Skip to main content
Top
Published in: BMC Infectious Diseases 1/2022

Open Access 01-12-2022 | Shingles | Research

Prevalence of and factors associated with herpes zoster in England: a cross-sectional analysis of the Health Survey for England

Authors: Sharon L. Cadogan, Jennifer S. Mindell, Judith Breuer, Andrew Hayward, Charlotte Warren-Gash

Published in: BMC Infectious Diseases | Issue 1/2022

Login to get access

Abstract

Background

Herpes zoster (commonly called shingles) is caused by the reactivation of varicella zoster virus, and results in substantial morbidity. While the risk of zoster increases significantly with age and immunosuppression, relatively little is known about other risk factors for zoster. Moreover, much evidence to date stems from electronic healthcare or administrative data. Hence, the aim of this study was to explore potential risk factors for herpes zoster using survey data from a nationally-representative sample of the general community-dwelling population in England.

Methods

Data were extracted from the 2015 Health Survey for England, an annual cross-sectional representative survey of households in England. The lifetime prevalence of self-reported herpes zoster was described by age, gender and other socio-demographic factors, health behaviours (physical activity levels, body mass index, smoking status and alcohol consumption) and clinical conditions, including; diabetes, respiratory, digestive and genito-urinary system and mental health disorders. Logistic regression models were then used to identify possible factors associated with shingles, and results were presented as odds ratios with 95% confidence intervals.

Results

The lifetime prevalence of shingles among the sample was 11.5% (12.6% among women, 10.3% among men), which increased with age. After adjusting for a range of covariates, increased age, female gender (odds ratio: 1.21; 95%CI: 1.03, 1.43), White ethnic backgrounds (odds ratio: 2.00; 95%CI: 1.40, 2.88), moderate physical activity 7 days per week (odds ratio: 1.29; 95%CI: 1.01, 1.66) and digestive disorders (odds ratio: 1.51; 95%CI: 1.13, 1.51) were each associated with increased odds of having had herpes zoster.

