and after the varicella vaccination programme.[17][18] Incidence has also increased in other countries such as Canada, the UK, and Japan, where there are no varicella vaccination programmes.[19][20][21]

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