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The Looming Rash of Herpes Zoster and the Challenge of Adult Immunization

James G. Donahue, DVM, PhD; and Edward A. Belongia, MD
[+] Article, Author, and Disclosure Information

From Marshfield Clinic Research Foundation, Marshfield, WI 54449.

Potential Conflicts of Interest: None disclosed. Forms can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0475.

Requests for Single Reprints: James G. Donahue, DVM, PhD, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, ML-2, Marshfield, WI 54449; e-mail, donahue.james@mcrf.mfldclin.edu.

Current Author Addresses: Drs. Donahue and Belongia: Marshfield Clinic Research Foundation, 1000 North Oak Avenue, ML-2, Marshfield, WI 54449.

Ann Intern Med. 2010;152(9):609-611. doi:10.7326/0003-4819-152-9-201005040-00011
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Herpes zoster is getting a lot of attention these days: A Google search on this topic will generate more than 1.3 million hits. There is good reason for this interest. At some point during their life, approximately 30% of people will develop herpes zoster, more commonly known as “shingles” (1). In raw numbers, approximately 1 million people in the United States are affected with herpes zoster every year (2). That number can be expected to increase because the risk for herpes zoster increases as cell-mediated immunity declines with advancing age, and an ever-increasing number of baby boomers are entering the retirement years; 20% of the population will be at least 65 years of age by 2030, compared with only 12.8% in 2008 (3).

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Submit a Comment/Letter
No Title
Posted on May 12, 2010
Harry W. Daniell
UC Davis
Conflict of Interest: None Declared

To the The Editor:

The publication by Hurley et al (1) and the related editorial by Donahue and Belongia (2) do not acknowledge all factors which have limited the use of herpes zoster vaccine.

As a general internist, many of my patients have wanted to compare the benefits which they could expect to receive from the vaccine with the associated inconvenience and cost of its administration.

My response, derived largely from the publication by Oxman et al (3), included observations that the vaccine was 30% less effective in patients over age 70 than those ages 60-69, and in this older age group prevented less than 50% of cases of herpes zoster, but that the infection when present was often less severe in this age group and less frequently followed by post-herpetic neuralgia. They are also told that immune responses to vaccines generally are less vigorous with increasing age, that no studies documenting benefit from the herpes vaccine in patients over age 80 had been published, and that the reported incidence of herpes zoster in patients over age 75 was approximately 1% per year, suggesting a life-time incidence of less than 10% in many of them.

In order to more accurately define the potential benefits of herpes zoster vaccine in older age groups, stratification of the patients studied by Oxman et al into 5 year age groups, with appropriate age group analysis of their results, would aid patients and their physicians in better resulting at an appropriate recommendation for its use.


1. Hurley L, Lindley M, Harpaz R, Stokley S, Daley M, Craine L, et al. Barriers to the Use of Herpes Zoster Vaccine. Ann Intern Med 2010;152:555-60. [PMID: 20439573]

2. Donahue J, Belongia E. The Looming Rash of Herpes Zoster and the Challenge of Adult Immunization. Ann Intern Med 2010;152:609- 11.[PMID:20439578]

3. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults. N Engl J Med 2005;352:2271-84. [PMID:15930418]

Conflict of Interest:

None declared

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