Conclusions

Age, gender, ethnicity and digestive disorders may be risk factors for herpes zoster among a nationally representative sample of adults in England. These potential risk factors and possible mechanisms should be further explored using longitudinal studies.
Appendix
Available only for authorised users
Literature
1.
go back to reference Steiner I, Kennedy PG, Pachner AR. The neurotropic herpes viruses: herpes simplex and varicella-zoster. Lancet Neurol. 2007;6(11):1015–28.CrossRef Steiner I, Kennedy PG, Pachner AR. The neurotropic herpes viruses: herpes simplex and varicella-zoster. Lancet Neurol. 2007;6(11):1015–28.CrossRef
2.
go back to reference Ultsch B, Siedler A, Rieck T, Reinhold T, Krause G, Wichmann O. Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis. 2011;11(1):173.CrossRef Ultsch B, Siedler A, Rieck T, Reinhold T, Krause G, Wichmann O. Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis. 2011;11(1):173.CrossRef
3.
go back to reference Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20(8):748–53.CrossRef Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20(8):748–53.CrossRef
4.
go back to reference Leung J, Harpaz R, Molinari N-A, Jumaan A, Zhou F. Herpes zoster incidence among insured persons in the United States, 1993–2006: evaluation of impact of varicella vaccination. Clin Infect Dis. 2011;52(3):332–40.CrossRef Leung J, Harpaz R, Molinari N-A, Jumaan A, Zhou F. Herpes zoster incidence among insured persons in the United States, 1993–2006: evaluation of impact of varicella vaccination. Clin Infect Dis. 2011;52(3):332–40.CrossRef
5.
go back to reference Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341–9.CrossRef Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341–9.CrossRef
6.
go back to reference Gialloreti L, Merito M, Pezzotti P, Naldi L, Gatti A, Beillat M, et al. Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: a retrospective, population-based study. BMC Infect Dis. 2010;10(1):230.CrossRef Gialloreti L, Merito M, Pezzotti P, Naldi L, Gatti A, Beillat M, et al. Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: a retrospective, population-based study. BMC Infect Dis. 2010;10(1):230.CrossRef
7.
go back to reference van Hoek AJ, Gay N, Melegaro A, Opstelten W, Edmunds WJ. Estimating the cost-effectiveness of vaccination against herpes zoster in England and Wales. Vaccine. 2009;27(9):1454–67.CrossRef van Hoek AJ, Gay N, Melegaro A, Opstelten W, Edmunds WJ. Estimating the cost-effectiveness of vaccination against herpes zoster in England and Wales. Vaccine. 2009;27(9):1454–67.CrossRef
8.
go back to reference Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002;347(5):340.CrossRef Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002;347(5):340.CrossRef
9.
go back to reference Kovac M, Lal H, Cunningham AL, Levin MJ, Johnson RW, Campora L, et al. Complications of herpes zoster in immunocompetent older adults: incidence in vaccine and placebo groups in two large phase 3 trials. Vaccine. 2018;36(12):1537–41.CrossRef Kovac M, Lal H, Cunningham AL, Levin MJ, Johnson RW, Campora L, et al. Complications of herpes zoster in immunocompetent older adults: incidence in vaccine and placebo groups in two large phase 3 trials. Vaccine. 2018;36(12):1537–41.CrossRef
10.
go back to reference Kost RG, Straus SE. Postherpetic neuralgia–pathogenesis, treatment, and prevention. N Engl J Med. 1996;335(1):32–42.CrossRef Kost RG, Straus SE. Postherpetic neuralgia–pathogenesis, treatment, and prevention. N Engl J Med. 1996;335(1):32–42.CrossRef
11.
go back to reference Thompson RR, Kong CL, Porco TC, Kim E, Ebert CD, Acharya NR. Herpes zoster and postherpetic neuralgia: changing incidence rates from 1994 to 2018 in the United States. Clin Infect Dis. 2020;73:e3210.CrossRef Thompson RR, Kong CL, Porco TC, Kim E, Ebert CD, Acharya NR. Herpes zoster and postherpetic neuralgia: changing incidence rates from 1994 to 2018 in the United States. Clin Infect Dis. 2020;73:e3210.CrossRef
12.
go back to reference Gauthier A, Breuer J, Carrington D, Martin M, Rémy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2009;137(1):38–47.CrossRef Gauthier A, Breuer J, Carrington D, Martin M, Rémy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2009;137(1):38–47.CrossRef
13.
