Recurrent Shingles: More Common Than Once Thought

Once considered a rare occurrence, recurrent shingles is now receiving more attention from medical researchers and health care providers alike. At least 2 studies have concluded that reactivation of the varicella zoster virus (VZV) that causes shingles (herpes zoster, HZ) is more common than once thought.

The first study,¹ based in Minnesota, involved more than 1600 adults 22 years and older with medically documented episodes of HZ. Of these patients, 95 had 105 recurrences of the infection, with a recurrence rate at 8 years of 6.2%.

Researchers found that recurrences were significantly more likely in persons with zoster-associated pain lasting 30 days or more at the initial episode, in immunocompromised individuals, in women, and in those aged 50 or older. In some cases, recurrence occurred in as little as 3 months after the first outbreak. People with compromised immune systems were found to be about 2.4 times more likely to have a recurrence than immunocompetent individuals.

“Rates of HZ recurrence appear to be comparable to rates of first HZ occurrence in immunocompetent individuals, suggesting that recurrence is sufficiently common to warrant investigation of vaccine prevention in this group,” the researchers concluded.1 “Zoster vaccine is recommended for prevention of incident cases of HZ. Our high HZ recurrence rates suggest that zoster vaccination should be offered in people who have had an HZ episode to prevent potential recurrences.”

The second study,² conducted in Korea, concluded that HZ recurrence is much more common than generally expected, and that associated risk factors—including age and gender—can play an important role in predicting recurrence. The recurrence rate in patients over 50 years was 5.8%, compared with 4.5% in younger participants. Women had more frequent recurrence than men.

Vaccination is the first line of defense against shingles and its recurrence. In 2017, Shingrix was approved by the FDA and CDC to prevent shingles and related complications in adults aged 50 and older. More recently, the FDA expanded its approval to include immunocompromised adults 18 and older. The CDC’s Advisory Committee on Immunization Practices followed suit, recommending Shingrix for adults 19 years and older who are or will be immunodeficient or immunosuppressed due to disease or therapy.

Shingrix was proven in clinical trials to be over 90% effective in preventing shingles and its complications. It is given as a 2-dose series administered over 2 to 6 months.

Virtually every person over the age of 50 in the United States carries the virus that causes shingles, infected before there was an effective vaccine against it. As they age, their immune systems decline and become less resistant to the virus, increasing their risk of developing shingles. Shingrix works by boosting protection against the virus. It can be given before or after a shingles episode.

References

1. Yawn BP, Wollan PC, Kurland MJ, St Sauver JL, Saddier P. Herpes zoster recurrences more frequent than previously reported. Mayo Clin Proc. 2011;86(2):88-93. Doi:10.4065/mcp.2010.0618
2. Kim YJ, Lee CN, Lee MS, et al. Recurrence rate of herpes zoster and its risk factors: A population-based cohort study. J Korean Med Sci. 2018;34(2):e1. Doi:10.3346/jkms.2019.34.e1