Herpes Zoster (Shingles)

Picture of Herpes Zoster Virus Rash on Chest

Picture of Herpes Zoster Virus Rash on Back of Shoulder

Picture of Herpes Zoster Ophthalmicus on the Face and Eye

  • What is the most important risk factor for zoster?

    Age is the most important risk factor for zoster.1

    • ~99.5% of adults aged ≥40 years are at risk for zoster because they have had chickenpox.1
    • Nearly all adults over the age of 50 are at risk for zoster.1 Risk increases with age.1,2

    RISK OF ZOSTER BY AGE GROUP2Risk of Herpes Zoster by Age Group ChartAfter age 50, risk and severity of zoster increase markedly due to age-related decline in immunity.3

    US Census Bureau projections show a substantial, steady increase in the US population aged ≥60 years—a 60% increase is projected between 2010 and 2030.4

    PROJECTED US POPULATION AGED ≥60 YEARS4Increasing Older Population Impacts the Number of Zoster Cases You'll See

    The increasing older population impacts the number of zoster cases you’ll see.2,4

  • How do you know which patients will be affected by zoster?

    You can’t know which patients will be affected by zoster.5

    • There is no way to predict when the varicella-zoster virus (VZV) will reactivate, who will develop zoster, or how severe any individual case may be.1,3,6–8
    • Picture of Dermatomal Herpes Zoster Rash

      Dermatomal zoster rashes.

      Picture of Herpes Zoster Virus Rash on Chest
      Picture of Herpes Zoster Rash on Shoulder

      Dermatomal zoster rashes.

    According to the CDC, approximately 1 in
    3 people will experience zoster in their lifetime.1

    • Nearly 1 million new cases of zoster are diagnosed in the United States each year.1,2
    • An estimated 70% of the annual cases occur in people aged ≥50 years.9
  • How do patients describe zoster?

    Almost all patients experience more than a rash.

    • Even though zoster generally presents as a rash, typically patients also experience pain.6
    • Pain can occur daily and be potentially severe.8

    In a 2004 study designed to describe the acute pain of zoster and assess its impact on patients (n=110)8:

    • 96% of patients in this study experienced acute pain.
    • 45% reported that they experienced pain every day.
    • 42% reported that their worst zoster-associated pain was “horrible” or “excruciating.”
  • Are zoster complications common, and what are they?

    Even before the rash appears, the damage may already be done.10

    • A severe hemorrhagic inflammation occurs in the dorsal root ganglia as VZV reactivates and replicates.
    • VZV causes scarring and loss of nerve cells and fibers, which can lead to neuropathic pain.
    • Depiction of Dorsal Root Ganglia

    Postherpetic neuralgia (PHN) is the most common complication of zoster.3

    • PHN is chronic neuropathic pain lasting for at least 3 months after rash onset and can last months or even years.3
    • Not everyone who experiences zoster suffers from PHN.3
    • The incidence of PHN increases with age.3
    • Patients have described PHN as: burning, throbbing, stabbing, shooting, and/or sharp pain.6, 11

    In addition to PHN, other complications of zoster can vary in degree of severity.7

    • 10% to 25% of zoster patients suffer from ophthalmic zoster.1
    • 50% to 72% of patients who develop ophthalmic zoster will suffer chronic, recurring ocular disease and visual loss.7
    • Ophthalmic Herpes Zoster Rash
      Ophthalmic zoster rash. NOT TYPICAL.

    1 in 4 zoster patients will experience 1 or more complications, some of which may be severe, including12:

    • Scarring
    • Bacterial superinfection
    • Pneumonia
    • Cranial and motor neuron palsies
    • Visual impairment, when eye area is involved
    • Hearing loss, when ear area is involved
Disease Information

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CDC Information

CDC=Centers for Disease Control and Prevention.

US-CIN-00004 02/19
1. Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57(RR-5):1–30.
2. Insinga RP, Itzler RF, Pellissier JM, et al. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20(8):748–753.
3. Johnson RW, Bouhassira D, Kassianos G, et al. The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Med. 2010;8(37). doi:10.1186/1741–7015–8–37.
4. Centers for Disease Control and Prevention (CDC). Population projections, United States, 2004-2030. http://wonder.cdc.gov/population-projections.html. Accessed March 14, 2014.
5. Whitley RJ. Herpes zoster: natural history, diagnosis and therapy. In: Watson CPN, Gershon AA, eds. Herpes Zoster and Postherpetic Neuralgia, 2nd Revised and Enlarged Edition. Amsterdam, the Netherlands: Elsevier Science B.V.; 2001:65-78. Pain Research and Clinical Management; vol 11.
6. Schmader KE, Dworkin RH. Natural history and treatment of herpes zoster. J Pain. 2008;
9(1)(suppl 1):S3–S9.
7. Pavan-Langston D. Ophthalmic zoster. In: Arvin AM, Gershon AA, eds. Varicella-Zoster Virus: Virology and Clinical Management. Cambridge, UK: Cambridge University Press; 2000:276–298.
8. Katz J, Cooper EM, Walther RR, et al. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis. 2004;39(3):342–348.
9. Pappagallo M, Haldey EJ. Pharmacological management of postherpetic neuralgia. CNS Drugs. 2003;17(11):771–780.
10. Schmader K, Gnann JW Jr, Watson CP. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. J Infect Dis. 2008;197(suppl 2):S207–S215.
11. Oxman MN. Clinical manifestations of herpes zoster. In: Arvin AM, Gershon AA, eds. Varicella-Zoster Virus: Virology and Clinical Management. Cambridge, UK: Cambridge University Press; 2000:246–275.
12. Yawn BP, Saddier P, Wollan PC, et al. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341–1349.