go back to reference Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? Lancet Infect Dis. 2004;4(1):26–33.CrossRef Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? Lancet Infect Dis. 2004;4(1):26–33.CrossRef
14.
go back to reference Opstelten W, Van Essen GA, Schellevis F, Verheij TJM, Moons KGM. Gender as an independent risk factor for herpes zoster: a population-based prospective study. Ann Epidemiol. 2006;16(9):692–5.CrossRef Opstelten W, Van Essen GA, Schellevis F, Verheij TJM, Moons KGM. Gender as an independent risk factor for herpes zoster: a population-based prospective study. Ann Epidemiol. 2006;16(9):692–5.CrossRef
15.
go back to reference Lee TJ, Hayes S, Cummings DM, Cao Q, Carpenter K, Heim L, et al. Herpes zoster knowledge, prevalence and vaccination rate by race. J Am Board Fam Med. 2013;26(1):45–51.CrossRef Lee TJ, Hayes S, Cummings DM, Cao Q, Carpenter K, Heim L, et al. Herpes zoster knowledge, prevalence and vaccination rate by race. J Am Board Fam Med. 2013;26(1):45–51.CrossRef
16.
go back to reference Schmader K, George L, Burchett B, Pieper C. Racial and psychosocial risk factors for herpes zoster in the elderly. J Infect Dis. 1998;178(1):S67.CrossRef Schmader K, George L, Burchett B, Pieper C. Racial and psychosocial risk factors for herpes zoster in the elderly. J Infect Dis. 1998;178(1):S67.CrossRef
17.
go back to reference Marin M, Harpaz R, Zhang J, Wollan P, Bialek S, Yawn B. Risk factors for herpes zoster among adults. Open Forum Infect Dis. 2016;3(3). Marin M, Harpaz R, Zhang J, Wollan P, Bialek S, Yawn B. Risk factors for herpes zoster among adults. Open Forum Infect Dis. 2016;3(3).
18.
go back to reference Joesoef RM, Harpaz R, Leung J, Bialek SR. Chronic medical conditions as risk factors for herpes zoster. Mayo Clin Proc. 2012;87:961.CrossRef Joesoef RM, Harpaz R, Leung J, Bialek SR. Chronic medical conditions as risk factors for herpes zoster. Mayo Clin Proc. 2012;87:961.CrossRef
19.
go back to reference Long MD, Martin C, Sandler RS, Kappelman MD. Increased risk of herpes zoster among 108 604 patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37(4):420–9.CrossRef Long MD, Martin C, Sandler RS, Kappelman MD. Increased risk of herpes zoster among 108 604 patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37(4):420–9.CrossRef
20.
go back to reference Heymann AD, Chodick G, Karpati T, Kamer L, Kremer E, Green MS, et al. Diabetes as a risk factor for herpes zoster infection: results of a population-based study in Israel. Infection. 2008;36(3):226–30.CrossRef Heymann AD, Chodick G, Karpati T, Kamer L, Kremer E, Green MS, et al. Diabetes as a risk factor for herpes zoster infection: results of a population-based study in Israel. Infection. 2008;36(3):226–30.CrossRef
21.
go back to reference Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ. 2014;348: g2911.CrossRef Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ. 2014;348: g2911.CrossRef
22.
go back to reference Kawai K, Gebremeskel B, Acosta C. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4. Kawai K, Gebremeskel B, Acosta C. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4.
23.
go back to reference Hales C, Harpaz R, Bialek M. Self-reported herpes zoster, pain, and health care seeking in the Health and Retirement Study: implications for interpretation of health care–based studies. Ann Epidemiol. 2016;26(6):441–6.CrossRef Hales C, Harpaz R, Bialek M. Self-reported herpes zoster, pain, and health care seeking in the Health and Retirement Study: implications for interpretation of health care–based studies. Ann Epidemiol. 2016;26(6):441–6.CrossRef
24.
go back to reference Schmader K, George LK, Newton R, Hamilton JD. The accuracy of self-report of herpes zoster. J Clin Epidemiol. 1994;47(11):1271–6.CrossRef Schmader K, George LK, Newton R, Hamilton JD. The accuracy of self-report of herpes zoster. J Clin Epidemiol. 1994;47(11):1271–6.CrossRef
25.
go back to reference Mindell J, Biddulph JP, Hirani V, Stamatakis E, Craig R, Nunn S, et al. Cohort profile: the health survey for England. Int J Epidemiol. 2012;41(6):1585–93.CrossRef Mindell J, Biddulph JP, Hirani V, Stamatakis E, Craig R, Nunn S, et al. Cohort profile: the health survey for England. Int J Epidemiol. 2012;41(6):1585–93.CrossRef
27.
go back to reference Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc. 2017;92(12):1806–21.CrossRef Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc. 2017;92(12):1806–21.CrossRef
28.
