Blackmores Institute

<table><tbody><tr><td> Key Points - Shingles is a debilitating condition that is on the increase -Population studies show shingles is increasing yearly -The CDC is also reporting increased prevalence in younger adults -Older adults (above 50) and the immunocompromised are more at risk due to diminished immune function -An ageing population increases shingles prevalence but does not explain the overall increase, especially in younger people -There are many risk factors for shingles, but researchers are still puzzled for what is behind the global increase </td></tr></tbody></table> Shingles (herpes zoster or HZ) is a potentially debilitating condition caused by the reactivation of the chicken pox (varicella) virus. After exposure to chicken pox, the virus lies dormant in the spinal and cranial sensory nerves. Reactivation is caused by many factors but is mostly seen in those over 50 years old due to an ageing immune system, or in those who are immunocompromised. It is reported to affect approximately 1 in 3 people; however, multiple studies show shingles prevalence is on the increase.1-4<h3>Research shows significant increases in prevalence </h3>A 2021 systematic review, focusing on incidence rate specifically in individuals 50 years of age and over, found that globally ‘Over the last few decades, the incidence of HZ has increased alongside a growing ageing population, and this trend is independent of geographic location.'4 However, although older age is a significant factor in shingles incidence, the increase has also been seen in other age groups, with the Centers for Disease Control and Prevention (CDC) reporting an increase in younger adults.5 This is supported by a 2016 population-based cohort study in USA that reviewed the incidence rate using data from 1945-1960 and 1980-2007 in people aged from 0.3 to 101.7 years old. Across these six decades shingles increased at a rate of 4.5 times for all age groups, with a greater impact on those over 65 years old. Initially 0.76 of every 1,000 people acquired shingles however between 2000 and 2007 this increased to 3.15 per 1,000.3 Increasing trends have also been reported in Australia. Between 1998 and 2013, researchers found an increase of 2.5 per 100,000 recorded cases from GPs, while prescription rates increased by 4.2% each year between 2002 and 2012. Older adults (above 60) had even greater increases.1 <h3> </h3><h3>Reasons for shingles increase unknown</h3>immunity occurring over the age of 50, and being immunocompromised (at any age). Other risk factors include: <ul><li>gender – a higher prevalence is reported in females</li><li>ethnicity </li><li>family history of shingles</li><li>stress</li><li>physical trauma</li><li>comorbidities (systemic lupus erythematosus, rheumatoid arthritis, asthma, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, renal disease and cardiovascular disease).1,2,4</li></ul> However, even with an ageing population, none of the risk factors have yet been linked to the increasing prevalence of shingles across the age groups, with one researcher reporting that they are no closer to knowing what is behind the increase in shingle cases – it remains a puzzle.6 Sources:<ol><li>Macintyre R, Stein A, Harrison C, et al. Increasing trends of herpes zoster in Australia. PLoS One. 2015;10(4):e0125025.</li><li>Marra F, Parhar K, Huang B, et al. Risk factors for herpes zoster infection: A meta-analysis. Open Forum Infect Dis. 2020;7(1):ofaa005.</li><li>Kawai K, Yawn BP, Wollan P, et al. Increasing incidence of herpes zoster over a 60-year period from a population-based study. Clin Infect Dis. 2016;63(2):221-226.</li><li>Van Oorschot D, Vroling H, Bunge E, et al. A systematic literature review of herpes zoster incidence worldwide. Hum Vaccin Immunother. 2021;17(6):1714-1732.</li><li>Center for Disease Control and Prevention. Shingles (Herpes Zoster) clinical overview. Viewed 27 January 2022, https://www.cdc.gov/shingles/hcp/clinical-overview.html 6. Watson, S. Shingles on the Rise Among Younger People. WebMD. rel="noopener noreferrer" Viewed 30 January 2022, https://www.cdc.gov/shingles/hcp/clinical-overview.html</li></ol>

Shingles prevalence has been on the increase over the last few decades. Although this debilitating condition mostly affects those over 50 years, data shows there are even increases in younger age groups, with researchers baffled as to why.

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