Prevalence and Incidence of Shingles

Prevalence/Incidence of Shingles: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the prevalence and/or incidence of Shingles.

Herpes zoster: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Herpes zoster results from reactivation of varicella virus that has lain dormant in the cerebral ganglia (extramedullary ganglia of the cranial nerves) or the ganglia of posterior nerve roots since a previous episode of chickenpox. Exactly how or why this reactivation occurs isn’t clear. Some believe that the virus multiplies as it's reactivated and that antibodies remaining from the initial infection neutralize it. However, if effective antibodies aren't present, the virus continues to multiply in the ganglia, destroy the host neuron, and spread down the sensory nerves to the skin.

Herpes zoster occurs primarily in adults, especially those older than age 50. It seldom recurs. It's also seen in patients with human immunodeficiency virus and other immunodeficiency disorders.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Chickenpox (Varicella, Herpes Zoster): Chickenpox - epidemiology
(The 5-Minute Pediatric Consult)

• Person-to-person transmission occurs by direct contact with varicella or zoster and respiratory secretions.
• Varicella is most common during late winter and early spring, but seasonality is now less pronounced.
• The introduction of an index case of varicella into a home results in transmission of the virus to susceptible persons and secondary cases of disease in 87–98% of susceptible persons:
  • Secondary cases in this situation usually have more severe disease.
  • Most reported cases occur between the ages of 5 and 9 years, although in areas of the US, where many 1–4-year-olds are in daycare, this age group predominates with an increase in complications. Since 2002, regions where vaccine coverage is >80% have experienced increasing numbers of adolescents and adults with varicella secondary to having not been vaccinated and remaining susceptible.
• Immunity from natural disease is usually lifelong, but symptomatic reinfections do occur; more common are asymptomatic reinfections, with a 4-fold boost in antibody level. The 2nd dose of vaccine boosts titers 12-fold to levels seen after natural disease.
• Immunocompromised individuals with either primary varicella or zoster are at risk for severe disease.
• Disease is also more severe in infants >3 months, adolescents, adults, persons on oral and/or IV steroids or long-term aspirin therapy, or persons with pulmonary disorders including asthma.
• Congenital varicella syndrome risk is about 2% and is greatest from the 12th to the 20th week of gestation.
• Incubation 10–21 days after contact; cases most contagious 2 days before the rash appears and until 5 days after lesions stop cropping (longer in immunocompromised patients)
• In varicella-active surveillance sites, breakthrough varicella or reinfection with varicella now represents 62% of all reported varicella cases. These rashes are atypical of varicella, are of shorter duration, usually have fewer lesions, are usually itchy, come in crops, and scab. Individuals with >50 lesions have been shown to transmit disease; however, it is less contagious (30%) than natural VZV (87%). When the diagnosis is in doubt; it may be verified by either polymerase chain reaction (PCR) of the lesion and/or acute and convalescent serum IgG showing a rise in titer. Only wild-type varicella has been identified from these confirmed cases of reinfection (breakthrough) VZV. Using these diagnostic tests, the Centers for Disease Control and Prevention (CDC) Varicella Active Surveillance Project in Philadelphia has demonstrated that 50% of what physicians thought might be a VZV reinfection is not.

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Source: The 5-Minute Pediatric Consult, 2008

About prevalence and incidence statistics:

The term 'prevalence' of Shingles usually refers to the estimated population of people who are managing Shingles at any given time. The term 'incidence' of Shingles refers to the annual diagnosis rate, or the number of new cases of Shingles diagnosed each year. Hence, these two statistics types can differ: a short-lived disease like flu can have high annual incidence but low prevalence, but a life-long disease like diabetes has a low annual incidence but high prevalence. For more information see about prevalence and incidence statistics.

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