go back to reference Marra F, Parhar K, Huang B, Vadlamudi N. Risk factors for herpes zoster infection: a meta-analysis. Open Forum Infect Dis. 2020;7(1). Marra F, Parhar K, Huang B, Vadlamudi N. Risk factors for herpes zoster infection: a meta-analysis. Open Forum Infect Dis. 2020;7(1).
29.
go back to reference Fleming D, Cross K, Cobb W, Chapman R. Gender difference in the incidence of shingles. Epidemiol Infect. 2004;132(1):1–5.CrossRef Fleming D, Cross K, Cobb W, Chapman R. Gender difference in the incidence of shingles. Epidemiol Infect. 2004;132(1):1–5.CrossRef
30.
go back to reference Schmader K, George LK, Burchett BM, Pieper CF. Racial and psychosocial risk factors for herpes zoster in the elderly. J Infect Dis. 1998;178(Supplement_1):S67–70.CrossRef Schmader K, George LK, Burchett BM, Pieper CF. Racial and psychosocial risk factors for herpes zoster in the elderly. J Infect Dis. 1998;178(Supplement_1):S67–70.CrossRef
31.
go back to reference Maretic Z, Cooray M. Comparisons between chickenpox in a tropical and a European country. J Trop Med Hygiene. 1963;66(12):311–5. Maretic Z, Cooray M. Comparisons between chickenpox in a tropical and a European country. J Trop Med Hygiene. 1963;66(12):311–5.
32.
go back to reference Liu B, Heywood A, Reekie J, Banks E, Kaldor J, McIntyre P, et al. Risk factors for herpes zoster in a large cohort of unvaccinated older adults: a prospective cohort study. Epidemiol Infect. 2015;143(13):2871–81.CrossRef Liu B, Heywood A, Reekie J, Banks E, Kaldor J, McIntyre P, et al. Risk factors for herpes zoster in a large cohort of unvaccinated older adults: a prospective cohort study. Epidemiol Infect. 2015;143(13):2871–81.CrossRef
33.
go back to reference Schmidt SA, Sørensen HT, Langan SM, Vestergaard M. Associations of lifestyle and anthropometric factors with the risk of herpes zoster: a nationwide population-based cohort study. Am J Epidemiol. 2021;190(6):1064–74.CrossRef Schmidt SA, Sørensen HT, Langan SM, Vestergaard M. Associations of lifestyle and anthropometric factors with the risk of herpes zoster: a nationwide population-based cohort study. Am J Epidemiol. 2021;190(6):1064–74.CrossRef
34.
go back to reference Walsh NP, Gleeson M, Shephard RJ, Gleeson M, Woods JA, Bishop N, et al. Position statement part one: immune function and exercise. 2011. Walsh NP, Gleeson M, Shephard RJ, Gleeson M, Woods JA, Bishop N, et al. Position statement part one: immune function and exercise. 2011.
35.
go back to reference Yang YW, Chen YH, Wang KH, Wang CY, Lin HW. Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study. CMAJ. 2011;183(5):E275–80.CrossRef Yang YW, Chen YH, Wang KH, Wang CY, Lin HW. Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study. CMAJ. 2011;183(5):E275–80.CrossRef
36.
go back to reference Munoz-Quiles C, López-Lacort M, Ampudia-Blasco FJ, Díez-Domingo J. Risk and impact of herpes zoster on patients with diabetes: a population-based study, 2009–2014. Hum Vaccin Immunother. 2017;13(11):2606–11.CrossRef Munoz-Quiles C, López-Lacort M, Ampudia-Blasco FJ, Díez-Domingo J. Risk and impact of herpes zoster on patients with diabetes: a population-based study, 2009–2014. Hum Vaccin Immunother. 2017;13(11):2606–11.CrossRef
37.
go back to reference Nassaji-Zavareh M, Taheri R, Ghorbani R, Aminian M. Undiagnosed diabetes mellitus in patients with herpes zoster. Indian J Dermatol. 2008;53(3):119.CrossRef Nassaji-Zavareh M, Taheri R, Ghorbani R, Aminian M. Undiagnosed diabetes mellitus in patients with herpes zoster. Indian J Dermatol. 2008;53(3):119.CrossRef
38.
go back to reference Du J, Sun G, Ma H, Xiang P, Guo Y, Deng Y, et al. Prevalence and risk factors of anxiety and depression in patients with postherpetic neuralgia: a retrospective study. Dermatology. 2020;237:891–5.CrossRef Du J, Sun G, Ma H, Xiang P, Guo Y, Deng Y, et al. Prevalence and risk factors of anxiety and depression in patients with postherpetic neuralgia: a retrospective study. Dermatology. 2020;237:891–5.CrossRef
Metadata
Title
Prevalence of and factors associated with herpes zoster in England: a cross-sectional analysis of the Health Survey for England
Authors
Sharon L. Cadogan
Jennifer S. Mindell
Judith Breuer
Andrew Hayward
Charlotte Warren-Gash
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07479-z

Other articles of this Issue 1/2022

BMC Infectious Diseases 1/2022 Go to the issue